Bacterial diarrhea remains a major global health problem and common reason for patients seeking medical care. While strategies can improve diagnostic ability, such as increasing stool culture yield and new rapid tests, emerging antimicrobial resistance among common bacterial causes has challenged treatment. Recent studies showing favorable results for rifaximin, a nonabsorbed antibiotic, provide a potential solution as resistance grows to traditionally used antibiotics. However, prudent antibiotic use remains important to slow further development of resistance.
Kawasaki disease is a childhood vasculitis that causes inflammation of blood vessels. It is the leading cause of acquired heart disease in children in the US and Japan. The disease is characterized by prolonged fever and changes in the mouth, hands, and feet. Untreated, approximately 20% of patients develop coronary artery abnormalities like aneurysms which can lead to thrombosis, heart attack, or sudden death. While the cause is unknown, evidence supports an infectious origin. Proper diagnosis is based on symptoms, and treatment seeks to prevent cardiac complications through administration of intravenous immunoglobulin and aspirin.
This document provides an overview of the 2009 H1N1 influenza pandemic from an Indian perspective. It discusses the challenges faced in recognizing and confirming cases of the disease. It also outlines treatment recommendations, including the use of antiviral drugs like Tamiflu and supportive care. Complications tend to be more severe in younger people, possibly due to a 'cytokine storm' immune response, and include pneumonia and acute respiratory distress syndrome.
This document provides guidance for cytopathology laboratories handling samples from patients with suspected or confirmed COVID-19. It outlines precautions to take during procedures like fine needle aspiration, sample processing, disposal, and spill management. Proper personal protective equipment and disinfection protocols are emphasized. Reporting and staff training procedures are adapted to minimize risk of virus transmission.
This document provides information on COVID-19. It describes COVID-19 as an infectious disease caused by SARS-CoV-2. The first cases were seen in Wuhan, China in December 2019. Most people experience mild to moderate symptoms, but older people and those with pre-existing medical conditions are more likely to develop serious illness. Diagnosis is made through PCR testing of respiratory samples. Common CT findings include ground glass opacities and consolidation.
COVID-19 (coronavirus disease 2019) is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), previously known as 2019 novel coronavirus (2019-nCoV), a strain of coronavirus. The first cases were seen in Wuhan, China in December 2019 before spreading globally. The current outbreak was recognized as a pandemic on 11 March 2020.
The non-specific imaging findings are most commonly of atypical or organizing pneumonia, often with a bilateral, peripheral, and basal predominant distribution. No effective treatment or vaccine exists currently (March 2020).
Coronaviruses & COVID 19 - Its Morphology, Role, Mechanism of Action, and Tre...Haider Ali Malik
This document discusses COVID-19 and coronaviruses. It defines COVID-19 as a novel coronavirus first identified in Wuhan, China in late 2019. Coronaviruses are a large family of viruses that can cause illnesses ranging from the common cold to more severe diseases like MERS and SARS. The document then provides details on the structure, replication, and transmission of coronaviruses, symptoms of COVID-19, the ongoing global pandemic, and the discovery and identification of SARS-CoV-2 under electron microscopy.
The document discusses coronaviruses and COVID-19. It notes that coronaviruses can infect humans and cause diseases like the common cold, SARS, and MERS. COVID-19 is caused by a new coronavirus called SARS-CoV-2 that was first detected in Wuhan, China in December 2019 and causes respiratory illness. Symptoms range from mild to severe pneumonia and death. While there is no vaccine yet, prevention focuses on hand washing, social distancing, and isolation of sick individuals.
Kawasaki disease is a childhood vasculitis that causes inflammation of blood vessels. It is the leading cause of acquired heart disease in children in the US and Japan. The disease is characterized by prolonged fever and changes in the mouth, hands, and feet. Untreated, approximately 20% of patients develop coronary artery abnormalities like aneurysms which can lead to thrombosis, heart attack, or sudden death. While the cause is unknown, evidence supports an infectious origin. Proper diagnosis is based on symptoms, and treatment seeks to prevent cardiac complications through administration of intravenous immunoglobulin and aspirin.
This document provides an overview of the 2009 H1N1 influenza pandemic from an Indian perspective. It discusses the challenges faced in recognizing and confirming cases of the disease. It also outlines treatment recommendations, including the use of antiviral drugs like Tamiflu and supportive care. Complications tend to be more severe in younger people, possibly due to a 'cytokine storm' immune response, and include pneumonia and acute respiratory distress syndrome.
This document provides guidance for cytopathology laboratories handling samples from patients with suspected or confirmed COVID-19. It outlines precautions to take during procedures like fine needle aspiration, sample processing, disposal, and spill management. Proper personal protective equipment and disinfection protocols are emphasized. Reporting and staff training procedures are adapted to minimize risk of virus transmission.
This document provides information on COVID-19. It describes COVID-19 as an infectious disease caused by SARS-CoV-2. The first cases were seen in Wuhan, China in December 2019. Most people experience mild to moderate symptoms, but older people and those with pre-existing medical conditions are more likely to develop serious illness. Diagnosis is made through PCR testing of respiratory samples. Common CT findings include ground glass opacities and consolidation.
COVID-19 (coronavirus disease 2019) is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), previously known as 2019 novel coronavirus (2019-nCoV), a strain of coronavirus. The first cases were seen in Wuhan, China in December 2019 before spreading globally. The current outbreak was recognized as a pandemic on 11 March 2020.
