Acute diarrhoeal diseases for mail

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Acute diarrhoeal diseases for mail

  1. 1. ACUTE DIARRHOEAL DISEASES Dr. Indrajeet Kumar Department of Community Medicine M.G.M Medical College, Jamshedpur.
  2. 2. MAJOR CAUSES OF IMR (Infant Mortality Rate) Diarrhoea ARI (acute respiratory infection) Malaria Measles Malnutrition.
  3. 3. 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.
  4. 4. 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.
  5. 5. 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)
  6. 6. 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.
  7. 7. 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.
  8. 8. INCUBATION PERIOD : 10 – 14days MODE OF TRANSMISSION: faeco - oral urino - oral
  9. 9. 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”
  10. 10. 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.
  11. 11. 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:
  12. 12. Transmission level a. PERSONAL HYGIENE: b. ENVIRONMENTAL SANITATION: :- water sanitation :- food sanitation. :- excreta disposal.
  13. 13. 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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