PAS 602 GI Infections/Nutritional Deficiencies

Jim and Mary just returned from a weekend cruise to Bermuda. This morning Jim has had the acute onset of vomiting and diarrhea. No fever. No blood.

norovirus

Billy is having a great time in Mexico drinking tequila and even ate the worm in the bottom of the bottle. He went to an outdoor food festival Friday night and had a blast. Sunday morning he woke up with terrible abdominal cramps and diarrhea but no fever.

- E. coli

- Clostridium perfringens

Jane had a great time at the 4th of July BBQ today and really enjoyed the cream puffs. It is now 3am and she is puking her guts out.

staph aureus

Joe had a great time camping with the guys last weekend. Today ( a week later) he is nauseous, passing some awful smelly gas and has an uneasy crampy feeling in his gut. After he came out of the bathroom with a bout of diarrhea his girlfriend asked him what died inside of him?

Giardia lamblia

Jack has been studying for his pharm exam and ordered out for fried rice about 6pm. He feel asleep Thursday while studying and woke up at 4am and put the leftovers in the frig. On Saturday around noon he got up and reheated the rice and ate it. It is now Sunday morning and he feels awful

and has diarrhea and cramps.

- Bacillus cereus

- Clostridium perfringens

32 year old traveler returns from Southeast Asia. She states she ate mostly fresh shellfish while

there. She presents with abdominal cramps, profuse diarrhea, and vomiting without hematemesis. Her oral mucosa and conjunctiva are dry. Stools are grey, watery and non bloody. BP is 90/60 mmHg and the patient is unable to maintain concentration.

Vibrio cholera

23 year old presents with weakness of increasing severity for the past 2 days with dysphagia. Has not had any urine output for 24 hours despite copious fluid intake and a palpable bladder to the periumbilical region. Initially patient had some motor function in the lower extremities but now appears completely paralyzed with decreased DTR's. Pertinent hx includes ingestion of home canned

green beans 3 days prior. On admission patient goes into respiratory arrest and is put on a ventilator

Clostridium botulinum

14 year old presents with nausea, vomiting, diarrhea, low grade fever and abdominal pain for the past 3 days. Last meal prior to symptom onset was a fried egg sandwich his Mom made for him. He is sad as he is missing show and tell and wanted to bring Ringo his pet turtle. On PE he has mild diffuse abdominal tenderness and signs of dehydration.

- Salmonella

- Cryptosporidium Parvum

A 28 year old male Peace Corp volunteer home for about 3 weeks complains of a gradual onset of intermittent crampy abdominal pain with foul smelling frothy loose stools daily. The stools sometimes contain blood and mucus. He also complains of lower abdominal tenderness, flatulence and tenesmus. He thinks he may have lost some weight as well. On PE he has tenderness in the RUQ and a positive Murphy's sign. Slight hepatomegaly is noted.

Entamoeba histolytica

What are enterotoxins?

target secretory cells

What are endotoxins?

cause mucosal inflammation

What are cytotoxins?

cause mucosal cell destruction resulting in inflammation and decreased absorptive capacity

All results:

aid in dx in conjunction with clinical picture

Where are Non-inflammatory Enteric Infections MC found?

small bowel

What is the leading cause of diarrhea in infants and children?

rotavirus

Who is enteric adenovirus MC in?

Older infants and children

What is the leading cause of diarrhea in older children and adults?

Calicivirus (Noroviruses)

What is traveler's diarrhea?

Enterotoxigenic E. coli

How is Enterotoxigenic E. coli tx?

supportive

What is transmitted in hiking/camping streams with fecal material?

Giardia lamblia

What is seen in Giardia lamblia?

strong odor

What is tx for Giardia lamblia?

metronidazole

How is Cryptosporidium Parvum transmitted?

Fish, mammals, reptiles, recreational water

How is Cryptosporidium Parvum tx?

supportive + Nitazoxanide

If food poisoning incubation is 1-6 hours, the toxin was produced:

before ingestion

If food poisoning incubation is 8-16 hours, the toxin was produced:

after ingestion

How is staph aureus transmitted?

dairy (CUSTARD), processed meats

How is staph aureus tx?

self limiting - supportive care

How is Bacillus cereus transmitted?

rewarmed foods

How is Clostridium perfringens transmitted?

Rewarmed meat and poultry

How is Vibrio cholerae transmitted?

shellfish

What has grey watery diarrhea?

Vibrio cholerae

What requires request for Cary Blair media?

Vibrio cholerae

What is tx for Vibrio cholerae?

IV fluids

How is Clostridium botulinum transmitted?

Homemade canned, preserved, fermented foods

What are sxs of Clostridium botulinum?

Neurotoxin → descending paralysis

How is Clostridium botulinum tx?

ventilation & IV polyvalent antitoxin

Where are inflammatory enteric infections MC found?

large intestine

How is campylobacter jejuni transmited?

domestic/wild animals, water contamination

How is campylobacter jejuni tx?

azithromycin

What infection is a risk factor for Guillain-Barre Syndrome?

campylobacter jejuni

How is salmonella transmitted?

reptiles

How is shigella transmitted?

Person to person no animal reservoir

How is shigella tx?

ciprofloxacin, ceftriaxone

How is Enterohemorrhagic E. coli (EHEC) transmitted?

rare/undercooked ground beef

What infection can lead to HUS?

Enterohemorrhagic E. coli (EHEC)

What are the manifestations of HUS?

Coombs neg Hemolytic anemia & thrombocytopenia

How is Entamoeba histolytica transmitted?

humans; sexual transmission

How is Entamoeba histolytica tx?

metronidazole & tinidazole

What enteric infections have systemic involvement?

Penetrating Enteric Infections

How is Salmonella typhi transmitted?

person to person

How does Salmonella typhi manifest?

Fever, rose spots

How is Salmonella typhi tx?

ceftriaxone, ciprofloxacin, azithromycin

How is Yersinia entercolitica transmitted?

Undercooked meats

How is Yersinia entercolitica tx?

usually self limiting, can use aminoglycosides, doxycycline if severe

How is Clostridium difficile transmitted?

recent abx use

How is Clostridium difficile tx?

oral vancomycin or fidamoxicin

What are the complications of Clostridium difficile?

toxic megacolon

What are RF for vitamin C (ascorbic acid) deficiency?

diets lacking raw citrus fruits and green vegetables

What are sxs of vitamin C (ascorbic acid) deficiency?

- hyperkeratosis

- hemorrhage

- hematologic abnormalities

What is the manifestation of vitamin D deficiency in adults?

osteomalacia

What is the manifestation of vitamin D deficiency in children?

rickets

What are effects of vitamin A excess?

teratogenicity

What are effects of vitamin A deficiency?

Night blindness and visual changes

What are the manifestations of riboflavin B2 deficiency?

angular stomatitis, glossitis, sore red eyes, dermatitis

What are the manifestations of pyridoxine B6 deficiency?

peripheral neuropathy

What are the manifestations of thiamine B1 deficiency?

- dry beriberi

- wet beriberi

- Wernicke-Korsakoff syndrome

What are the manifestations of niacin B3 deficiency?

- dermatitis

- diarrhea

- dementia

What are the manifestations of niacin B3 toxicity?

niacin flush, painful tingling, GI distress