ACUTE DIARRHOEAL DISEASES

Dr. Indrajeet Kumar

Department of Community Medicine M.G.M Medical College, Jamshedpur.

MAJOR CAUSES OF IMR (Infant Mortality Rate)

DiarrhoeaARI (acute respiratory infection)MalariaMeaslesMalnutrition.

DEFINITION

DIARRHOEA: Passage of loose, liquid watery stool.

CHRONIC DIARRHOEA: Diarrhoea lasting for 3wks or more.

ACUTE DIARRHOEA: Diarrhoea of sudden onset which usually lasts for 3-7days.

DYSENTERY: Watery stool with presence of blood.

GASTROENTERITIS: Acute diarrhoea of infective origin.

Infections causing diarrhoea

VIRAL : Rotavirus Adenovirus

Corona virus Enterovirus; e.g. Polio, hepatitis-A & E.

BACTERIAL: Campylobacter jejuni Escherichia coli**

Shigella Salmonella

Vibrio cholerae** & parahemolyticus Bacillus cereus.

PROTOZOAL:Entamoeba histolytica, Giardia intestinalis, Cryptosporidium***, OTHERS: intestinal worms.

SALMONELLA INFECTION

Gram negative bacilli.

Species which infect human being a. S. typhimurium & enteritidis – acute gastroenteritis. b. S.typhi & paratyphi – Typhoid & para - typhoid fever (ENTERIC FEVER)

ENTERIC FEVER

AGENT FACTOR:Agent: 95% by S.typhi 5% by S.paratyphi. :- 3 types of antigen ‘O’ , ‘H’ & ‘Vi’.

Reservoir: Human Cases & Carrier.

Infective material: Faeces & urine.

Period of infectivity: a.case: during I.P & early disease b. carrier: longer period or life long.

HOST FACTOR

AGE: highest between 5-19yrs.

SEX: Cases more in male. Carrier rate more in female.

IMMUNITY: No strong immunity after infection. Hence re-infection occurs.

INCUBATION PERIOD : 10 – 14days

MODE OF TRANSMISSION: faeco - oral urino - oral

Clinical features

Divided into stages of 4wks

1st Week: Prodromal symptoms similar to URTI. Remittent or Step ladder fashion temperature. Relative bradycardia.

2nd Week: Maculo-papular “rose spot rash”, Pea soup stool or constipation, soft spleenomegaly.

3rd Week: “Week of complications” : hemolytic anaemia, meningitis, acute cholecystitis, UTI, intestinal perforation and haemorrhage.

4th Week: “Week of convalescence”

INVESTIGATION

1st Week of fever: Blood culture.

2nd Week of fever: Widal test & urine culture.

3rd Week of fever: Stool culture.

4th Week of fever: Stool culture.

CONTROL OF TYPHOID

At source level

CASE “EARLY DIAGNOSIS & TREATMENT” Diagnosis by lab methods. Treatment in isolation. a. Quinolones drug of choice. Ciprofloxacin 500mg bid for 7days. Ofloxacin 200mg bid for 7days. b. 3rd Generation cephalosporins. Cefixime: 200mg x 2 x 7days Cefotaxime 2gm bid im/iv

Disinfection: a. Concurrent: of stool/urine by 5% cresol. b. Terminal : of room/bed etc.

Follow up : at 3month & 12month by stool/

urine culture.

CARRIER “EARLY DIAGNOSIS & TREATMENT” Diagnosis by lab methods: Vi antibody positive. :urine/stool culture +ve even months after Tt Treatment: biliary carrier: Cholecystectomy

+

Ciprofloxacin 750mg x bid x 4wks.

urinary carrier: Ciprofloxacin 750mg x bid x 4wks + / - Nephrectomy (of damaged kidney)

Disinfection:

Follow up:

Transmission level

a. PERSONAL HYGIENE:

b. ENVIRONMENTAL SANITATION: :- water sanitation :- food sanitation. :- excreta disposal.

At host level by vaccination

PARENTERAL Killed vaccine.

Types MONOVALENT ( S.typhi) BIVALENT (S.typhi & S.paratyphi A)

TRIVALENT /“TAB Vaccine”(S.typhi , paratyphi A & B)

Dose: 2doses - s.c – 6wks apart.

Booster: every 3yrs

Protection rate: 70 to 85% for 3-4yrs.

ORAL VACCINE Live attenuated vaccine.

Strains of s.typhi used Ty21a developed by swiss. 541Ty developed by US.

Dose: one cap. On day 1 – 3 – 5 before meals.

Booster: every 3yrs (all 3doses).

Protection: 90% protection for 3yrs.

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