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61 Cards in this Set

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What are the signs of a bacterial infection?
High fever (103F)
Large volume stools
Bloody diarrhea
Severe abdominal pain
>6 stools / 24 hrs
Diarrhea > 7 days
Signs of a viral infection?
Low grade fever
Small volume stools
Watery diarrhea
Mild to moderate epigastric pain
<6 stools / 24 hrs
Nausea & Vomiting
Tests for parasites?
Ova & Parasites
Immunoassay
Modified acid-fast stain
Positive fecal leukocytes indicates what?
inflammatory process is present
Infectious causes of a positive fecal leukocyte?
Shigella
Salmonella
Invasive E Coli
Yersinia
C. dificile
Aeromonoas (Vibrio)
Pleisiomonas
Non-infectious causes of positive fecal leukocyte?
IBD
Radiation colitis
Ischemic colitis
What are the 2 main intestinal viruses?
Norovirus and Rotavirus
What is the most common cause of infectious diarrhea?
Norovirus
Facts about Norovirus
Norovirus
Most common cause of infectious diarrhea
Infects all age groups
Contaminated food & water OR person-to-person
N/V/D, abdominal cramping, HA
Symptoms last 12-72 hours
Symptoms of Norovirus?
Symptoms last 12-72 hours

Nausea
Vomiting
Diarrhea
Abdominal cramps
Headache
Which virus is mainly seen in children < 5yrs old?
Rotavirus
Facts about Rotavirus
Rotavirus
Usually infants & children
Seasonal dz
Spread by fecal-oral route
Watery diarrhea
Fever
Vomiting
Respiratory sx
Incubation period 1-4 days
Which intestinal virus often has respiratory symptoms?
Rotavirus
Symptoms of Rotavirus?
Watery diarrhea
Fever
Vomiting
Respiratory symptoms
Which virus is mainly seen in infants and young children, and is seasonal?
Rotovirus
Which virus is seen in all ages, all year round?
Norovirus
What are the most common bacterial pathogens?
Campylobacter jejuni
Salmonella
Shigella
E Coli
Vibrio
Most common bacterial enteric pathogen in USA?
Campylobacter
How is Campylobacter spread?
undercooked meat / dairy products

peak incidence in summer when people are grilling
Symptoms of Campylobacter?
Symptoms last 7-10 days

Abdominal discomfort
Cramping
Bloody diarrhea
chills

No antibiotics needed
Most common ages for Campylobacter?
children < 1 yrs old and adults 20-29
Do you treat Campylobacter with antibiotics?
No! but, can use erythromcyin if pt has complications
What 2 diseases does Salmonella cause?
Enteric Fever & Enteritis (food poisoning)
Facts about Enteric Fever (= Typhoid fever)
Enteric / Typhoid Fever

caused by Salmonella typhi or paratyphi

spread by human fecal contamination of food
Infects lymphatics in small instestine & spreads thru body
Can cause intestinal perforations

Treat with Antibiotics!!
Symptoms of Typhoid Fever?
1-3 weeks after exposure:
HA, fever, RLQ pain, splenomegaly, diarrhea
Rose spots on abdomen
Carrier state of Typhoid Fever...
Carrier harbors S. typhi in gallbladder, and can excrete organism for more than a year!
How do you get Salmonella enteritis?
Salmonella enterica from chickens and reptiles
Symptoms of Salmonella enteritis?
Watery diarrhea - may have blood and mucus
Fever
Cramps

can develop into sespis, pneumonia, endocardititis, meningitis
Abdominal pain
Most common bacterial enteric pathogens?
Campylobacter
Salmonella
Shigella
E coli
Vibrio
Which bacteria causes dysentery?
Shigella
What is dysentery?
High fever, severe abdominal pain, tenesmus
Frequent watery diarrhea with blood and mucus
dehydration
How do you get Shigella?
Humans are only known reservoir
Only a few organisms needed for infection
Person-to-person, food, water, flies, fingers of infected persons
How do you treat Shigella?
Rehydration
Antibiotics
Most common bacterial enteric pathogens?
Campylobacter
Salmonella
Shigella
E coli
Vibrio
4 types of E coli
Enterotoxigenic - ETEC
Enteropathogenic - EPEC
Enteroinvasive - EIEC
Enterohemorrhagic - EHEC **
Enterotoxigenic (ETEC) causes...
Enterotoxigenic (ETEC) causes traveler's diarrhea
Enteroinvasive (EIEC) causes...
Enteroinvasive (EIEC) causes...

