Gastrointestinal infections

GASTROINTESTINAL INFECTIONS

In medical terminology " gastrointestinal " refers to the stomach. A gastrointestinal infection that is affecting the stomach or intestines and usually lead to diarrhea. Some infections, such as E. coli and shingles is caused by bacteria. Others, such as Norwalk and Sapporo, are caused by viruses. Giardia is a gastrointestinal infection caused by parasites. Many of these infections are very contagious. An abdominal infection can spread if a person with traces of bacteria on their hands to touch another person or food from another person. Salmonella is a bacterial infection that is transmitted in this way. It is often found in eggs and chicken. If these products are not properly handled or undercooked, people can become sick. 

 

Gastrointestinal infections associated with eating undercooked contaminated meat, usually that goats, sheep and cows. The infection in the intestines usually caused by an overgrowth of certain bacteria or yeasts. gastro-intestinal infection usually causes germs diarrhea.Which are responsible for diarrhea depends on the geographical infected person, their level of sanitation, economic development, and hygiene. Gastrointestinal infections are common in bacteria, Salmonella, Shigella, E. coli, and parasites such as Giardia and Cryptosporidium. The most common symptoms are: abdominal cramps followed by diarrhea, fever, loss of appetite, nausea, vomiting, weight loss, dehydration, mucus or blood in the stool.

Shingella is a gastrointestinal infection caused by bacteria. Shingella usually transmitted through consumption of infected material, such as water. The bacteria can cause dysentery, which is a disease in which the intestine is inflated. Mucus lining the intestinal wall usually start to decompose and can become apparent in the gut. A person may also develop bleeding ulcers as a result of this infection.

 

The viruses that cause diarrheal diseases, also known as viral gastroenteritis, can pass through a house (or college dorm or anywhere else where many people live together) quickly because they are highly infectious. Luckily, the diarrhea usually goes away by itself within a few days. For teens and healthy adults, viral gastroenteritis is a common problem, but minor. But young children and people with chronic diseases, can lead to dehydration that requires medical attention. Many types of bacteria and parasites can also cause gastrointestinal infections and diarrhea. Most are not serious and disappear after a few days, but others may be very serious.

The incubation period for a gastrointestinal infection can vary depending on the particular germ at the origin. For example, the Shigella incubation period is usually 2-4 days but the period for viral infections ranges from 4-48 hours. Parasitic generally have longer incubation periods, such as Giardia, where the symptoms can take from one to four weeks appears. Then, as the germ and the general health of the person, a diarrheal illness lasting several days or weeks.

Diarrheal infections are very contagious. They can spread from person to person by dirty hands, contaminated food or water and some animals. Most cases are contagious for as long as someone has diarrhea, but some infections can be contagious for longer.

The most effective way to prevent contagious diarrheal infections is to wash your hands frequently. Dirty hands carry germs into your body when you do things like biting your nails or use your hands when you eat. It is important to always wash hands with soap and water after using the toilet and before eating, especially if you know there's a disease going around. Make sure bathroom surfaces are clean can also help prevent infection.

 

 Make sure kitchen counters and cooking utensils are clean, too, especially after they have been in contact with raw meat, eggs and poultry. Avoid eating foods that have been neglected for a few hours, even if it has been reheated, because toxins can survive in food.

If you're traveling or camping, never drink the streams, springs or lakes where the local health authorities have certified the clean water to drink. In some developing countries, you can stick to bottled water and drinks rather than tap water - and watch street vendors to buy food. Pets, especially reptiles, can spread bacteria if not kept separate from the family of European food sectors. Do not clean pet cages or bowls in the sink itself, and the family to prepare meals. And always wash your hands after handling your pet .