The non-specific imaging findings are most commonly of atypical or organizing pneumonia, often with a bilateral, peripheral, and basal predominant distribution. No effective treatment or vaccine exists currently (March 2020).
Coronaviruses & COVID 19 - Its Morphology, Role, Mechanism of Action, and Tre...Haider Ali Malik
This document discusses COVID-19 and coronaviruses. It defines COVID-19 as a novel coronavirus first identified in Wuhan, China in late 2019. Coronaviruses are a large family of viruses that can cause illnesses ranging from the common cold to more severe diseases like MERS and SARS. The document then provides details on the structure, replication, and transmission of coronaviruses, symptoms of COVID-19, the ongoing global pandemic, and the discovery and identification of SARS-CoV-2 under electron microscopy.
The document discusses coronaviruses and COVID-19. It notes that coronaviruses can infect humans and cause diseases like the common cold, SARS, and MERS. COVID-19 is caused by a new coronavirus called SARS-CoV-2 that was first detected in Wuhan, China in December 2019 and causes respiratory illness. Symptoms range from mild to severe pneumonia and death. While there is no vaccine yet, prevention focuses on hand washing, social distancing, and isolation of sick individuals.
The document discusses coronavirus disease (COVID-19) including its definition, transmission, clinical presentation, course, and diagnostic testing recommendations. It defines healthcare personnel and notes COVID-19 is a new coronavirus strain discovered in 2019 that is zoonotic, mainly spread through respiratory droplets. Symptoms can range from mild to severe and include fever, cough and shortness of breath. Older patients and those with chronic conditions are at higher risk. Diagnostic testing is recommended for suspected cases using molecular tests on respiratory specimens.
This document provides an overview of COVID-19, including its aetiology, epidemiology, clinical features, diagnosis, management, and prevention. It describes how COVID-19 is caused by a novel coronavirus, SARS-CoV-2, which likely originated in animals. It summarizes the symptoms of COVID-19 and outlines recommendations for preventing and treating both mild and severe cases. The document also discusses differential diagnoses and provides references for further information.
This is a presentation for all the people who are unaware about COVID-19.
COVID-19 = Corona Virus Disease 2019. Please like and share my presentation.
Presentation by:-
C. S. Nelson
VI - E
D.A.V Boys Senior Secondary School.
D.A.V Group of School.
Covid Pathophysiology and clinical featuresNaveen Kumar
The document summarizes the pathophysiology of COVID-19. It discusses that SARS-CoV-2 enters cells through the ACE2 receptor and causes a cytokine storm. This can lead to organ damage and failure. Symptoms range from mild to severe and include fever, cough and shortness of breath. Those at highest risk are the elderly, immunocompromised, and those with pre-existing conditions like heart or lung disease. The clinical severity is classified as mild, moderate or severe based on symptoms and oxygen levels.
The document discusses the 2009 H1N1 influenza pandemic. It provides details on the virus, symptoms, transmission, management and treatment recommendations, and control measures. As of December 2009, over 9,500 deaths had been reported worldwide from the H1N1 virus. While the overall global mortality rate was approximately 1%, continued virus transmission was observed across many regions. Vaccines and antiviral medications such as oseltamivir were the primary interventions recommended for treatment and prevention.
The document summarizes the findings of a pathology presentation on COVID-19 pulmonary pathology. It describes the histopathological examination of lung tissue from 38 COVID-19 patient deaths in Italy which found evidence of diffuse alveolar damage, hyaline membrane formation, thrombi in small arteries, and type II pneumocyte hyperplasia. It also discusses the similarities to findings from SARS, MERS, and influenza, including epithelial infection, microvascular damage, and organizing pneumonia that can progress to pulmonary fibrosis.
The document summarizes the key details regarding the emergence and spread of the 2019 novel coronavirus (2019-nCoV) in Wuhan, China. It describes the initial cases reported in December 2019 among people exposed to a seafood market, the subsequent closure of the market and isolation of suspected patients. It also outlines the diagnostic testing and identification of 2019-nCoV, clinical characteristics and treatment of patients, as well as outcomes. Limitations of the initial data and knowledge gaps are also discussed.
This document describes the clinical presentation of a 54-year-old male patient admitted to the hospital with COVID-19. It provides details of the patient's medical history, symptoms, physical examination findings, lab and imaging results, medications and treatment plan. It also discusses coronavirus in general, including the classification of different types, origin, transmission, incubation period, clinical manifestations and diagnostic evaluation, management and prevention of COVID-19.
This document provides an overview of coronaviruses including their viral composition, epidemiology, transmission routes, clinical manifestations, and impact on respiratory and enteric systems. Key points include that coronaviruses are common causes of respiratory illness, especially in winter, and have also been linked to gastrointestinal symptoms in some cases. While they account for a percentage of respiratory infections, evidence also links coronaviruses to conditions like croup, asthma attacks, pneumonia, and some cases of diarrhea.
This document provides information on coronaviruses through a disease briefing. It discusses the facts, morphology, structure, replication, epidemiology, and mortality of coronaviruses. Specifically, it covers the six known human coronaviruses prior to 2019 (HCoV-229E, HCoV-OC43, HCoV-NL63, HCoV-HKU1, SARS-CoV, MERS-CoV) and provides details on the SARS outbreak in 2002-2003 and SARS-CoV.
