diarrhea
<ul><li>Acute < 2 wk </li></ul><ul><li>Invasive vs noninvasive </li></ul><ul><li>Invasive: fever,dysentery,severe abdomina...
<ul><li>Empirical antibiotic : 3-5 day </li></ul><ul><ul><li>Ciprofloxacin 1000 mg /day </li></ul></ul><ul><ul><li>Norflox...
Invasive  <ul><li>Campylobacter </li></ul><ul><li>Samonella </li></ul><ul><li>shigella </li></ul><ul><li>Vibrio parahaemol...
Campylobacter <ul><li>chicken </li></ul><ul><li>Resist to ciprofloxacin in Thailand 80% </li></ul><ul><li>Guillain-Barre s...
Samonella  <ul><li>Sepsis in immunocompromised host </li></ul><ul><li>ABO: in age< 3 mo,> 50yr AIDS, malignancy </li></ul>...
shigella <ul><li>S.dysenteriae : ABO to all +ve culture,prevent outbreak </li></ul><ul><li>Reiter syndrome </li></ul><ul><...
Vibrio parahaemolyticus <ul><li>Raw fish </li></ul><ul><li>Self limited </li></ul>
E.Coli O 157:H 7 <ul><li>Dysentery ,no or low grade fever </li></ul><ul><li>ABO:  risk HUS </li></ul><ul><li>meat </li></ul>
Toxin-induced bacterial gastroenteritis <ul><li>Non invasive (bacterial and viral) </li></ul><ul><li>Clinical: watery,mini...
Non invasive
Vibrio species <ul><li>Except: V.parahaemolyticus </li></ul><ul><li>V.gravis (cholera) :rice water, > 1 Liter/hr </li></ul...
Scomboid fish <ul><li>Tuna,Mackerel </li></ul><ul><li>Heat stable </li></ul><ul><li>Produce histamine ,improper refrigerat...
Ciguatera fish poisoining <ul><li>Ciguatoxin neurotoxin </li></ul><ul><li>Odorless,taseless </li></ul><ul><li>GI symptoms ...
Enterotoxigenic Escherichia coli(ETEC) <ul><li>Most common cause of traveler’s diarrhea </li></ul>
Clostridium difficile  <ul><li>Normal gut flora </li></ul><ul><li>Board spectrum ABO  overgrowth  produced toxin,develop...
Viral gastroenteritis <ul><li>Adult: norovirus </li></ul><ul><li>Children: rotavirus </li></ul><ul><li>Dx in adult: one of...
Diarrhea in AIDS <ul><li>20-25% multiple pathogens </li></ul><ul><li>Cryptosporidium and isospora belli persist in CD4 < 2...
Diarrhea in AIDS <ul><li>Diagnosis </li></ul><ul><li>H/C : in MAC, samonella, CMV </li></ul><ul><li>CBC: eosinophillia in ...
Diarrhea in AIDS <ul><li>SE HAART: PI  nelfinavir, lopinavir/rotinavir </li></ul><ul><li>Rx </li></ul><ul><ul><li>CMV:gan...
Traveler’s diarrhea <ul><li>ETEC most common </li></ul><ul><li>Mild,non dysentery,single dose of ciprofloxacin 750 mg PO c...
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Sep11 summary diarrhea

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By Kanjanee Wachirarangsiman, MD

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Transcript of "Sep11 summary diarrhea"