 

Most infections, infections that cause diarrhea infections, especially viral, will disappear without treatment. Relax at home and drink plenty of fluids to avoid dehydration are the best ways to overcome the disease. If you become dehydrated, you may need to go to hospital for intravenous (IV) fluids to replace those lost to diarrhea, vomiting and fever. Most infections caused by gastrointestinal viruses and many bacterial infections without treatment, but someone with a weakened immune system that receives a bacterial disease of the bowel may need to be prescribed antibiotics to prevent infection spread throughout the body.

What is peritonitis ?

INTRAABDOMINAL INFECTIONS 

PRIMARY ( SPONTANEOUS ) BACTERIAL PERITONITIS ( PBP ) 

Spontaneous bacterial peritonitis (SBP) is to develop peritonitis (infection of the abdominal cavity), although there is no obvious source of infection.It occurs almost exclusively in cases of portal hypertension of people (more of Increased portal vein pressure ), usually a result of cirrhosis of the liver and liver.It may also occur in nephrotic syndrome patients.

Primary bacterial peritonitis  is seen as the result of a combination of factors associated with cirrhosis and ascites, and prolonged bacteremia secondary to compromised host defenses, maneuvers intrahepatic blood colonized, and the defective bactericidal activity in the ascites fluid. Contrary to previous theories, transmucosal migration of bacteria in the intestine of ascites is no longer considered to play an important role in the etiology of SBP. With regard to the compromised host defenses, patients with chronic liver disease often have severe acute deficiency of the complement and possibly a system malfunction of neutrophils and the reticuloendothelial system.

ETIOLOGIES 

Traditionally, three-quarters of infections were spontaneous bacterial peritonitis caused by gram-negative aerobic organisms (50% of Escherichia coli to be), with one quarter of these infections are caused by aerobic Gram-positive (streptococci 19% .) E. coli is shown in the picture below. However, some data suggest that the percentage of Gram positive infections can aumento.2, 3 One study cited an incidence of 34.2% of streptococci, ranking second after oral streptococci Enterobacteriaceae.3 represented 73.8% of these strains streptococcus. anaerobic organisms are rare due to high oxygen tension of ascites. A body was found in 92% of cases, and 8% of cases are polymicrobial.

SIGN AND SYMPTOMS 

Some Symptoms of fever, chills, nausea, vomiting, abdominal pain and malaise. Patients have complain of abdominal pain and worsening ascites. No sign and symptoms in thirteen percent of patients.Hepatic   encephalopathy  could be the only manifestation of Spontaneous Bacterial Peritonitis in the absence of a trigger for precise encephalopathy, all patients should undergo paracentesis or elimination of ascites fluid to assess the Spontaneous Bacterial Peritonitis.

MORTALITY / MORBIDITY 

The rate of spontaneous bacterial peritonitis mortality ranges from 40-70% in adult patients with cirrhosis and is lower in children with nephrosis. Patients with concomitant renal failure has been demonstrated at a higher risk of mortality of spontaneous bacterial peritonitis than those without concomitant renal insufficiency. due to spontaneous bacterial peritonitis can lower mortality among all subgroups of patients because of advances in diagnosis and treatment.

DIAGNOSIS 

The diagnosis of  Primary Spontaneous Bacterial Peritonitis need paracentesis (fluid aspiration with a needle) from  the cavity of abdomen .  If the fluid contains bacteria or a big amount  of neutrophils (white blood cells), the infection is known, and antibiotics are necessary to avoid complications. In addition to antibiotics, and administered a infusions of albumin.

TREATMENT 

Empirical therapy must be directed against likely causative organisms, such as cocci.Ceftriaxone Gram-negative and Gram-positive or piperacillin / tazobactam is appropriate treatment regimen should be empirically reduced after the etiology is expected to continue for 5-14 days identified.Treatment depending on how quickly the patient's condition improves.

PREVENTION 

Up to 70% of patients relapse within a year.Fluoroquinolones PBP or trimethoprim - sulfametaoxazole. provides an effective method of contraception. However, serious staphylococcal infections resistant to antibiotics or grow over time. 