Coronaviruses are a group of related viruses that cause diseases in mammals and birds. In humans, coronaviruses cause respiratory tract infections that can be mild, such as some cases of the common cold, and others that can be lethal, such as SARS, MERS, and COVID-19. Symptoms in other species vary: in chickens, they cause an upper respiratory tract disease, while in cows and pigs they cause diarrhea. There are yet to be vaccines or antiviral drugs to prevent or treat human coronavirus infections.
Here, I present the recent updates about n-CoV known as " Corona Virus".
History of Corona virus
Introduction of corona virus
Types of corona virus (CoV)
Pathogenesis of nCoV
Diagnosis
treatment
Covid 19 aka mers cov2 update and perinatal covidSri ChowdarRy
This document provides an overview of COVID-19 (coronavirus disease 2019), caused by the novel coronavirus SARS-CoV-2. It discusses the virology, epidemiology, clinical features, course, complications, diagnosis, and prevention of COVID-19. Key points include that SARS-CoV-2 is a betacoronavirus that uses the ACE2 receptor for cell entry, most infections are mild but some can be severe or critical, common symptoms include fever and cough but some patients are asymptomatic, and chest CT often shows bilateral ground-glass opacities consistent with viral pneumonia.
guidelines of WHO on Coronavirus, structure of coronavirus, prevention and ongoing researches for COVID-19, what does pandemic mean, role of immune system for coronavirus and how to improve general immunity, how COVID-19 got its name, about SARS-CoV-2, when and how to use mask and dispose it off, myths related to coronavirus, studies going on in Oxford University for vaccine of COVID-19 from chimpanzee called as ChAdOx1 nCoV-19
COVID-19 I Coronavirus Disease I Harshit JadavHarshit Jadav
Coronaviruses are a large family of viruses that can cause illness in animals and humans. COVID-19 is caused by a new strain of coronavirus called SARS-CoV-2. It spreads mainly from person to person through respiratory droplets when an infected person coughs or sneezes. Common symptoms include fever, cough, and shortness of breath. While most cases result in mild symptoms, some can progress to viral pneumonia and multi-organ failure. The elderly and those with pre-existing medical conditions are most at risk. There is currently no vaccine, though supportive care and symptomatic treatment are being used. Social distancing, hand washing, and other preventive measures are recommended to reduce transmission.
covid-19 disease or novel corona virus disease or sars-cov 2 information includes all about virology,patho physiology, taxonomy of virus, taxonomy of intermediary host pangolin,and preventive measures needed to be followed by public etc, in a most possible concised manner illustrated in this presentation.
This document discusses Covid-19 in children. It notes that while fewer Covid cases have been diagnosed in children, most pediatric cases are mild. Hospitalization rates are significantly lower in children. The pathophysiology and risk factors for children are also discussed. Common symptoms in children are cough and fever. Diagnostic methods, treatment options, and prevention strategies are summarized.
This document provides information about COVID-19 including its transmission, structure, types, lifespan, mechanisms, symptoms, prevention, and impacts. It discusses how the virus is transmitted through infectious material or contaminated surfaces. COVID-19 is a disease caused by a new strain of coronavirus. The document outlines the two main types, MERS and SARS, and discusses their classifications and origins. It notes the symptoms of COVID-19 such as fever, cough, and difficulty breathing, and recommendations for prevention including hand washing and social distancing. Finally, it examines the wide-ranging impacts of COVID-19 on the economy, education, religious activities, travel, and other areas.
This document discusses the pathophysiology of diarrhea in children. It begins by describing normal intestinal function, including digestion, fluid and electrolyte transport, and the mechanisms that maintain equilibrium. Diarrhea occurs when there is increased intestinal secretion, reduced absorption, or a combination of both. Common causes of diarrhea in children include infectious diarrhea from bacteria or viruses, malabsorption from conditions like cystic fibrosis or coeliac disease, food allergies, and surgical resections of the intestine. Understanding the normal physiology and mechanisms of diarrhea allows clinicians to better diagnose and treat children with gastrointestinal issues.
La Unión Europea ha acordado un embargo petrolero contra Rusia en respuesta a su invasión de Ucrania. El embargo prohibirá la mayoría de las importaciones de petróleo ruso a la UE a partir de finales de año. Se espera que el embargo aumente los precios mundiales del petróleo, pero los líderes de la UE creen que es necesario aumentar la presión económica sobre Rusia para poner fin a la guerra.
The document discusses coronavirus disease (COVID-19) including its definition, transmission, clinical presentation, course, and diagnostic testing recommendations. It defines healthcare personnel and notes COVID-19 is a new coronavirus strain discovered in 2019 that is zoonotic, mainly spread through respiratory droplets. Symptoms can range from mild to severe and include fever, cough and shortness of breath. Older patients and those with chronic conditions are at higher risk. Diagnostic testing is recommended for suspected cases using molecular tests on respiratory specimens.
This document provides an overview of COVID-19, including its aetiology, epidemiology, clinical features, diagnosis, management, and prevention. It describes how COVID-19 is caused by a novel coronavirus, SARS-CoV-2, which likely originated in animals. It summarizes the symptoms of COVID-19 and outlines recommendations for preventing and treating both mild and severe cases. The document also discusses differential diagnoses and provides references for further information.
