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acute diarrhoeal diseases

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acute diarrhoeal diseases

  1. 1. ACUTE DIARRHOEAL DISEASES Dr. Vishwajeet M. Chavan Asst. Professor SPM vishwajeetdada@gmail.com
  2. 2. Diarrhoea Abnormal increase in- stool liquidity stool frequency stool quantity Under nutrition , recent measles (in case of under 5yrs) are associated with increased incidence, severity or duration of diarrhoea.
  3. 3. Risk factors • Bottle fed babies have more chances to develop diarrhoea because of unclean bottles • Houseflies bring germs to uncovered food • Drinking contaminated water/ food • Through milk, unclean hands & unclean utensils
  4. 4. Acute diarrhoea • Caused due to infections by a wide variety of micro - organisms such as bacteria, viruses, protozoa & helminthes or due to toxins produced by them, is an inflammation of G.I. tract. • Both the stomach & small intestine are involved. • Characterized by the presence of vomiting & diarrhoea, the latter being prominent in cases of bacterial origin.
  5. 5. Epidemiology ( A.G.E.) • Magnitude of the problem Acute gastroenteritis is a major cause of morbidity and mortality, especially in children under 5 yrs of age. • World wide more than a billion cases of gastroenteritis, majority being from developing world, are reported every year. • In India incidence rate ranges from 1 to 3 episodes per child per year.
  6. 6. • In slum areas of major cities incidence found is 7 episodes/child/year • National Family Health Survey-4 (2015-16) showed that 9% children under 5yrs of age suffered from diarrhoea in preceding 2wks
  7. 7. Depending on the presence of blood in stool, these agents are classified as- (A) Causes of acute gastroenteritis without blood in stool () Viruses : Rotavirus, Astrovirus, Norwalk group of virus, Enteric adenovirus, Hepatitis A () Bacteria : Shigella, Salmonella infection, Enterotoxigenic E. coli (ETEC), Enteropathogenic E. coli (EPEC), Enteroaggregative E. coli (EAVC), Staph aureus, V. Cholera, Clostridium perfringens, C. difficile, Bacillus cereus and B. subtilis
  8. 8. (iii) Protozoa : Giardiasis, Cryptosporidiosis, Cyclospora cayetenesis (iv) Helminths : Strongyloidiasis
  9. 9. (B) Causes of acute gastroenteritis with blood in stool () Bacteria : Shigella, Enterohaemorrhagic E.coli, Campylobacter jejuni, Yersinia entercolitis () Protozoa : Entamoeba histolytica, Balantidium coli enterocolitis () Helminths : Massive trichuris infection, Schistosoma mansoni, S. japonicum Reservoir and source of infection : Man is the principal reservoir of the infections.
  10. 10. Agent factors • Contaminated food or water serves as the principal source of infection. • The causative agents are significantly different from each other as far as the mode of transmission and virulence is concerned. • Vibrio and S. typhi are spread by water, others like Staph. aureus and C. perfringens are spread by food.
  11. 11. • Some like salmonella non - typhi, which multiply in food & V. cholerae have the potential of causing outbreaks. • C. jejuni and E. histolytica produce sporadic diseases. Patients with acute amoebic dysentery pose only limited danger as it’s fragile nature. • Asymptomatic or mild cases excreting cystic forms of E. histolytica on the other hand are important reservoir of infection.
  12. 12. Host factors : • Man has no natural immunity against these organisms. Both sexes are equally susceptible. • Children and the old-aged suffer more. • Transient immunity develops against the specific strain of some of the organisms like Shigella. • Host differences such as race and age have been described as affect susceptibility of individuals to infection
  13. 13. • Intestinal motility plays an important role in providing protection against the infection. • Increased gut motility associated with diarrhoea is a highly effective defense mechanism. • Incidence is highest at the time of weaning i.e. between 6 - 11 months
  14. 14. Environmental factors : • Non - availability, inadequacy or lack of access to clean drinking water. • Inadequate disposal of fecal waste and poor hygiene and sanitation increases the likelihood of these diseases. Travelers travelling from developed countries to developing countries usually contract disease agents
  15. 15. • Diarrhoeal diseases follow a distinct seasonal pattern. • Rotavirus diarrhoea tends to occur throughout the year, increasing in frequency during the drier, cool months, whereas bacterial diarrhoeas tend to peak during the warmer, rainy season.