SECONDARY PERITONITIS 

Secondary peritonitis has several major causes. Bacteria can reach the peritoneum through a hole (perforation) and the digestive tract, which may be caused by a rupture appendix, stomach ulcer or perforated colon. Condition can occur when pancreatic enzymes leak into the peritoneum during pancreatitis or biliary bile loss due to injury, because these chemicals can cause irritation of the peritoneum. Foreign contaminants can also cause secondary peritonitis if they have the abdominal cavity. This can happen if the use of peritoneal dialysis catheters. Inflammation of the abdominal cavity causing bacteria can cause inflammation of the blood (sepsis) and severe disease. Secondary peritonitis can also affect premature babies who have necrotizing enterocolitis.

CLINICAL FEATURES 

Initial symptoms may be localized or vague and depends on the primary organ involved. Once infection has spread to the abdomen, the pain increases, patients LIE still, knees bent often avoid stretching nerve fibers of the abdominal cavity. coughing or sneezing cause serious sharp pain .Voluntary and involuntary marked guarding of anterior abdominal musculature , with often rebound tenderness and fever .

DIAGNOSIS AND TREATMENT 

Studies marked leukocytosis with a left  shift to find the source of peritonitis are the main treatment.  Abdominal taps should be done in cases of abdominal injury to exclude hemoperitoneum. Antibiotic selection for aerobic gram-negative bacilli and anaerobes , for example combinations of penicillin beta-lactamase inhibitors, or in critical condition in intensive care patients, imipenem, or mixed use, such as ampicillin and metronidazole plus ciprofloxacin.Surgical action is often necessary.

PERITONITIS IN PATIENT'S UNDERGOING CHRONIC AMBULATORY PERITONEAL DIALYSIS 

Common causative agents include coagulase negative staphylococci about 30% of cases. Staphylococcus aureus, Gram negative bacilli and fungi such as Candida spp.Several hundered mm dialysis fluid should be centrifuged and sent for culture, blood culture bottles perfectly to improve diagnostic treatment should be directed against the species yield.Empirical  therapy should be given for staphylocaccal and gram negative. If the resistance to methicillin is common, vancomycin may be given and should be allowed to remain in the peritoneal cavity for 6 hours. the critically ill patient should have the same regimen IV.Catheter  removal scheme should be considered if the patient does not improve within 48 hours ....... read more

Peritonitis

Micro-organism enter the sterile abdominal cavity and cause peritonitis if this infection goes untreated patient survives abscesses

INTRAABDOMINAL INFECTIONS 

The intraperitoneal infection, usually due to normal anatomic barrier is broken. This disorder can occur when the appendix, diverticulum, wound or ulcer ruptures, when the intestinal wall is impaired ischemia, tumor or infection (for example, in inflammatory bowel disease ), or adjacent to inflammatory processes, such as pancreatitis or inflammatory pelvic disease in which the enzyme (in the previous case), or bodies (in this case) can leak into the abdominal cavity.


Regardless incitement case, when the inflammation develops and bodies are often contained within the intestines or other body normally sterile peritoneal space, a predictable series of events takes place. intra-abdominal infections occur in two stages: peritonitis and if the patient survives this stage, and Treat an abscess formation. types of micro-organism every phase of infection are responsible for the pathogenesis of the disease.

Most intra-abdominal infections arise from a source in the gastrointestinal tract. They are usually caused by enteric aerobic and anaerobic. The management usually involves an invasive procedure to control the source of infection and antimicrobial therapy against pathogenic microorganisms. In a small number of highly selected patients, these infections can be treated without due process of final source code control.


Antimicrobial therapy is tailored to each patient, with narrow spectrum agents used to treat community infections intra-abdominal and wider spectrum of agents used for nosocomial infections. In general, these infections are associated with significant morbidity and mortality, especially among high-risk patients have impaired host defenses.