This is a presentation for all the people who are unaware about COVID-19.
COVID-19 = Corona Virus Disease 2019. Please like and share my presentation.
Presentation by:-
C. S. Nelson
VI - E
D.A.V Boys Senior Secondary School.
D.A.V Group of School.
Covid Pathophysiology and clinical featuresNaveen Kumar
The document summarizes the pathophysiology of COVID-19. It discusses that SARS-CoV-2 enters cells through the ACE2 receptor and causes a cytokine storm. This can lead to organ damage and failure. Symptoms range from mild to severe and include fever, cough and shortness of breath. Those at highest risk are the elderly, immunocompromised, and those with pre-existing conditions like heart or lung disease. The clinical severity is classified as mild, moderate or severe based on symptoms and oxygen levels.
The document discusses the 2009 H1N1 influenza pandemic. It provides details on the virus, symptoms, transmission, management and treatment recommendations, and control measures. As of December 2009, over 9,500 deaths had been reported worldwide from the H1N1 virus. While the overall global mortality rate was approximately 1%, continued virus transmission was observed across many regions. Vaccines and antiviral medications such as oseltamivir were the primary interventions recommended for treatment and prevention.
The document summarizes the findings of a pathology presentation on COVID-19 pulmonary pathology. It describes the histopathological examination of lung tissue from 38 COVID-19 patient deaths in Italy which found evidence of diffuse alveolar damage, hyaline membrane formation, thrombi in small arteries, and type II pneumocyte hyperplasia. It also discusses the similarities to findings from SARS, MERS, and influenza, including epithelial infection, microvascular damage, and organizing pneumonia that can progress to pulmonary fibrosis.
The document summarizes the key details regarding the emergence and spread of the 2019 novel coronavirus (2019-nCoV) in Wuhan, China. It describes the initial cases reported in December 2019 among people exposed to a seafood market, the subsequent closure of the market and isolation of suspected patients. It also outlines the diagnostic testing and identification of 2019-nCoV, clinical characteristics and treatment of patients, as well as outcomes. Limitations of the initial data and knowledge gaps are also discussed.
This document describes the clinical presentation of a 54-year-old male patient admitted to the hospital with COVID-19. It provides details of the patient's medical history, symptoms, physical examination findings, lab and imaging results, medications and treatment plan. It also discusses coronavirus in general, including the classification of different types, origin, transmission, incubation period, clinical manifestations and diagnostic evaluation, management and prevention of COVID-19.
This document provides an overview of coronaviruses including their viral composition, epidemiology, transmission routes, clinical manifestations, and impact on respiratory and enteric systems. Key points include that coronaviruses are common causes of respiratory illness, especially in winter, and have also been linked to gastrointestinal symptoms in some cases. While they account for a percentage of respiratory infections, evidence also links coronaviruses to conditions like croup, asthma attacks, pneumonia, and some cases of diarrhea.
This document provides information on coronaviruses through a disease briefing. It discusses the facts, morphology, structure, replication, epidemiology, and mortality of coronaviruses. Specifically, it covers the six known human coronaviruses prior to 2019 (HCoV-229E, HCoV-OC43, HCoV-NL63, HCoV-HKU1, SARS-CoV, MERS-CoV) and provides details on the SARS outbreak in 2002-2003 and SARS-CoV.
Coronaviruses are a group of related viruses that cause diseases in mammals and birds. In humans, coronaviruses cause respiratory tract infections that can be mild, such as some cases of the common cold, and others that can be lethal, such as SARS, MERS, and COVID-19. Symptoms in other species vary: in chickens, they cause an upper respiratory tract disease, while in cows and pigs they cause diarrhea. There are yet to be vaccines or antiviral drugs to prevent or treat human coronavirus infections.
Here, I present the recent updates about n-CoV known as " Corona Virus".
History of Corona virus
Introduction of corona virus
Types of corona virus (CoV)
Pathogenesis of nCoV
Diagnosis
treatment
Covid 19 aka mers cov2 update and perinatal covidSri ChowdarRy
This document provides an overview of COVID-19 (coronavirus disease 2019), caused by the novel coronavirus SARS-CoV-2. It discusses the virology, epidemiology, clinical features, course, complications, diagnosis, and prevention of COVID-19. Key points include that SARS-CoV-2 is a betacoronavirus that uses the ACE2 receptor for cell entry, most infections are mild but some can be severe or critical, common symptoms include fever and cough but some patients are asymptomatic, and chest CT often shows bilateral ground-glass opacities consistent with viral pneumonia.
guidelines of WHO on Coronavirus, structure of coronavirus, prevention and ongoing researches for COVID-19, what does pandemic mean, role of immune system for coronavirus and how to improve general immunity, how COVID-19 got its name, about SARS-CoV-2, when and how to use mask and dispose it off, myths related to coronavirus, studies going on in Oxford University for vaccine of COVID-19 from chimpanzee called as ChAdOx1 nCoV-19
COVID-19 I Coronavirus Disease I Harshit JadavHarshit Jadav
Coronaviruses are a large family of viruses that can cause illness in animals and humans. COVID-19 is caused by a new strain of coronavirus called SARS-CoV-2. It spreads mainly from person to person through respiratory droplets when an infected person coughs or sneezes. Common symptoms include fever, cough, and shortness of breath. While most cases result in mild symptoms, some can progress to viral pneumonia and multi-organ failure. The elderly and those with pre-existing medical conditions are most at risk. There is currently no vaccine, though supportive care and symptomatic treatment are being used. Social distancing, hand washing, and other preventive measures are recommended to reduce transmission.
covid-19 disease or novel corona virus disease or sars-cov 2 information includes all about virology,patho physiology, taxonomy of virus, taxonomy of intermediary host pangolin,and preventive measures needed to be followed by public etc, in a most possible concised manner illustrated in this presentation.
