GASTROENTEROLOGY ARTICLE OF THE WEEK
January 7, 2010
DuPont HL. Bacterial diarrhea. N Engl J Med 2009;361:1560-9
1. The development of watery diarrhea without vomiting 6 hours after eating chicken salad in a family picnic would be typical for
a. Shiga-toxin, lactose fermenting E. coli infection
b. Staphylococal food poisoning
c. Clostridium perfringes food poisoning
d. Vibrio infection
e. Plesiomonas colitis
2. The most effective chemoprophylactic regimen recommended to prevent traveler’s diarrhea is
a. Ciprofloxacin 500mg daily
b. Rifaximin 400 mg tid
c. Peptobismol 2 tablets qid
d. Rifaximin 200mg bid or qd
e. Metronidazole 500mg tid
3. Stool cultures are indicated in which of the following circumstances
a. Diarrhea in a person who returned from Mexico 12 hours ago
b. Bloody diarrhea
c. Watery diarrhea of 1 day duration
d. Diarrhea that has persisted for more than 1 week
e. Diarrhea with high fever
True or False
4. Most cases of Campylobacter enteritis present as bloody diarrhea
5. Shiga-toxin producing E. coli may cause dysentery characterized by high fever and watery stools that then become bloody.
6. C. difficile is the most common cause of antibiotic-associated diarrhea in the hospitalized patient.
7. Anti-motility agents can be used in cases of bacterial diarrhea as long as the patient is receiving adequate antibiotic therapy
8. The absence of sorbitol-negative E. coli colonies in stool culture does not exclude the possibility of Shiga-toxin producing E. coli organisms
9. The treatment of choice for Shiga-toxin producing E. coli is Levofloxacin 500mg daily for 7-10 days
10. Patients who develop diarrhea while traveling should undergo stool culture prior to determining the need for antibiotics