  1. 1. diarrhea
  2. 2. <ul><li>Acute < 2 wk </li></ul><ul><li>Invasive vs noninvasive </li></ul><ul><li>Invasive: fever,dysentery,severe abdominal pain, wbc-rbc in stool </li></ul><ul><li>Stool c/s in :suspected invasive, immunocompromise host, protracted diarrhea > 3 day </li></ul><ul><li>Stool for parasite : duration > 7 day </li></ul>
  3. 3. <ul><li>Empirical antibiotic : 3-5 day </li></ul><ul><ul><li>Ciprofloxacin 1000 mg /day </li></ul></ul><ul><ul><li>Norfloxacin 800 mg/day </li></ul></ul><ul><ul><li>Levofloxacin 500 mg/day </li></ul></ul><ul><ul><li>Azithromycin 500 mg/day (ped,pregnancy,campylobacter in thai) </li></ul></ul><ul><li>Persistent diarrhea </li></ul><ul><ul><li>Metronidazole 250 mg tid :7-10 day(rx:giardia) </li></ul></ul>
  4. 4. Invasive <ul><li>Campylobacter </li></ul><ul><li>Samonella </li></ul><ul><li>shigella </li></ul><ul><li>Vibrio parahaemolyticus </li></ul><ul><li>Enterohemorrhagic Escherichia coli </li></ul>
  5. 5. Campylobacter <ul><li>chicken </li></ul><ul><li>Resist to ciprofloxacin in Thailand 80% </li></ul><ul><li>Guillain-Barre syndrome </li></ul><ul><li>Rieter syndrome </li></ul>
  6. 6. Samonella <ul><li>Sepsis in immunocompromised host </li></ul><ul><li>ABO: in age< 3 mo,> 50yr AIDS, malignancy </li></ul><ul><li>ABO may prolong carrier stage </li></ul><ul><li>Reiter syndrome </li></ul>
  7. 7. shigella <ul><li>S.dysenteriae : ABO to all +ve culture,prevent outbreak </li></ul><ul><li>Reiter syndrome </li></ul><ul><li>Seizure in children </li></ul>
  8. 8. Vibrio parahaemolyticus <ul><li>Raw fish </li></ul><ul><li>Self limited </li></ul>
  9. 9. E.Coli O 157:H 7 <ul><li>Dysentery ,no or low grade fever </li></ul><ul><li>ABO:  risk HUS </li></ul><ul><li>meat </li></ul>
  10. 10. Toxin-induced bacterial gastroenteritis <ul><li>Non invasive (bacterial and viral) </li></ul><ul><li>Clinical: watery,minimal fever,little or no abdominal pain,no wbc-rbc in stool </li></ul>
  11. 11. Non invasive
  12. 12. Vibrio species <ul><li>Except: V.parahaemolyticus </li></ul><ul><li>V.gravis (cholera) :rice water, > 1 Liter/hr </li></ul><ul><li>V.vulnificus: contact sea water with open wounds:hemorrhagic bleb+septic shock,MR 50% </li></ul>
  13. 13. Scomboid fish <ul><li>Tuna,Mackerel </li></ul><ul><li>Heat stable </li></ul><ul><li>Produce histamine ,improper refrigeration </li></ul><ul><li>Metallic, bitter or peppery taste </li></ul>
  14. 14. Ciguatera fish poisoining <ul><li>Ciguatoxin neurotoxin </li></ul><ul><li>Odorless,taseless </li></ul><ul><li>GI symptoms and constellation of neurological symptoms </li></ul><ul><li>Tingling around mouth, painful teeth, burning feet,CNS chage;ataxia,weakness,vertigo,confusion </li></ul><ul><li>Misdiagnosis :AGE with hyperventilation syndrome </li></ul>
  15. 15. Enterotoxigenic Escherichia coli(ETEC) <ul><li>Most common cause of traveler’s diarrhea </li></ul>
  16. 16. Clostridium difficile <ul><li>Normal gut flora </li></ul><ul><li>Board spectrum ABO  overgrowth  produced toxin,develops during ABO administration or within 2 wk of discontinue </li></ul><ul><li>Toxin A  attract neutrophil and monocyte </li></ul><ul><li>Toxin B  disrupt colonic epithelial cell </li></ul><ul><li>Clinical : same as invasive group </li></ul><ul><li>25% better when stop ABO 48-72 hr </li></ul><ul><li>Rx: first line oral or iv metronidazole,if severe oral vancomycin </li></ul>
  17. 17. Viral gastroenteritis <ul><li>Adult: norovirus </li></ul><ul><li>Children: rotavirus </li></ul><ul><li>Dx in adult: one of exclusion </li></ul>
  18. 18. Diarrhea in AIDS <ul><li>20-25% multiple pathogens </li></ul><ul><li>Cryptosporidium and isospora belli persist in CD4 < 200 cell/mm 3 </li></ul><ul><li>MAC and CMV in CD4 <100 cell/mm 3 </li></ul><ul><li>samonella esp. S.typhimurium high risk bacteremia </li></ul><ul><li>Consider strongyloids in any immunocompromised pt who  sudden clinical deterioration,eosinophillia,polymicrobial sepsis, meningitis, adynamic ileus </li></ul>
  19. 19. Diarrhea in AIDS <ul><li>Diagnosis </li></ul><ul><li>H/C : in MAC, samonella, CMV </li></ul><ul><li>CBC: eosinophillia in stronyloides, Isospora </li></ul><ul><li>Rectal biopsy: CMV  inclusion body with clear halo </li></ul>
  20. 20. Diarrhea in AIDS <ul><li>SE HAART: PI  nelfinavir, lopinavir/rotinavir </li></ul><ul><li>Rx </li></ul><ul><ul><li>CMV:ganciclovir,foscarnet </li></ul></ul><ul><ul><li>MAC:clarithromycin,azithromycin;poorly response to rx,death within 6-8 mo after dx </li></ul></ul><ul><ul><li>Strongyloid:ivermectin 200 mcg/day 1-2 day,thiabendazole 50 mg/kg/day 2 day, if disseminated rx for at least 5 day </li></ul></ul>
  21. 21. Traveler’s diarrhea <ul><li>ETEC most common </li></ul><ul><li>Mild,non dysentery,single dose of ciprofloxacin 750 mg PO combination with loperamide </li></ul><ul><li>High fever,bloody stools,typical invasive picture, norfloxacin 400 mg bid or ciprofloxacin 500 mg for 3 day </li></ul>
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