Lets talk about some important invasive bacterial
diarrhea. What you can expect clinically
and how you would manage your patient effectively.
Shigella. Now, shigella is rather interesting.
And the reason for that is because there is
certain recommendations that are made by CDC.
But without going into too much detail, lets just
make sure I give you just enough so you know what's
going on. Number 1, bloody diarrhea with fever and
bacteremia. Well you've heard of something called
shiga toxin or shigella dysenteriae type I which very
much behaves like EHEC or Enterohemorrhagic E.coli
associated with HUS. If the patient and a proper
targeting has been done, a susceptibility test,
then ampicillin could be used along with your
trimethoprim-sulfamethoxazole. However, there is an
increasing tide of resistance taking place with such
antibiotics. So with that said, drugs that you are now
considering other placement include azithromycin,
maybe fluoroquinolones. Salmonella typhimurium
is the most common in US. Associated with poultry,
non-bloody diarrhea. Treatment of mild symptoms
may lead to prolonged carrier state and
here your management would be ciprofloxacin.
Parahemolyticus, ingestion of undercooked shellfish
as I mentioned earlier. Antibiotic may or may not be
of value. And we have the E.coli or EHEC and
hemorrhagic. And at this point I would think that
you have O157:H7 memorized. Undercooked beef is
what you're thinking about. Bloody diarrhea
in a child, hemolytic uremic syndrome. Uremia to
you should mean renal failure. In a child
next step of management, my goodness you choose
hemodialysis with antibiotic at the same time.
Hemodialysis, next step of management, HUS. Forever
more? Thank goodness no. You kill of the bacteria
in the child then the child comes back to be
perfectly normal. That's what makes me happy.
When a child gets sick, that's not nice. Antibiotic
therapy not necessarily effective hence the hemodialysis.
Staph. aureus, here we have extremely rapid,
rapid,rapid type of diarrhea that we talked about.
Enterocolitis with positive stool culture. Yersinia
enterocolitica. Chronic enteritis. Can mimic your Crohn's.
Could be associated with ankylosing spondylitis.
Treatment here is your co-trimoxazole.
Campylobacter jejuni. Extremely common and
mimics once again your ulcerative colitis.
We have vibrio vulnificus. Raw shellfish or wound
infection. I was talking to you about this earlier
when I was referring to the gulf. So vulnificus gulf,
if you want to call it gulfnificus, that might
perhaps help you. And the wound infection is what
happens here. It enters and take a look,
I told you mortality increases to the point where
this is exactly what happens. Necrotizing fascitis
in cirrhotics. Vulnificus.