  16. 16. Mode of Transmission : • Infection by all organisms is by ingestion of contaminated food or drink i.e. fecal- oral route. • Individuals primarily responsible for transmission are those with poor personal hygiene & those who fail to cleanse contaminated hands and carry organisms under their fingernails after defecation.
  17. 17. • Contaminated water is believed to play a major role in the transmission of amoebiasis. • Amoebic cysts are not killed by chlorine in amounts normally added for water disinfection. • Water can be rendered free from amoeba-cyst only by sand filtration.
  18. 18. • Milk & food are contaminated by infected water or by the hands of a carriers or case. • Cockroaches also can act as vehicles for contamination of crockery, cutlery, kitchen utensils. • Dust containing cysts in case of Entamoeba histolytica also responsible for transmision of agent • Vegetables from fields irrigated with polluted water or especially those cultivated with raw sewage as practiced in improper sewage farming are liable to carry infection.
  19. 19. Incubation period and Period of communicability : Several hours as in case of bacillary dysentery to (2 to 4 weeks), but can be prolonged to several months, as in case of amoebic dysentery. Diarrhoea and bacillary dysentery cases are most infective during the clinical illness. A case of amoebic dysentery is infective mostly during the non - clinical period between the remissions of clinical attack, because it is the cystic stage of amoeba which is infective.
  20. 20. Clinical Features • Diarrhoea, vomiting occasionally both. • The frequency and consistency of the stool depends on the causative organism. • Conventionally diarrhoea is the passage of 3 or more loose or liquid stools per day, or more frequently than is normal for the individual. Acute diarrhoea is an attack of sudden onset which usually lasts for 3 – 7 days
  21. 21. • Most cases of infectious diarrhoea are acute. • Usually acute gastroenteritis is not associated with constitutional symptoms • But abdominal cramps may be present in some cases especially with dysentery. • Fever may be occasionally present especially in salmonella and shigella infections. • In some cases, due to excessive loss of fluid, features of dehydration like thirst, restlessness or irritable behavior, dry mucosa, decreased skin turgor and sunken eyes, may be present.
  22. 22. • Rotavirus infection occurs worldwide & it is estimated to cause 20% of childhood(under 5yrs of age) deaths. • Children less than 3 years of age are most commonly infected. • Vomiting is an early feature and fever is common. • Diarrhoea is usually watery and large in volume. • Colicky abdominal pain, ill defined tenderness and exaggerated bowel sounds are common
  23. 23. Prevention • Immunization • Better MCH practices- Maternal nutrition Child nutrtion – Breast feeding promotion – Appropriate weaning practices – Supplementary feeding – Vit. A supplementation
  24. 24. Two live, oral, attenuated rotavirus vaccines licensed in India since 2006 for prevention of Rotavirus infection… 1. Rotarix: 2 oral doses (1st-6wks 2nd -12wks) 2. Rota Teq: 3 oral doses at ages 2, 4 & 6 months
  25. 25. 20 mg per day of Zn supplementation for 14 days starting as early as possible after onset 10 mg per day for infants 2-6 months WHO/UNICEF Joint statement (2001), IAP 2003, GOI 2007 Recommendations for use of zinc in clinical management of acute diarrhoea :
  26. 26. Outbreak prevention (a) Isolation : This will break the chain of transmission. (b) Rehydration : All cases must be given reduced osmolarityORS liberally. (c) Breastfeeding : Because of its protective qualities, breastfeeding must be continued for sick children. (d) Safe drinking water : Water supplies should be adequately chlorinated. (e) Food safety : Food hygiene should be made stricter. Adequate storage facility for storage of food (both cooked and uncooked)and adequate water for cleaning and cooking must be provided.All crockery and cutlery must be adequately cleaned before use.Milk should be boiled before consumption.
  27. 27. WHO Safety guidelines for food • Cook raw food thoroughly • Eat cooked food immediately • Prepare food for only one meal • Avoid contact between raw food & cooked food • Choose food processed for safety • Wash hands repeatedly • keep food preparation premises meticulously clean • Use safe water • Be cautious with food purchased outside • Breast-feed infants & babies

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