Acute Infectious Diarrhea
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Transcript of Acute Infectious Diarrhea
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