PERITONITIS 

Peritonitis Inflammation of the peritoneum, a thin line membrane covering the abdomen and internal organs. The inflammation caused by bacterial or fungal infections in this film. There are two different types of peritonitis. Primary peritonitis due to the spread of infection from blood and lymph to the peritoneum. This type of peritonitis rare - less than 1% of all peritonitis is a priority. The most common type of peritonitis-called secondary peritonitis, caused by infection of the peritoneum should be in the stomach or biliary tract. In both cases of peritonitis are very serious and can be fatal if not treated quickly....... read more

Primary ( Spontaneous )  bacterial peritonitis
Secondary peritonitis

Peritonitis in patients undergoing chronic ambulatory peritoneal dialysis

Abdominal infections

INTRAABDOMINAL INFECTIONS -INTRAPERITONEAL ABSCESSES 

Untreated peritonitis can form abscesses as an extension of the infection process and as an attempt by the host's defenses to contain the infection.Most of the abscesses can originate from colonic sources.Abscesses can occur anywhere in the abdomen and retroperitoneum. They mainly follow the operations, injuries or conditions involving abdominal infection and inflammation, especially when there is a perforation or peritonitis. Symptoms include malaise, fever and abdominal pain. The CT diagnosis. The treatment is drainage, either surgical or percutaneous. Antibiotics are auxiliary.

 

CAUSES 

 

Intra-abdominal abscesses can be  classified as

1. INTRAPERITONEAL 
2. RETRO-PERITONEAL OR VISCERAL 

INTRAABDOMINAL ABSCESSES. Many intra-abdominal abscess developing after perforation of a hollow organ or cancer of the colon. Others develop from the spread of infection or inflammation caused by conditions such as appendicitis, diverticulitis, Crohn's disease, pancreatitis, pelvic inflammatory disease or condition that causes generalized peritonitis. abdominal surgery, particularly those affecting the gastrointestinal tract or bile is another important risk factor: The peritoneum can become contaminated during or after surgery to events such as anastomotic leakage. lacerations and bruises abdominal injuries, especially liver, pancreas, spleen and intestine, abscesses can develop, whether treated or not functioning properly.

Transmitted  infecting organisms generally reflect the normal intestinal flora and a complex mixture of aerobic and anaerobic bacteria. The most common strains of aerobic gram-negative bacilli (e.g. Escherichia coli and Klebsiella) and anaerobic (Bacteroides fragilis in particular). undrained abscess can spread to adjacent structures, damage to the vessels surrounding the passage (due to bleeding or thrombosis), will rupture the peritoneum, or bowel or a skin fistula. sub-diaphragmatic abscess may extend to the thoracic cavity, resulting in empyema, lung abscess or pneumonia. abdominal abscess may track down the thigh or perirectal Fossa. splenic abscess is a rare cause of persistent bacterial endocarditis that persists despite appropriate antimicrobial therapy. 

 

CLINICAL PRESENTATION 

Wide range of presenting complaints , the patients may have general malaise and anorexia or weight loss, other people present in critically ill septic shock with acute abdomen. visceral abscesses do not develop gastrointestinal perforation after local disease (diverticulitis, etc), trauma or surgery, secondary peritonitis subsequently becomes walled by adhesions, inflammatory bowel loops or mesentery omentum abscess and other intra-abdominal abdominal viscera also can develop after primary peritonitis (spontaneous bacterial peritonitis). Sx: fever, pain, nausea, vomiting, anorexia. Physical examination: local pain, perhaps a palpable mass, post-operative evaluation of abscess confused by painkillers and pain in the incision, with more than half is within 10 days of the initial operation. Laboratry: elevated white blood cell count, the yield of direct aspiration of Gram-positive, anti-culture, positive blood cultures ~ 25% depending on the site.

