ID - Diarrhea

Acute diarrhea

< 14 days

Chronic diarrhea

> 30 days

MC toxogenic diarrhea

C. Perfingens

Poultry prepared the night before...reheated

C. Perfingens

MCC food poisoining in the USA

C. Perfingens

C. Perfingens Incubation

8-16hrs

MCC of waterborne diarrhea

Giardiasis

Backpackers Diarrhea

Giardiasis

Giardiasis incubation

1-3 weeks (sxs after travel)

Five Fs of Giardiasis

Fecal-oral

Flatulence

Foul-smelling

Fatty stool

Flagyl

Dx Giardiasis

Stool antigen is test of choice

*trophozoite cysts

Giardiasis tx

Metro

GI & neuro sxs --> cold wash cloth feels hot

Ciguatera Fish Poisoning

MC form of fish poisoing

Ciguatera Fish Poisoning

In this fish poison, the fish is odorless and tasteless so humans cant tell

Ciguatera Fish Poisoning

Ciguatera Fish Poisoning Incubation

2-6 hours

Neuro sxs that increase when drinking alcohol

Ciguatera Fish Poisoning

Ciguatera Fish Poisoning - what increases neuro sxs?

Drinking alc

Ciguatera Fish Poisoning Treatment

Supportive

Can do: Mannitol*, Amitroptyline, Gabapentin

Fried rice

B. cereus

Pt presents with allergic reaction type sxs

Scromboid Fish poisoning

Scromboid Fish poisoning - what causes the sxs?

Toxic histamine-like substance

Scromboid Fish poisoning - incubation

20-60 minutes

In this fish poison the fish tastes bitter and like pepper so it warns the eater

Scromboid Fish poisoning

Is Scromboid Fish poisoning an allergic rxn?

NO

Scromboid Fish poisoning - whose fault?

The fish supplier who failed to refrigerate the fish after - NOT the cook or the resturaunt

Scromboid Fish poisoning - TX

IV benadryl

Patient presents with red face, tachy, increased BP...

Niacin Toxicity

Niacin Toxicity - Toxic sxs

Hives

sweating

blurry vision

Liver damage

glucose intolerance

Niacin Toxicity tx

Reassure patient

Diminish dose of niacin

Cab driver eats in car...

Carbon monoxide

What neuro sxs would present in botulism?

Symmetric cranial and peripheral nerve impairment

Descending flaccid paralysis

*NO sensory or mental impairment

*Normal DTRs

6Ds of Botulism

Diplopia

Dysarthria

Dysphagia

Dilated pupils

Descending paralysis

Diarrhea

When infants get botulism it is aka

floppy baby syndrome

DX of Botulism is us

serum for toxin

tx Botulism

Antitoxin

Cruise ships - think

Norwalk

MCC viral enteritis in north america

Norwalk

Raw oysters/sushi bars commonly asscoiated with

Norwalk

Dx norwalk

Stool PCR

Treat norwalk

NO ABX, supportive

R/O HEP A

MCC of severe diarrhea in children

Rotavirus

Baby with rotavirus, doesn't pee

admit them

Ground beef, bloody diarrhea

E.coli

ETEC

Enterotoxigenic E. coli causing traveler's diarrhea.

EHEC

O157:H7

May present with HUS

EIEC

Enteroinvasive E. coli

EPEC

P = Pediatric - diarrhea in children

Sxs of HUS

Microangiopathic hemolytic anemia

Renal failure

Thrombocytopenia

Schistocytes

Treat HUS

NO ABX

Plasmapheresis, monoclonal aB can be used

Usu caused from unpasturized milk

Campylobacter

Campylobacter unique features

can cause Reiter's or GB

Campylobacter treatment

supportive

if severe give azithromycin

Uncooked eggs

Salmonella

Pet turtles

salmonella

Onset of salmonella

16-72 hours

Outpatient tx of Salmomella

Cipro

Inpatient tx of Salmonella

Ceftriaxone

Relative bradycardia is commonly seen with

Salmonella Typhi

-admit and give ceftriaxone

3 main things with Reiters

Conjunctivitits

Balanitis circanta

Keroderma blennorhagica

____ in 80% of Reiter's patients

HLA B27

Reiters tx

NSAIDs - indomethacin

Tetracyclines, Bactrim if needed

RLQ that mimicks appendicits

Yersinia

New PET in the house

Yersinia

Tx Yersinia

Supportive

bactrim if needed (bactrim for kids!)

AMS + non-bloody diarrhea

Listeria

When is Listeria bad

Preg women in 3rd trimester

Neonatal menigintiis

Meninigits in IC

Usu tx Listeria with

Amp