This document discusses Covid-19 in children. It notes that while fewer Covid cases have been diagnosed in children, most pediatric cases are mild. Hospitalization rates are significantly lower in children. The pathophysiology and risk factors for children are also discussed. Common symptoms in children are cough and fever. Diagnostic methods, treatment options, and prevention strategies are summarized.
This document provides information about COVID-19 including its transmission, structure, types, lifespan, mechanisms, symptoms, prevention, and impacts. It discusses how the virus is transmitted through infectious material or contaminated surfaces. COVID-19 is a disease caused by a new strain of coronavirus. The document outlines the two main types, MERS and SARS, and discusses their classifications and origins. It notes the symptoms of COVID-19 such as fever, cough, and difficulty breathing, and recommendations for prevention including hand washing and social distancing. Finally, it examines the wide-ranging impacts of COVID-19 on the economy, education, religious activities, travel, and other areas.
This document discusses the pathophysiology of diarrhea in children. It begins by describing normal intestinal function, including digestion, fluid and electrolyte transport, and the mechanisms that maintain equilibrium. Diarrhea occurs when there is increased intestinal secretion, reduced absorption, or a combination of both. Common causes of diarrhea in children include infectious diarrhea from bacteria or viruses, malabsorption from conditions like cystic fibrosis or coeliac disease, food allergies, and surgical resections of the intestine. Understanding the normal physiology and mechanisms of diarrhea allows clinicians to better diagnose and treat children with gastrointestinal issues.
La Unión Europea ha acordado un embargo petrolero contra Rusia en respuesta a su invasión de Ucrania. El embargo prohibirá la mayoría de las importaciones de petróleo ruso a la UE a partir de finales de año. Se espera que el embargo aumente los precios mundiales del petróleo, pero los líderes de la UE creen que es necesario aumentar la presión económica sobre Rusia para poner fin a la guerra.
1) Streptococcus pneumoniae (pneumococcus) is a common cause of community-acquired pneumonia worldwide. It colonizes the upper respiratory tract of healthy individuals but can invade the lungs and cause disease.
2) The pneumococcus genome contains genes that allow it to both colonize the upper airways and cause invasive disease. Specific clones have developed phenotypes optimized for either colonization or invasion.
3) Risk factors for invasive pneumococcal disease include young or old age, medical conditions that impair the immune system like asplenia or HIV, and antecedent viral infections like influenza. Vaccines have reduced the incidence of disease caused by vaccine-targeted serotypes but non-vaccine serotypes
Diarrea aguda infecciosa en pediatria, epidemiologia, prevencion y tratamientofranklinaranda
This document discusses acute diarrheal disease in children. It notes that diarrhea is a leading cause of morbidity and mortality in children worldwide, responsible for 2-3 million deaths per year. In the US, acute diarrhea accounts for 9% of pediatric hospitalizations. The causes of acute diarrhea vary but include viruses like rotavirus and norovirus, as well as bacterial and parasitic pathogens. Treatment focuses on fluid replacement and management, while prevention efforts include vaccination against rotavirus.
Haemophilus influenzae is a small, gram-negative bacterium that colonizes the human respiratory tract. It requires factors X and V for growth that can be supplied by erythrocytes. There are encapsulated and nonencapsulated strains, with encapsulated type b strains historically causing most invasive infections in children. Nontypeable strains cause mainly mucosal infections like otitis media and exacerbations of chronic lung diseases. Immunity to H. influenzae is complex, with antibodies targeting strain-specific surface antigens, leaving hosts susceptible to recurrent infections by different strains. Effective conjugate vaccines against type b strains have greatly reduced invasive infections in children.
This document summarizes research on nontypeable Haemophilus influenzae (NTHi), an important cause of respiratory infections. It discusses how NTHi can exist as either a commensal or pathogen in the human respiratory tract. As a commensal, NTHi must dampen the host inflammatory response and evade defenses. As a pathogen, NTHi can adhere to and invade respiratory epithelial cells, initiating proinflammatory pathways. Different NTHi strains possess varying combinations of virulence factors like adhesins, and utilize phase variation to modulate host interactions. The host response ultimately determines the outcome of colonization.
Haemophilus Influenzae Y Otros Haemophilus Spp Exposicion [Modo De Compati...Luz Mery Mendez
Este documento describe las características de Haemophilus influenzae y otros Haemophilus spp. Son bacterias Gram negativas que requieren factores de crecimiento específicos. H. influenzae puede causar infecciones invasivas y no invasivas, siendo la meningitis la enfermedad más grave causada por cepas encapsuladas. El documento explica los mecanismos de patogenicidad, formas de diagnóstico e identificación, y la prevención mediante vacunación.