DIAGNOSTIC INVESTIGATIONS 

 

CT SCAN  is more useful. Ultra Sound and Nuclear Magnetic Resonance  (MRI )from time to time ,is not used to guide the drainage. CT or ultrsound guided percutaneous or surgical drainage  to be considered in all cases to confirm the diagnosis, microbiological evaluation, and therapy. Indium gallium is rarely necessary for diagnosis with the advent of these new imaging modalities.

 

TREATMENT 

 

MEDICAL TREATMENT 

 

Antibiotic therapy requires parenteral administration of empirical antibiotics. Start treatment before the abscess drainage, and be careful when all signs of systemic sepsis is resolved. As the abscess fluid generally includes both aerobic and anaerobic organisms early empirical therapy directed against both microbes. This can be achieved by antibiotic treatment or combination therapy with broad spectrum, a management representative. Special treatment, then guided by the results of cultures, retrieved from a boil. Patients who are immunosuppressed, yeast fungi species can be an important pathogenic role, and amphotericin B therapy may be indicated.

 

DRAINAGE 

 

The drainage of pus is mandatory and is the first line of defense against infections gradually. Percutaneous catheter drainage guided by CT became the standard treatment for most intra-abdominal abscesses. It can be difficult to avoid laparotomy, requires anesthesia, eliminates the possibility of wound complications of open surgery, and may reduce the length of hospitalization. It also avoids the possibility of contamination of other areas in the peritoneal cavity. CT-guided drainage of the abscess cavity delimited and can provide secure access for percutaneous drainage. When performed by experienced hands, but also avoids the risk of injury to adjacent organs or blood vessels. 

 

After surgical drainage, clinical improvement should occur in 48-72 hours. The lack of improvement in this period, the second term of the CT review additional abscesses. surgical drainage should be compulsory, if the remaining liquid can be removed with irrigation catheter manipulation, merger or other investments.

 

SURGICAL INTERVENTION 

 

The surgical procedure can also be intended to persist with the content of abscesses, such as hematoma, infection, fungal infection or pancreatic abscesses. Surgical drainage is an option if the skin is dry or fails if the collections are not susceptible to drainage catheter. surgical approach can be either open or laparoscopic drainage (laparotomy) drainage. transperitoneal approach is safer to open a prudent use of preoperative antibiotics. Although contamination of otherwise non-infected sites is an important concern, this complication is particularly reduced if the organizations involved are sensitive to selected drugs. transabdominal examination of the abdomen and allows for full cleaning of fibrin. It also allows full bowel movement to identify and remove all synchronized with the abscesses, which occur in more than 23% of patients.

 

Improved clinical outcomes in three days after treatment indicates drainage. The lack of improvement may indicate inadequate drainage or any other source of infection. If left untreated, inevitably sepsis multiorgan failure. The transabdominal approach open to intra-abdominal abscess can be extremely difficult. Even Matt bowel and adhesions, and loss of anatomic integrity can pose serious problems. This is particularly true when the sensitive organs, like a loop of small intestine, observed intermittent wall abscess or cavity. Therefore, whenever possible, CT-guided drainage is a useful first step.

 

Food poisoning - Cholera - v.cholerae - rota virus infections

Babies in day care have an increased risk of infection by rotavirus ,giardia lamblia and compylobactor

INFECTIOUS  NON - INFLAMMATORY DIARRHEAS 

BACTERIAL FOOD POISONING 

 

Evidence of a common source outbreaks occur frequently. First Staphylococcus aureus enterotoxin produced in food left at room temperature (eg a picnic). The incubation period is 1-6 hours. Disease products within 12 hours, and consist of diarrhea, vomiting and stomach cramps usually without fever. Second Bacillus cereus . (A). emetic form : this is a food poisoning associated with S. aureus contaminated fried rice. (B). Diarrhea as: incubation period of 8-16 hours, diarrhea, cramping, no vomiting. 3rd Clostridium perfringens : spores resistant to heat sufficient in meat, poultry and legumes, incubation 8-14 hours, 24 hours of diarrhea and cramping abdominal disease, without vomiting or fever.

