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 .

 

Diarrhea causes

Diarrhea in the 14 days called persistent diarrhea

INFECTIOUS  NON - INFLAMMATORY DIARRHEAS 

Diarrhea is a deviation from normal intestinal movements are characterized by increased stool frequency or liquidity, or both, often accompanied by an abnormal increase in stool weight per day (200 grams / day). It is classified as acute if the onset occurred within 14 days. Diarrhea in the 14 days called persistent, and beyond 30 days, is considered chronic. Diarrhea can be  recurrent diarrhea, infectious and noninfectious diarrhea, inflammatory diarrhea, which causes inflammation of the colon and diarrhea that are not lit noninflamatory colon.

There are different clinical settings where patients are more at risk than the general population of developing diarrhea. Babies in day care have an increased risk of infection by rotavirus, Giardia lamblia, and Campylobacter. Although HIV / AIDS patients may have atypical infections are most often infected with pathogens such as Escherichia coli usual. Cryptosporidiosis, Isospora belli, herpes simplex, Chlamydia trachomatis, Clostridium difficile, Shigella and other types of infection causes diarrhea in AIDS patients. Travelers are at risk from the bacterium E. enterotoxigenic E. coli, Rotavirus, Salmonella and Shigella.

Inflammatory diarrhea is suspected when patients present with acute diarrhea accompanied by bloody stools, fever, tenesmus, or abdominal pain. If the inflammation is in the colon, the stool is frequent and small in volume, whereas diarrhea due to small bowel inflammation is usually high in volume. In either case, stool leukocytosis is present, with more leukocytes the more distal the inflammation, as a rule. Infectious causes of inflammatory diarrhea include Salmonella, Shigella, Campylobacter, enterohemorrhagic E. coli, enteroinvasive E. coli, C. difficile, Entamoeba histolytica, and Yersinia. When inflammatory diarrhea is recurrent, noninfectious etiology should be suspected, such as Crohn's disease, ulcerative colitis, and radiation or ischemic colitis.

inflammatory diarrhea characterized by watery stools that may exceed 1 liter in volume, without symptoms suggestive of inflammation. It is caused by bacteria such as Vibrio cholerae, E coli and Staphylococcus food poisoning and Clostridium, viruses such as rotavirus and Norwalk virus and protozoa such as Cryptosporidium and Giardia. enterotoxins Many of these organizations and the development of interfering with the mechanism of absorption or secretion of diarrhea in the intestine, causing.

TRAVELER'S DIARRHEA 

People traveling in Asia, Africa and South and Central America 20 to 50% experience sudden onset of stomach cramps, loss of appetite and diarrhea. The disease usually begins within 3-5 days of arrival, containated associated with eating food or water, it takes 1-5 days, mostly due to enterotoxigenic Escherichia coli, subsalicylates bismuth can be used preventively. Liquefaction is usually adequate treatment, but if desired, 1-3 days during the fluoroquinolones can reduce the duration of illness is 24-36 hours. Antimotility agents can control diarrhea.

Giardiasis

INFECTIOUS NON - INFLAMMATORY DIARRHEAS

GIARDIASIS
Giardiasis, a disease that affects the gastrointestinal tract, is caused by a microscopic parasite called Giardia lamblia. The parasite attaches to the mucosa of the small intestine in humans, which sabotages the body absorb fats and carbohydrates in food digestion. Giardia is a major cause of diarrhea in the United States, and is transmitted by contaminated water. It can survive the normal amount of chlorine used to purify the water supply of the Community, and can live more than two months in cold water. As little as 10 microscopic parasites in a glass of water can cause a severe case of giardiasis in a human being who drinks it.

Travellers are the largest group at risk of giardiasis infection, especially those traveling to developing countries. Giardiasis is common among hikers and campers, people who swim in public pools, children attending day care, and gay men. Others are high-risk close contacts of infected people and those with contact with infected animals.

INCUBATION PERIOD

Symptoms usually begin 1-2 weeks (an average of seven days) after a person is infected. In healthy people, symptoms can last from 2-6 weeks. Although symptoms may last longer, medications can help reduce the duration of symptoms.

TRANSMISSION

Giardiasis is caused by ingestion of infected cysts. There are several modes of communication including bilateral disease, water and sexually transmitted diseases. Bilateral transfer of the majority of infections with Giardia and is generally associated with poor hygiene and sanitation. transmission of water is common in the United States Giardia outbreaks, often associated with ingestion of unfiltered water (polluted). Sex of disease transmission occurs through fecal-oral contamination. Moreover, changing diapers, and hand washing is a low risk factors for transmission of infected children. Finally, Giardia outbreaks of epidemics has been developed for food contamination by infected food handlers.

