Acute Infectious Diarrhea

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Lecture By Dr.Satti Moh'd Saleh …

Lecture By Dr.Satti Moh'd Saleh
Medical Director

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  • 1. ACUTE INFECTIOUS DIARRHEA :BY DR.SATTI MOH’D SALEH INFECTIOUS DISEASE  PHYSICIAN MEDICAL DIRECTOR  MEEQAT GENERAL HOSPITAL  CBAHI INFECTION CONTROL 
  • 2. MECHANISM OF DISEASE OSMOTIC LOAD. 1 INTESTINAL SECRETION. 2 MECHANISM OF DISEASE1. DISEASE INTESTINAL MALABSORPTION. 3 OSMOTIC LOAD 2. INTESTINAL SECRETION MOTILITY.4 ALTERED INTESTINAL 3. INTESTINAL MALABSORPTION 4.ALTERED INTESTINAL MOTILITY
  • 3. OSMOTIC DIARRHEANON ABSOBABLE SUBSTANCE (.(PURGATIVE(MAL ABSORTION (GLUCOSE SPECIFIC MALABSORTION DEFECT (.(DISACHARIDASE
  • 4. SECRETORY DIARRHEAENTEROTOXIN (HORMONES (VIP (BILE SALTS (ILEAL VESECTION (FATTY ACIDS (ILEAL VESECTION (LAXATIVES (DSS 
  • 5. INFLAMATORY DIARRHEA
  • 6. ABNORMAL MOTILITY DM,VAGOTOMY,HYPERTHYROIDISM  MOTILITYALTEREDDM,VAGOTOMY,HYPERTHYROIDISM
  • 7. ACUTE INFECTIOUSDIARRHEA:DEFINITIONAlteration 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 enzymesInvasive pathogens - - infalm, Int. secretion altered-.motility
  • 8. HOST DEFENSE Host defenses1- Gastric Acidity Gastric Acidity- 1 2- Bowel Motility Bowel Motility- 2 3- Colonic Flora Colonic Flora- 3 4- Local anti-body Local anti-body- 4 
  • 9. CAUSES CAUSES OF ACUTE INFECTIOUS DIARRHEAWATERY DIARRHEA WATERY DIARRHEA-B. CEREUS B. CEREUS -- STAPHYLOCOCCUS STAPHYLOCOCCUS -- VIBRIO VIBRIO -- ETEC ETEC -- EPEC -- SALMONELLA SPP. EPEC- CAMPYLOBACTER .SALMONELLA SPP - CAMPYLOBACTER- CLOSTRIDIUM PERFRINGENS - CLOSTRIDIUM PERFRINGENS- CLOSTRIDIUM DEFFICILE - CLOSTRIDIUM DEFFICILE -
  • 10. DYSENTERYSHIGELLA -SALMONELLA -CAMPYLOBACTER -EIEC -EHEC -.YERSENIA ENT -VIBRIO PARAHAEMOLYTICUS -CLOSTRIDIUM DEFICILE -
  • 11. Selected notifiable diseases by region Jul - Sept 2011Madina KSA
  • 12. SYMTOMS & SIGNSTOXIGENIC INFLAMMATORY VIRALNo systemic upset Systemic upsetAbdminal Systemic upsetSmall number pain, tenesmus, fever . URTILarge volume Stool Fever nauseaStool no RBCs no Large number Frequent Myalgialeukocytes. Small volume blood -stain Stool mucus, pus cells Voluminous, watery Mechanism Mechanism Invasion of enterocytes Osmatic or secretory leading to mucosal cell death and inflammatory response
  • 13. APROACH TOwith diarrhea Approach to pt PATIENTS ( entrotoxin ( a febrile- 1  potentially invading( Fever + blood or – 2  ( dysentery completely invading ( fever + bactreamia- 3  Diarrhea with GI bleeding- 4  Investigation Rectal swab, stool general , Stool c/s , toxin- assay ,elisa, PCR
  • 14. entrotoxin ( a febrile ) - 12 – potentiallyinvading( Fever + blood ordysentery )3- completely invading ( fever+ bactreamia4- Diarrhea with GI bleedingInvestigation- Rectal swab, stool general ,Stool c/s , toxin assay ,elisa, PCR