Shigella bacteria cause the infectious disease shigellosis or bacillary dysentery. It is estimated to cause around 90 million cases annually, resulting in over 100,000 deaths mostly in children in developing countries. The bacteria are highly contagious and can be transmitted through contaminated food or water. Symptoms include bloody diarrhea, abdominal cramps, and fever. Treatment involves rehydration and antibiotics to reduce duration of symptoms.
H. pylori is a common human pathogen that causes peptic ulcer disease and gastric cancer by infecting the stomach and causing inflammation. It is transmitted through poor sanitation and hygiene. Over time, the inflammation can lead to cell damage in the stomach lining and increase cancer risk. Treating H. pylori infections with antibiotics can eliminate gastric cancer risk by eradicating the bacteria. The risk level depends on how much damage has already occurred, so follow up after treatment may be needed to check cancer risk in areas where it is more common.
Antimicrobial Resistance: A Major Cause for Concern and a Collective Responsi...Theresa Lowry-Lehnen
Antimicrobial resistance poses a major global threat as no new class of antibiotics has been introduced in decades and bacteria are developing resistance faster than new drugs can be developed. Antibiotic overuse and misuse in healthcare, agriculture, and the environment contribute to the rise of resistant bacteria. In response, Ireland and many other countries have implemented national action plans to promote appropriate antibiotic use and strengthen surveillance of resistant infections through improved prescribing, infection control, and public education. Coordinated global efforts are needed to address the growing crisis of antimicrobial resistance.
This study analyzed 103 stool samples from infants under 12 months old with diarrhea in Iraq. Rapid immunochromatography tests found that 52 samples (50.5%) were positive for rotavirus, 30 (29.1%) for norovirus, and 21 (20.4%) for adenovirus. The most affected age group was 1-4 months. Rural infants had higher rates of viral diarrhea than urban infants. Mixed feeding was associated with more cases than breastfeeding alone. Common symptoms included watery stool, fever, weakness, abdominal pain, and vomiting. The major causes of infantile diarrhea in the study area were identified as rotavirus, followed by norovirus and adenovirus.
Dr. Robert Tauxe - Public Health Concerns About Resistant Foodborne InfectionsJohn Blue
Public Health Concerns About Resistant Foodborne Infections - Dr. Robert Tauxe, Deputy Director, Division of Foodborne, Waterborne and Environmental Infections, Centers for Disease Control and Prevention, from the 2013 NIAA Symposium Bridging the Gap Between Animal Health and Human Health, November 12-14, 2013, Kansas City, MO, USA.
More presentations at http://www.trufflemedia.com/agmedia/conference/2013-niaa-antibiotics-bridging-the-gap-animal-health-human-health
Dr. Robert Tauxe - Antimicrobial Resistance and The Human-Animal Interface: T...John Blue
Antimicrobial Resistance and The Human-Animal Interface: The Public Health Concerns - Dr. Robert Tauxe, Deputy Director, Division of Foodborne, Waterborne and Environmental Diseases, US Centers for Disease Control and Prevention, from the 2014 NIAA Symposium on Antibiotics Use and Resistance: Moving Forward Through Shared Stewardship, November 12-14, 2014, Atlanta, Georgia, USA.
More presentations at http://www.swinecast.com/2014-niaa-antibiotics-moving-forward-through-shared-stewardship
ENTERIC FEVER IN CHILDREN IN INDIA AND MIDDLE EASTanitn2020
This document discusses enteric fever, also known as typhoid fever. It is caused by Salmonella enterica serovar Typhi and Paratyphi and transmitted through the fecal-oral route. The bacteria infect the small intestine, lymphoid tissues, and reticuloendothelial system. Clinical features include sustained fever over 1-2 weeks, headache, abdominal discomfort, and possible complications like intestinal bleeding or perforation. Diagnosis involves blood or bone marrow cultures. Treatment depends on illness severity and local antibiotic resistance patterns, and may involve oral or intravenous antibiotics like cefixime, azithromycin, or ceftriaxone. Antibiotic resistance is a growing problem.
This document discusses the use of multiplex nucleic acid amplification tests (NAATs) to diagnose infectious diarrhea. It notes that traditional diagnostic methods have low sensitivity and long turnaround times. Multiplex NAATs allow simultaneous testing of stool for multiple pathogens, with higher sensitivity and shorter turnaround. However, they cannot provide antibiotic susceptibility or confirm identifications. The document reviews the pathogens detected by five FDA-approved multiplex NAAT platforms and notes their limitations, such as inability to distinguish carriers from infections or serotypes. It concludes that interpretation requires acknowledging limitations and clinical judgment, and more studies are needed on their cost-effectiveness and impact.
This document discusses antimicrobial resistance and provides information on several key points:
- It defines antimicrobial resistance and explains why it is a global concern due to the rise of hard-to-treat infections.
- It outlines the current situation of drug resistance in several pathogens like E. coli, K. pneumoniae, S. aureus, HIV, malaria, and fungi. Mechanisms of resistance include restricting antibiotic access, destroying antibiotics, and changing antibiotic targets.
- Factors contributing to resistance include inappropriate antibiotic use in humans, animals, and the environment.
- Actions to address resistance include preventing infections, improving antibiotic use, and halting resistance spread.
