Microbiology Nuts & Bolts
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Gastroenteritis and Diarrhoea and Vomiting (D&V)

Gastroenteritis is inflammation of the stomach and small intestine causing ≥3 liquid or loose stools/diarrhoea in 24 hours with or without vomiting.

Clinical Features

• Liquid or loose stool, which takes the shape of the container it is put in (types 5-7 on the Bristol Stool Chart, see Appendix 2)
• Vomiting
• Speed of onset related to infectious cause
   - Minutes to hours caused by pre-formed toxin
   - Hours to days caused by viruses and bacteria
• Systemic symptoms, fever, sweats, chills, aches and pains, caused by Campylobacter spp., typhoid and paratyphoid
• Chronic symptoms (>2 weeks) commonly caused by parasites
​

Common Causes

Pre-formed toxin
• Staphylococcus aureus
• Bacillus cereus
• Clostridium perfringens

Viruses
• Norovirus
• Rotavirus
• Adenovirus

Bacteria
• Campylobacter sp.
• Shigella sp.
• Salmonella sp.
• Escherichia coli, including O157
• Clostridium difficile

Parasites
• Cryptosporidium parvum
• Giardia lamblia

Causes in Returned travellers

Bacteria 
As per common plus:
• Vibrio cholerae
• Vibrio parahaemolyticus
• Salmonella typhi (typhoid)
• Salmonella paratyphi (paratyphoid)

Investigations

• Stool
  - Culture or PCR for bacteria
  - Toxin testing for Clostridium difficile
  - Antigen testing or PCR for viruses
  - ​Microscopy is not routinely performed:
​    (request ova, cysts and parasites (OCP) only if these are clinically suspected)
    o PCR for Cryptosporidium spp. and Giardia lamblia if available
Picture

Treatment

Supportive treatment only (adequate hydration) in patients with a normal immune system except for:
• Clostridium difficile (see section – Clinical Scenarios, Clostridium difficile Associated Disease)
• Typhoid and paratyphoid
• Giardia lamblia
Treatment - Gastroentreritis
Warning - Gastroenteritis - Ciprofloxacin
Total Duration
7-10 days 

Dosing
See section - Antibiotics, Empirical Antibiotic Guidelines.

Prognosis and Complications
It is estimated that one in every 1,000 Campylobacter infections (treated or untreated) leads to Guillain-Barre syndrome 1-3 weeks after infection (this equates to up to 40% of Guillain-Barre syndrome cases).
 
Prophylaxis and Prevention
Vaccinate against Rotavirus as part of the primary course of childhood immunisations.

​Most bacterial causes of gastroenteritis e.g. Campylobacter sp., Shigella sp., Salmonella sp. and Escherichia coli O157 are Notifiable Infectious Diseases (see section – Microbiology, Notifiable Infectious Diseases in the UK).

 
Infection Control Precautions
See section – Infection Control, Diarrhoea and Vomiting.
Warning - Gastroenteritis - Cohort
Microbiology Nuts & Bolts on Amazon
Topics in Clinical Scenarios - Gastrointestinal ​​Infections:
  • Gastroenteritis and Diarrhoea and Vomiting (D&V)
  • Clostridium difficile Associated Disease (CDAD)
  • Necrotising Pancreatitis
  • Cholecystitis and Cholangitis
  • Peritonitis
  • Viral Hepatitis
  • Peptic Ulcer Disease

​All these topics are covered in the book...Ready to buy your copy? Click here to buy your copy of "Microbiology Nuts & Bolts" Its updated and amazingly only slightly larger considering its got 1/3 more in it! (11cmx18cmx2.5cm).

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