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Gastrointestinal infections, Team members:, References:. Murray, P.…

- - - - Hygiene
      - Travels to other countries
      - Eating outside home in street food locations
      - Eating something rotten
      - Contaminated water
      - Overuse of antibiotics
      - Sexual practice
      - Age
    - - H. pylori
        
        Invasive
        
        Endoscopy w/ biopsy
        
        Noninvasive
        
        Serology
        
        Breath test
        
        Fecal antigen analysis
      - Campylobacters
        
        Stool culture
        
        Blood culture
        
        Direct examination of feces by darkfield or phase contrast microscopy
        
        Rapid presumptive diagnosis if its clinical features are present
      - Salmonella spp.
        
        McConkey agar for fresh stools
        
        Blood cultures in case of bacteremia/vascular infection
        
        Serology
      - Y. enterocolitica
        
        Blood agar
        
        McConkey Agar
        
        Serology
        
        Enzyme-linked immunosorbent essays
        
        Tube agglutination
        
        Immunoblotting
        
        PCR
      - V. cholerae
        
        Stool culture when not endemic in the area
        
        Serology
        
        Darkfield microscopy
        
        "Shooting star" motility of vibrios
        
        PCR
      - E.coli
        
        ETEC
        
        Cultures, immunoassays, PCR
        
        EPEC
        
        Probes and amplification assays
        
        EAEC
        
        DNA probe and amplification assays
        
        STEC
        
        Screening for O157:H7 with sorbitol-MacConkey agar, Serotyping for toxin detection (ELISA, latex agglutination), stool specimen and cultures.
        
        EIEC
        
        Sereny test, plaque assay, probes and amplification assays
      - E. histolytica
        
        Stool (Ova and Parasite)
        
        ELISA
        
        Serology
      - Rotavirus
        
        Enzyme-linked immunoassay
        
        Latex agglutination
        
        Electron microscopy (identify viral particles)
        
        RT-PCR
    - - Vomiting, diarrhea, fever and dehydration. Specially in children.
        
        Gastroenteritis due to rotaviruses
      - Secretory diarrhea
        
        Small intestine
        
        Watery, nonbloody diarrhea and abdominal cramps, less common nausea and vomiting
        
        Traveler's diarrhea
        
        Enterotoxigenic E. coli
        
        Gastroenteriris
        
        Watery diarrhea may be severe accompanied by fever and vomiting
        
        Children younger than 2 years
        
        Enteropathogenic E. coli
        
        Watery diarrhea, inflammatory cells with fever, nausea, vomiting and abdominal pain
        
        Growth retardation
        
        Children
        
        Enteroaggregative E. coli
      - Inflammatory diarrhea
        
        Large intestine
        
        Diarrhea with abdominal pain, sometimes vomiting
        
        Highest incidence children <5 yrs
        
        30-65% bloody diarrhea with severe abdominal pain
        
        Hemorrhagic colitis
        
        10% Acute renal failure, thrombocytopenia, microangiopathic hemolytic anemia
        
        Hemolytic Uremic Syndrome (HUS)
        
        Enterohemorrhagic E. coli
        
        Watery diarrhea
        
        A minority can present fever, abdominal cramps and blood and leukocytes in stool.
        
        Dysenteric form
      - Nausea, vomiting and nonbloody diarrhea. Also fever, abdominal cramps, myalgias and headache
        
        Salmonella enterica
        
        Gastroenteritis
        
        Gradually increasing fever
        
        Variable headache, cough, nausea, vomiting, myalgias, constipation and diarrhea
        
        Salmonella paratyphi A or B and Salmonella typhi
        
        Paratyphoid and typhoid fever
        
        Enteric fever
        
        Severe: Hepatosplenomegaly, intestinal hemorrhage and perforation, encephalopathy, seizures, meningitis and pneumonia
        
        Bradycardia, pulse-temperature dissociation
        
        Rose spots
        
        Uncommon in uncomplicated typhoid fever
      - Diarrhea, fever and abdominal paint for 1 to 2 weeks
        
        Chronic form persist for months
        
        Involves terminal ileum
        
        Y. enterocolitica
        
        Enterocolitis
        
        If involves mesenteric lymph nodes (enlarged)
        
        Pseudoapendicitis
      - Diarrhea, fever and severe abdominal pain
        
        10 or more bowel movements and stools may be bloody
        
        Acute enteritis
        
        Main clinical manifestations: acute colitis, abdominal pain mimicking acute appendicitis and chronic enteric infections.
        
        C. jejuni, C. coli and C. upsaliensis
      - Abdominal pain, cramping, colitis, with diarrhea (Dysentery in some cases/bloody)
        
        Intestinal amebiasis
        
        Other: Right upper quadrant pain, hepatomegaly, fever, cough, nausea, vomiting, abdominal distention
        
        Amebic liver abscess
        
        E. histolytica
      - Self-limited watery diarrhea and vomiting
        
        Fluid lost= rice-water stools
        
        Severe lost fluid: dehydration, painful muscle cramps, metabolic acidosis, hypokalemia and hypovolemic shock.
        
        V. cholerae O1
        
        Other: V. cholerae O139 or nonO1
        
        Cholera
      - Feeling of fullness, nausea, vomiting and hypochlorhydria
        
        Gastritis
        
        Common by H. pylori
        
        10% to 15% peptic ulcers
        
        Gastric (85%) and duodenum (95%) locations
        
        Chronic --> gastric cancer
        
        Small numer: MALT lymphoma
- - - - Gastroenteritis
- - - - Rehydration and electrolyte balance
        
        Antibiotics (Particularly Erythromycin and azithromycin)
    - - Initial treatment
        
        PPI triple therapy: PPI + clarithromycin + amoxicillin
        
        If it fails
        
        Bismuth quadruple therapy: PPI + metronidazole + tetracycline + bismuth
        
        Levofloxacin triple therapy: PPI + amoxicillin + levofloxacin
        
        Bismuth quadruple therapy: PPI + metronidazole + tetracycline + bismuth
        
        Non bismuth quadruple therapy: PPI + amoxicillin + metronidazole + clarithromycin
    - - Hydration and nutrition, avoid antimotility agents
        
        Susceptive to aminoglycosides, tetracyclines, trimethoprim-ssulfamethoxazole, piperacillin, third generation cephalosporins, quinolones
    - - Rehydration and electrolyte balance
    - - Fluid management
        
        Secondary treatment with antibiotics (Macrolides, fluoroquinolones, tetracyclines)
    - - Invasive
        
        Nitroimidazoles (eg. tinidazole or metronidazole)
      - Non-invasive
        
        Luminal agents
        
        Paromomycin (Nonabsorbable aminoglycoside)
        
        Diiodohydroxyquin
        
        Diloxanide
    - - Gastroenteritis treated via fluid replacement and electrolyte balance
        
        If bacteremia occurs, suspected to be caused by NTs, empirical therapy with cephalosporins and fluoroquinolones should be used until susceptibilities are known.
        
        Extraintestinal complications vary in management
    - - ETEC
        
        Rehydration, loperamide, bismuth + quinolone antibiotics or azithromycin in moire severe cases
      - EPEC
      - EAEC
      - STEC
        
        Volume resuscitation and avoidance of antimotility agents
      - EIEC
        
        Supportive, but antibiotics in severe cases