- The WHO AWaRe classification system categorizes antibiotics based
Impact of antimicrobial resistance (AMR) in developing countries.Robin Barmon
This document is a research paper submitted by Parth Protim Barmon to Professor Tahera Ahmed on antimicrobial resistance in developing countries. It provides background information on antimicrobial resistance as resistance of microorganisms to antimicrobial medicines. It discusses how antimicrobial resistance is a growing global problem, but has a greater impact in developing countries due to factors like poverty and limited access to healthcare. The paper aims to study the risk factors for antimicrobial resistance in developing countries, including socio-demographic factors, why developing countries are more vulnerable, the role of poverty, and the disease burden.
Emergence of Drug resistant microbes PPT By DR.C.P.PrinceDR.PRINCE C P
Antimicrobial resistance is resistance of a microorganism to an antimicrobial drug that was originally effective for treatment of infections caused by it.
Resistant microorganisms (including bacteria, fungi, viruses and parasites) are able to withstand attack by antimicrobial drugs, such as antibacterial drugs (e.g. antibiotics), antifungals, antivirals, and antimalarials, so that standard treatments become ineffective and infections persist, increasing the risk of spread to others.
This document discusses Candida infections in the ICU, including epidemiology, risk factors, pathogenesis, diagnosis, and treatment. Some key points:
- Candida species are the most common fungal pathogens in hospitals and ICUs, responsible for 17% of healthcare-associated infections. Non-albicans Candida species now account for around 50% of infections.
- Risk factors for invasive Candida infections include prolonged ICU stay, broad-spectrum antibiotic use, surgery, and underlying conditions like diabetes that impair immunity. Heavy Candida colonization is an independent risk factor.
- Diagnosis is challenging as symptoms mimic bacterial infections. Culture-based methods are slow. Biomarkers like beta-D-
Regional Antibiotic Resistance Of Helicobacter PyloriMelissa Dudas
This document discusses Helicobacter pylori (H. pylori), a bacterial pathogen that can cause peptic ulcers and is responsible for most stomach cancers. It begins by providing background on the history of understanding H. pylori's role in ulcers. It was originally thought that stress and diet caused ulcers, but in 1982 Robin Warren and Barry Marshall discovered the connection between H. pylori and ulcers. The document then discusses how H. pylori can cause ulcers if left untreated in the stomach or duodenum. It also notes that H. pylori infection is very common, affecting over half of the world's population.
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
All manuscripts are subject to rapid peer review. Those of high quality (not previously published and not under consideration for publication in another journal) will be published without delay.
This study analyzed blood cultures from neonatal intensive care unit patients from 1997 to 2001 in Tripoli Medical Center, Libya. A total of 1431 blood culture sets from 1092 patients were positive for bacterial growth in 801 sets, representing 648 cases of neonatal bacteraemia. The most common causative agents were members of the Enterobacteriaceae family including Serratia, Klebsiella, and Enterobacter species as well as coagulase-negative and positive Staphylococci. Antibiotic susceptibility testing found high levels of resistance among the most frequent pathogens, though resistance to newer antibiotics like aztreonam and imipenem was less common. Resistance in Staphylococcus to anti-stap
Anti-microbial resistance has become a world health issue today. Therefore it is imperative to know about the methods of acquiring resistance and ways to deal with the situation and prevent resistance.
Clostridium difficile is an anaerobic spore-forming bacterium that can cause infection through fecal-oral transmission. Antibiotic use is a major risk factor as it disrupts the normal gut flora and allows C. difficile to grow. Symptoms range from mild diarrhea to life-threatening conditions. Outbreaks have increased in hospitals and been linked to certain antibiotics like fluoroquinolones. Control measures include environmental decontamination and restricting antibiotic use.
Hepatitis A and typhoid fever are vaccine-preventable waterborne diseases transmitted through the fecal-oral route. They remain a major public health issue in Pakistan, with over two-thirds of the population lacking access to clean drinking water. Typhoid fever in particular is endemic in Pakistan, with high rates of multidrug-resistant Salmonella strains emerging. Vaccination is critical to control these diseases and reduce their significant health and economic burden.
This document provides information about malaria vaccines. It discusses the context of malaria globally and the need for a vaccine. Several potential vaccine candidates target different stages of the malaria parasite's lifecycle, including sporozoites, infected hepatocytes, and erythrocytic stages. Developing an effective vaccine is challenging due to the parasite's diversity and complexity. The most promising current candidate is RTS,S, which provides some protection against malaria in clinical trials but is not fully effective.
Similar to Diarrea aguda infecciosa bacteriana (20)
Mecanismos de resistencia del Streptococcus pneumoniaefranklinaranda
This document reviews the mechanisms of antibiotic resistance and tolerance in Streptococcus pneumoniae. It discusses how S. pneumoniae has developed three main mechanisms to resist antibiotics: preventing antibiotic access to targets, inactivating antibiotics, and altering antibiotic targets. Specifically, it describes how mutations in penicillin-binding proteins can reduce affinity for beta-lactam antibiotics like penicillin. It also explains how mutations in DNA gyrase and topoisomerase genes can confer resistance to fluoroquinolones by altering their targets. Recent studies on antibiotic tolerant mutants revealed new insights into controlling bacterial cell death.
1. Streptococcus pneumoniae is a major cause of pneumonia, meningitis, and other infectious diseases. It was one of the first pathogens shown to be extracellular and cause disease through replication outside of cells.
2. Early studies in the late 19th/early 20th century established S. pneumoniae's role in causing pneumonia epidemics and demonstrated that immunization with killed pneumococci or antiserum could prevent disease.
