ACUTE INFECTIOUS DIARRHEA

BY:

DR.SATTI MOH’D SALEH

INFECTIOUS DISEASE PHYSICIAN

MEDICAL DIRECTORMEEQAT GENERAL HOSPITALCBAHI INFECTION CONTROL

MEMBER

MECHANISM OF DISEASE

1 .OSMOTIC LOAD2 .INTESTINAL SECRETION3 .INTESTINAL MALABSORPTION4.ALTERED INTESTINAL MOTILITY

MECHANISM OF DISEASEMECHANISM OF DISEASE1. OSMOTIC LOAD2. INTESTINAL SECRETION3. INTESTINAL MALABSORPTION4.ALTERED INTESTINAL MOTILITY

OSMOTIC DIARRHEA

NON ABSOBABLE SUBSTANCE (PURGATIVE).

MAL ABSORTION (GLUCOSE)SPECIFIC MALABSORTION DEFECT

(DISACHARIDASE).

SECRETORY DIARRHEA

ENTEROTOXINHORMONES (VIP)

BILE SALTS (ILEAL VESECTION)FATTY ACIDS (ILEAL VESECTION)

LAXATIVES (DSS)

INFLAMATORY DIARRHEA

ABNORMAL MOTILITY

DM,VAGOTOMY,HYPERTHYROIDISM

ALTERED ALTERED DM,VAGOTOMY,HYPERTHYROIDISM

MOTILITYMOTILITY

ACUTE INFECTIOUS DIARRHEADEFINITION:

Alteration of normal physiological function GIT by ingested microorganisms or their products.

-Toxigenics organisms - - secretion + absorption.

-Rota Norwalk, otherinal illness - - infection of Entrocytes and loss of brush border enzymes.

-Invasive pathogens - - infalm, Int. secretion altered motility.

Host defenses

1 -Gastric Acidity 2 -Bowel Motility 3 -Colonic Flora 4 -Local anti-body

HOST DEFENSEHOST DEFENSE

1- Gastric Acidity 2- Bowel Motility 3- Colonic Flora 4- Local anti-body

CAUSES OF ACUTE INFECTIOUS DIARRHEA

WATERY DIARRHEA-B. CEREUS- STAPHYLOCOCCUS- VIBRIO- ETEC- EPEC- SALMONELLA SPP.- CAMPYLOBACTER- CLOSTRIDIUM PERFRINGENS- CLOSTRIDIUM DEFFICILE

CAUSESCAUSESWATERY DIARRHEA-B. CEREUS- STAPHYLOCOCCUS- VIBRIO- ETEC- EPEC- SALMONELLA SPP.- CAMPYLOBACTER- CLOSTRIDIUM PERFRINGENS- CLOSTRIDIUM DEFFICILE

DYSENTERY-SHIGELLA

-SALMONELLA-CAMPYLOBACTER

-EIEC-EHEC

-YERSENIA ENT.-VIBRIO PARAHAEMOLYTICUS

-CLOSTRIDIUM DEFICILE

Selected notifiable diseases by region Jul - Sept 2011 Madina KSA

SYMTOMS & SIGNSTOXIGENICTOXIGENIC INFLAMMATORYINFLAMMATORY VIRALVIRAL

No systemic upsetNo systemic upset

Small number Small number

Large volumeLarge volume

Stool no RBCs no Stool no RBCs no leukocytes.leukocytes.

Systemic upsetAbdminal Systemic upsetAbdminal pain, tenesmus, fever .pain, tenesmus, fever .

Stool Stool

Large number FrequentLarge number Frequent

Small volume blood -stainSmall volume blood -stain

mucus, pus cellsmucus, pus cells

MechanismMechanism

Invasion of enterocytes Invasion of enterocytes leading to mucosal cell leading to mucosal cell death and inflammatory death and inflammatory responseresponse

Systemic upsetSystemic upset

U R T IU R T I

Fever nauseaFever nausea

MyalgiaMyalgia

Stool Stool

Voluminous, wateryVoluminous, watery

MechanismMechanism

Osmatic or secretoryOsmatic or secretory

Approach to pt with diarrhea

1 -entrotoxin ( a febrile ) 2 – potentially invading( Fever +

blood or dysentery ) 3 -completely invading ( fever +

bactreamia 4 -Diarrhea with GI bleeding

Investigation

-Rectal swab, stool general , Stool c/s , toxin assay ,elisa, PCR

APROACH TO APROACH TO PATIENTSPATIENTS

1 -entrotoxin ( a febrile )

2 – potentially invading( Fever + blood or dysentery ) 3- completely invading ( fever + bactreamia 4- Diarrhea with GI bleeding Investigation - Rectal swab, stool general , Stool c/s , toxin assay ,elisa, PCR

DIARRHEA CLINICS -PRIMARY CARE CENTER

-SEASONAL CENTER -HOSPITALS

-EACH CLINIC Doctor

Nurse Health supervisor

Necessary requirements-Supervision

-Regional Infection control Committee + Preventive Medicine Dept.