CLINICAL MANIFESTATIONS

It is estimated that between 1% and 20% of the U.S. population has giardiasis, and this figure could be 20% or more in developing countries where giardiasis is a major cause of infantile diarrhea epidemic. But more than two-thirds of those infected may have no signs or symptoms of the disease, although the living parasite in their intestines. When the parasite causes symptoms, the illness usually begins with severe watery diarrhea without blood or mucus. Giardiasis affects the body's ability to absorb fat from the diet, so the diarrhea contains unabsorbed fats. This means that the diarrhea floats, is shiny and smells terrible.

DIAGNOSIS

It can diagnosed by parasite antigen detection in stool and /or multiple freshly collected samples of stool ,use to identify cyst by concentration methods ( oval with four nuclei ) or trophozoites ( pear shaped ,flattened parasites with two nuclei and four pairs of flagella ).

TREATMENT

Giardiasis is the most common treatment of metronidazole (Flagyl) is 5-10 days. Giardia does not suffocate with over 85% of the time, but often cause gastrointestinal side effects such as nausea, metallic taste and dizziness and headache. Although its efficacy, metronidazole is not FDA approved for the treatment of giardiasis United States. Only approved drug for the treatment of giardiasis in the United States and furazolidone (Furoxone) is 7-10 days. And broadly as effective as metronidazole. Tinidazole is available outside the U.S. is highly effective in treating Giardiasis (90%). It can also be administered as a single dose and is well tolerated. Quinacrina is a highly effective treatment for giardiasis, but is no longer available in U.S. paromomycin and albendazole are equally effective than other treatments.

Sometimes the treatment fail to eliminate Giardia. In this case, drugs may be altered or longer or higher dose may be used. Combination therapy may also be effective (e.g, quinacrina and metronidazole).

Treatment for diarrhea

TREATMENT

The main objective of acute diarrhea have been assured that patients are adequately hydrated, because a significant amount of fluid can be lost. This fluid loss is the principal mechanism of dying from acute diarrhea in patients. When you have moderate or severe diarrhea, this is often achieved with a saline solution or another suitable solution, which is given the IV line. mild diarrhea, it is often reasonable to reassure patients, to ensure adequate fluid intake, and wait. Children in developing countries, the World Health Organization recommends a solution of zinc supplementation and oral re-hydration to treat diarrhea.

RE-HYDRATION

In most cases, acute diarrhea, fluids and electrolytes are the main treatments. If the patient is otherwise healthy and not dry, adequate oral intake can be achieved by soft drinks, fruit juices, broth, soups and salted crackers. These excessive fluid loss and dehydration, more aggressive, such as IV fluids or oral re-hydration therapy with isotonic electrolyte solutions containing glucose or starch should be initiated. Oral re-hydration therapy is less expensive and often less effective and more convenient than intravenous fluids. Different oral re-hydration solutions are available Pedialyte, Re-hydralyte, Ricelyte (Infalyte), Resolute, World Health Organization formula, and then reduced osmolarity formula for children.

A mixture can we made in  home just as effective as same , salt half tea spoon (3.5 g) ,1 tsp baking powder (2.5 g NaHCO3), 8 tsp sugar (40 g) and 8 oz orange juice (1.5 g KCl), diluted to 1 L with water. Fluids should be given at rates of 50-200 ml/kg/24 h, depending on the state of hydration. IV fluids (e.g. Ringer's lactate solution) is preferred for patients with severe acute dehydration and for those who can not tolerate oral fluids.

DIET

Total food abstinence is unnecessary and not recommended. Foods provide calories needed to facilitate the renewal of the enterocytes. Patients should be encouraged to take frequent feedings of fruit drinks, tea, flat carbonated beverages, and soft, easily digestible foods such as bananas, apples, rice, potatoes, pasta, biscuits, toast, and soup. Dairy products should be avoided because transient lactase deficiency can cause gastrointestinal, viral and bacterial infections. beverages containing caffeine and alcohol, which can increase bowel movement, and fluids should be avoided.

MEDICATIONS  

Parasites (worms and amoeba) should always be treated as medicine.

Loperamide may reduce diarrhea in patients with Shigella , but not in patients with diarrhea due to E. enterotoxigenic E. coli traveler. A systematic review of randomized controlled trials have shown that loperamide may affect children under three years. A randomized controlled trial showed that racecadotril, an enkephalinase inhibitor, can reduce the amount of watery diarrhea. Norfloxacin may reduce the duration of acute diarrhea caused by bacterial pathogens. However, norfloxacin prolong infectivity in patients with resistant Salmonella and Campylobacter cause.

COMPLICATIONS

Dehydration and electrolyte imbalance (abnormal amounts of sodium, potassium, acid in the blood)
Weight loss.
Seizures ........read more