profuse diarrhea and high fever
Enterohemorrhagic (EHEC) causes...
Enterohemorrhagic E coli (EHEC)

food poisoning from unpasteurized milk, cider

can lead to hemolytic uremic syndrome (HUS)

** 0157:H7 **
Facts about 0157:H7
0157:H7
strain of enterohemorrhagic E coli
cramping, watery diarrhea
gross bloody diarrhea
NO fever

no antibiotics needed
can cause HUS and sudden kidney failure

Incubation 24-72 hours, duration 3 days

transmitted by food - spinach
Most common bacterial enteric pathogens
Campylobacter
Salmonella
Shigella
E coli
Vibrio
2 main Vibrio species?
Vibrio cholerae

Vibrio parahaemolyticus
Facts about Vibrio cholera
spread by contaminated food & waste water

dz from enterotoxin

voluminous diarrhea - rice water stools

massive loss of electrolytes

60% mortality of untreated
How do you treat cholera?
Replace fluids at rate lost - can exceed 1L / hr !

Tetracycline or doxycline
Which bacteria causes rice water stools?
Vibrio cholera
How is Vibrio parahaemolyticus spread?
shellfish
Symptoms of Vibrio Parahaemolyticus?
fever
cramps
watery to bloody diarrhea

No tx needed
What bacteria causes infection after antibiotics?
C dificile
Facts about C dificile
fecal-oral route

diarrhea is foul-smelling, mucoid, bloody

leukocytosis
fever
abdominal pain
pseudomembranes

normal flora in 5% of healthy adults
what bacteria can mimic appendicitis?
typhoid fever

yersinia
bacteria that cause food poisoning
Salmonella
Shigella
E coli
common enteric parasites
giardia lamblia
entamoeba histolytica
ascaris
pinworms
hookworm
whipworm
cryptosporidium - AIDS pts
most frequent parasite in USA?
Giardia lamblia
Facts about Giardia
Giarda lamblia

fecal-oral route via contaminated water
day care centers
tropical areas

can be asymptomatic!

diarrhea
abdominal pain
bloating & flatulence

steatorrhea & weight loss

chronic infection causes anemia

lactose intolerance is common complication

NO eosinophilia
treat giarida with?
metronidazole and paromomycin

(only paromomycin if pregnant)
Facts about Entamoeba histolytica
Entamoeba hystolytica

ingestion of cysts in fecally contaminated water

bloody diarrhea
abdominal pain
weight loss

secondary infection of liver
Facts about Ascaris / roundworm
Ascaris / roundworm

ingestion of eggs
poorly cooked food

minimal symptoms

worms are expectorated and migrate from lungs to esophagus & gut

fever
dry cough
pneumonia

can lead to malnutrition, weakness
obstruction of intestine or bile duct from worm mass

can travel to other organs & cause liver and appendix problems
Facts about Hookworm
Hookworm

Southeastern US & immigrants from warm climates

in soil contaminated with feces

larva penetrates skin & migrates to lungs, then to intestines, where they ingest blood

anemia
cough, low-grade fever, abdominal pain, weight loss

stool is heme-positive

eosinophilia
Facts about Trichuris trichuris / whipworm
Trichuris / Whipworm

large intestine / cecum

tropical areas

ingestion of contamined soil / vegetables

anorexia, insomia
RUQ pain
fever
flatulence
bloody diarrhea
weight loss
pruritus

can cause colitis or rectal prolapse in children!
Facts about pinworm / enterobius vermicularis
Pinworm

ingestion of eggs

cecum, appendix, iliem, ascending colon

warmer climates, winter & fall

female migrates to anus at night

scotch tape test
Causes of Traveler's Diarrhea
Russia: giardia & cyrptosporidium

Thailand: aeromonas

USA
Enterotoxigenic E coli
Shigella
Campylobacter
Causes of diarrhea with blood
Campylobacter
Salmonella
E coli
Amebiasis
Whipworm
Staph aureus