OUT PATIENT MANAGEMENT

FOR MILD DIARRHEA-SAUDI-RESIDENTS-HAJI WITH PROPER EASILY TRACED

ADDRESS

HOSPITAL MANAGEMENT

.1Severe Cases.2Positive Cases

- Vibrio - Others

3 .Suspected Cases with no proper address

SURVEY SHEET OF HOSPITALIZED INFECTIOUS DIARRHEA CASES IN MEDINA MUNAWARAH DURING HAJ.

HAJ NON HAJ

Name:

Age Years Sex: M/F Nationality:

History of:

Fever Nausea Vomiting

Tenesmus Headache Colic

Mayalgia Other (specify)

Stools:

Frequent >6/day Volume Large Actual amount >1/2 liter

> 6/day small >1/2 liter

Blood Mucus Consistency Formed

Semi formed

Watery

Other( specify)

Contacts: One person involved

Group with common food source

Examination:

Temp. Pulse BP Resp.

Dehydration Mild Level of consciousness Drowsy

Moderate Semiconscious

Severe Comatosed

Laboratory Tests:Blood CBC Hb PCV

RBS

UREA

CREATININE

ELECTROLYTES

STOOL GENERAL BLOOD

MUCUS

WBC

OVA / CYST AMOEBA / GIARDIA

OTHER( SPECIFY )

CULTURE RECTAL SWAB STOOL CULTURE BLOOD CULTURE

ROTA VIRUS Norwalk AGENT

MANAGEMENT & COMMENTS :

ANNUAL REPORT OF 2011 K.S.A.TYPHOID AND PARATHYROID = 57

SALMONELLA = 390CASESHIGELLA = 7

CHOLERA = 0( ة.

Jul sept 2011

TREATMENT OF MOST COMMON GASTROINTESTINAL PATHOGENS.

S. aureus Hydration Self limited B. cereus Hydration Self limited C. perfringeus Hydration Self limited V.cholrae Tetrcycline’s Ampicilin &

TMP-SMX So effective

Salmonella TMP-SMX Ampicilin Shigella TMP-SMX Quinolon

Yersinia TMP-SMX Tetracyclines, minoglycosides in severe cases.

Campylobacter Erythromycin Quinolones E. coli Hydration Self limiting

v. parahaemolyticus Tetracyclines TMP-SMX Rotavirus Hydration No specific

treatment Norwalk virus Hydration No specific

treatmentTNIDAZOLE Me tronidazole G. lambia

E. histolytica Me tronidazole

حاالت اإلسهال منطقة المدينة المنورة حتى شعبان1432 --- 1431

حاالت اإلسهال منطقة المدينة المنورة

حتى شعبان1432

2137476

MANAGEMENT OF INFECTIOUS DIARRHEA

.1REHYDRATION ORS IV FLUIDS SHOCK

SEVERE VOMITING DEPRESSED MENTAL

STATE2 .INDICATIONS FOR ANTIMICROBIALS

a) Parasitic infections E. histililytica G. lambia Other parasitic infection

b). V.cholerae Cases Carriers

discharge after 3 consecutive negative post treatment samples

c). Salmonella Infants

MANAGEMENTMANAGEMENT1. REHYDRATION ORS IV FLUIDS SHOCK SEVERE VOMITING DEPRESSED MENTAL STATE2. INDICATIONS FOR ANTIMICROBIALS a( Parasitic infections E. histililytica G. lambia Other parasitic infection b(. V.cholerae Cases Carriers discharge after 3 consecutive negative post treatment samples c(. Salmonella Infants

PREVENTION.11 .PROVISION OF SAFE WATER.

.22 .PERSONAL HYGIENE.

.33 .AVOID UNDERCOOKED FOOD.

.44 .HEALTH INSPECTION.

.55 .HEALTH EDUCATION.

.66 .ISOLATION & TREATMENT OF CARRIERS.

.77 .SCREENING OF FOOD HANDLERS.

Thank you