  • 15. DIARRHEA CLINICSPRIMARY CARE CENTER-SEASONAL CENTER-HOSPITALS-EACH CLINIC-DoctorNurseHealth supervisorNecessary requirementsSupervision -Regional Infection control Committee + Preventive -.Medicine Dept
  • 16. OUT PATIENT MANAGEMENT FOR MILD DIARRHEA SAUDI - RESIDENTS - HAJI WITH PROPER EASILY TRACED - ADDRESS
  • 17. HOSPITALMANAGEMENTSevere Cases 1.Positive Cases 2.Vibrio -Others -Suspected Cases. 3with no proper address
  • 18. HAJ NON HAJ:Name SURVEY SHEET OF HOSPITALIZED INFECTIOUS DIARRHEA CASES IN .MEDINA MUNAWARAH DURING HAJ:Age Years Sex: M/F Nationality:History ofFever Nausea VomitingTenesmus Headache Colic( Mayalgia Other (specify:StoolsFrequent >6/day Volume Large Actual amount >1/2 literday small >1/2 liter/6 <Blood Mucus Consistency FormedSemi formedWatery(Other( specifyContacts: One person involvedGroup with common food source:Examination.Temp. Pulse BP RespDehydration Mild Level of consciousness DrowsyModerate SemiconsciousSevere Comatosed
  • 19. :Laboratory TestsBlood CBC Hb PCVRBSUREACREATININEELECTROLYTESSTOOL GENERAL BLOODMUCUSWBCOVA / CYST AMOEBA / GIARDIA(OTHER( SPECIFYCULTURE RECTAL SWAB STOOL CULTURE BLOOD CULTUREROTA VIRUS Norwalk AGENT: MANAGEMENT & COMMENTS
  • 20. ANNUAL REPORT OF 2011 Jul septTYPHOID AND PARATHYROID = 57.K.S.A 2011SALMONELLA = 390CASESHIGELLA =7.‫ة‬ )CHOLERA = 0
  • 21. TREATMENT OF MOST COMMON.GASTROINTESTINAL PATHOGENSS. aureus Hydration Self limitedB. cereus Hydration Self limitedC. perfringeus Hydration Self limitedV.cholrae Tetrcycline’s Ampicilin & TMP-SMXSo effectiveSalmonella TMP-SMX AmpicilinShigella TMP-SMX Quinolon,Yersinia TMP-SMX Tetracyclines.minoglycosides in severe casesCampylobacter Erythromycin QuinolonesE. coli Hydration Self limitingv. parahaemolyticus Tetracyclines TMP-SMXRotavirus Hydration No specific treatmentNorwalk virus Hydration No specific treatmentTNIDAZOLE Me tronidazole G. lambiaE. histolytica Me tronidazole
  • 22. ‫حال ت الهسهال منطقة المدينة المنورة‬‫1341 --- 2341 حتى شعبان‬
  • 23. ‫حال ت الهسهال منطقة المدينة‬‫المنورة‬‫2341 حتى شعبان‬ ‫6747‬ ‫312‬
  • 24. MANAGEMENT MANAGEMENT OF INFECTIOUS DIARRHEA1. REHYDRATION REHYDRATION 1. ORS ORS IV IV FLUIDS FLUIDS SHOCK SHOCK SEVERE VOMITING SEVERE VOMITING DEPRESSED MENTAL STATE DEPRESSED MENTAL2. INDICATIONS FOR ANTIMICROBIALS STATE a( Parasitic infections E. histililytica INDICATIONS FOR ANTIMICROBIALS. 2 a) Parasitic infections G. lambia E. histililytica Other parasitic infection G. lambia b(. V.cholerae Cases Other parasitic infection Carriers b). V.cholerae Cases discharge after 3 consecutive negative post treatment samples c(. Carriers Salmonella Infants discharge after 3 consecutive negative post treatment samples c). Salmonella Infants
  • 25. PREVENTION.PROVISION OF SAFE WATER. 1 1..PERSONAL HYGIENE. 2 2..AVOID UNDERCOOKED FOOD. 3 3..HEALTH INSPECTION. 4 4..HEALTH EDUCATION. 5 5..ISOLATION & TREATMENT OF CARRIERS. 6 6..SCREENING OF FOOD HANDLERS. 7 7.
  • 26. Thank you 