 

CHOLERA 

 

Etiology 

Vibrio cholerae serogroups OI (EI biotypes classical and Tor and O139 ).

 

 

Epidemiology 

Occur in the delta of the Ganges in the Indian subcontinent and South east Asia and sometimes in coastal areas of Texas and Louisiana: the spread of faecal contamination of water and food sources. Infection requires a large consumption of inoculation. toxin to cause disease symptoms. clinical symptoms.

 

Clinical Manifestations 

Incubation period of 24-48 hours following a painless diarrhea and vomiting, which can cause serious and rapid dehydration and death within hours. Rice water turbid liquid stool gray with patches of mucus.

 

Diagnosis .. stool  culture on selective medium  (e.g. TCBS agar). 

 

 

TREATMENT 

Rapid replacement of fluid, electrolytes and base with high sodium levels to correct the loss of Na in the stool or Ringer's lactate in patients with> 10% weight loss.Antibiotics can be used together, doxycycline, ciprofloxacin single dose of 1 g / d or erythromycin three divided doses for 3 days.

 

 

VIBRIO PARAHAEMOLTICUS AND NON - OI ,CHOLERA 

 

These infections are associated with the consumption or contaminated by sea water, badly seafood.After an incubation period of four hours to four days, darrhea aqueous, abdominal cramps, nausea, vomiting and sometimes fever and chills develop.The disease lasts 3-7 days and requires supportive care. Patients with comorbid illness (eg liver disease), sometimes extra-intestinal infections requiring antibiotics 

 

 

NORWALK VIRUS AND RELATED HUMAN CALCIVIRUSES 

 

 

These viruses are common causes of traveler's diarrhea and viral gastroenteritis in patients of all ages and epidemics worldwide, with U.S. higher prevalence in colder climates. Shellfish concentrate the virus by filtration and are at particular risk. Very small Inocults required for infection. Thus, although the fecal-oral route is the main form of transmisson, aerosol, fomites of contact, and person to person contact can cause an infection.

 

Clinical Manifestations 

After incubation period of 24 hours (range 12-72 hours). The patients experience sudden onset of nausea, vomiting, diarrhea or abdominal cramps with constitutional symptoms. the stool is soft, watery, without blood or mucus leukocytes. disease lasts 12 60 hours.

 

Treatment 

Only the necessary support measures. 

 

 

ROTA VIRUS 

 

Rotavirus is the leading cause of severe diarrhea in infants and young children, and is one of several viruses that cause infections, often called stomach flu, but not from the flu. It is a kind of double-stranded RNA virus in the family Reoviridae. At the age of five years, nearly all children worldwide have been infected with rotavirus at least once. But each infection, immunity develops, subsequent infections are less serious, and adults are rarely affected. There are five species of this virus, called A, B, C, D and E. A rotavirus, the most common causes of more than 90% of infections in humans.

Rotavirus is transmitted by fecal-oral contact with contaminated hands, surfaces and objects, and possibly by the respiratory route. The faeces of an infected person can contain more than 10 billion of infectious particles per gram, only 10-100 of them are required to transmit the infection to another person.

 

Clinical Manifestations 

Rotavirus gastroenteritis is a mild to severe illness characterized by vomiting, watery diarrhea and mild fever. When a child is infected with the virus has an incubation period of about two days before the onset of symptoms. Symptoms often start with vomiting, followed by four to eight days of severe diarrhea. Dehydration is more common than rotavirus infection in most of those caused by pathogenic bacteria, and is the most common cause of deaths related to rotavirus infection.

 

Diagnosis 

Enzymes immunoassays (EIAs ) or viral RNA detection  ,like PCR can identify this virus in sample of stool . 

 

Treatments 

Only necessary treatment is required .Antimotility agents should be avoided .

 

Prevention 

For prevention ,vaccine was withdrawn shortly after approval by the U.S . Drug and Food intake because it was causally linked to intussusception .