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
• Vomiting
• Speed of onset related to infectious cause
  - Minutes to hours caused by preformed toxin
  - Hours to days caused by viruses and bacteria
• Systemic symptoms, fever, sweats, chills, aches and pains, caused by Campylobacter sp.,
typhoid and paratyphoid
• Chronic symptoms commonly caused by parasites

Causes

Common

Preformed 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

Returned travellers

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

Investigations

• Stool
  - Microscopy for ova, cysts and parasites (OCP)
  - Culture for bacteria
  - Toxin testing for Clostridium difficile
  - Antigen testing for viruses
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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
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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
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.
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Other Gastrointestinal Conditions:

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• Gastroenteritis and Diarrhoea and Vomiting (D&V)
• Clostridium difficile Associated Disease (CDAD)
• Peritonitis
• Cholecystitis and Cholangitis
• Viral Hepatitis


All these conditions are covered in the book,
"Microbiology Nuts & Bolts".









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