3. S. pneumoniae has 91 known serotypes based on capsular polysaccharides and was important in establishing the concept of serotype-specific immunity and developing polysaccharide vaccines.
Streptococcus pneumoniae is an important bacterial pathogen that causes pneumonia, meningitis, and other infectious diseases. It played a central role in the early discoveries of humoral immunity and that DNA is the genetic material. There are over 90 serotypes of S. pneumoniae identified based on differences in their capsular polysaccharides. The bacterium has a cell wall containing peptidoglycan and teichoic acid, and an external capsule made of repeating oligosaccharides that are responsible for its serotype classification.
1. Streptococcus pneumoniae is a major cause of pneumonia, meningitis, and other infectious diseases. It was one of the first pathogens shown to behave as an extracellular pathogen and stimulate humoral immunity.
2. S. pneumoniae played a central role in early microbiology discoveries including the identification of DNA as the genetic material.
3. S. pneumoniae commonly colonizes the nasopharynx and can cause invasive disease. Rates of invasive disease vary by age and are higher in infants, young children, and older adults.
Solucion salina en diarrea aguda infecciosafranklinaranda
This randomized study compared the effects of isotonic saline (0.9% saline) versus hypotonic saline (0.45% saline) for intravenous rehydration of children with gastroenteritis. 102 children were randomized to receive either isotonic or hypotonic saline. Plasma electrolytes were measured before and 4 hours after starting IV fluids. Children receiving hypotonic saline showed no change in sodium levels if initially hyponatremic, but became hyponatremic if initially normal. In contrast, children receiving isotonic saline became less hyponatremic if initially low, and remained normal if baseline was normal. No child became hypernatremic with either fluid. Isotonic saline is preferable for preventing hyponatremia
Fluido isotonico en rehidratacion pediatricafranklinaranda
This study aimed to determine if using isotonic fluids instead of hypotonic fluids prevents iatrogenic hyponatremia in pediatric patients requiring intravenous fluid maintenance therapy. 122 pediatric patients were randomly assigned to receive either isotonic fluids with 140 mEq/L sodium or hypotonic fluids with <100 mEq/L sodium. At 24 hours, the percentage of patients with hyponatremia was significantly higher in the hypotonic group compared to the isotonic group. The use of isotonic fluids did not increase adverse events compared to hypotonic fluids. The study concludes that hypotonic fluids increase the risk of hyponatremia in pediatric patients.
Three children presented to a hospital emergency department with seizures caused by camphor poisoning. The children ranged from 15 to 36 months old. Two children ingested camphor, while one was exposed through repetitive skin rubbing. All three required medical intervention to stop the seizures. Further investigation revealed that illegally imported camphor products were being widely used in certain communities as remedies, despite known risks of toxicity in young children. Public warnings were issued about the dangers of unregulated camphor use.
This document provides a practice guideline for the out-of-hospital management of camphor poisoning based on an expert consensus process and review of current scientific literature. The guideline consists of 9 recommendations for triaging and managing patients with suspected camphor exposures, including when to refer patients to the emergency department based on symptoms and estimated ingestion amount. The objective is to help poison centers provide appropriate care and avoid unnecessary emergency visits while optimizing patient outcomes.
This document discusses the role of infections in different types of urticaria (hives). It summarizes that while infections are a clear trigger for acute spontaneous urticaria, their role in other urticaria subtypes is less clear. Treatment of infections like Helicobacter pylori has been shown to help resolve chronic urticaria in some cases. The document reviews evidence that viral and bacterial infections can trigger acute urticaria episodes, especially in children, and discusses the possible pathogenesis through mast cell activation. It aims to update understanding of how infections may contribute to different urticaria conditions.
This document discusses the role of infections in different types of urticaria (hives). It summarizes that while infections are a clear trigger for acute spontaneous urticaria, their role in other urticaria subtypes is less clear. Treatment of infections like Helicobacter pylori has been shown to help resolve chronic urticaria in some cases. The document reviews evidence that viral and bacterial infections can trigger acute urticaria episodes, especially in children, and discusses the possible pathogenesis through mast cell activation. It aims to update understanding of how infections may contribute to different urticaria conditions.
Rotavirus, infeccion local y sistemica, Fisiopatologiafranklinaranda
This document summarizes our current understanding of the pathogenesis of intestinal and systemic rotavirus infection. Rotaviruses primarily cause gastroenteritis in children under 5 years old. The diarrhea is thought to be caused by multiple factors, including malabsorption due to enterocyte destruction, a viral enterotoxin (NSP4), and stimulation of the enteric nervous system. Recent evidence suggests rotavirus infection disrupts calcium homeostasis in enterocytes through NSP4, increasing intracellular calcium levels and disrupting tight junctions. NSP4 may also directly induce chloride secretion from crypt cells or stimulate the enteric nervous system to induce secretion. While rotavirus infection is usually limited to the intestine, rare systemic infections have been reported.
Lavado de manos y mascarillas son utiles para efranklinaranda
This cluster randomized controlled trial investigated whether hand hygiene and facemasks can prevent household transmission of influenza. The study assigned 407 households in Hong Kong to control (lifestyle advice only), hand hygiene, or hand hygiene plus facemasks interventions. It found that hand hygiene and facemasks seemed to reduce influenza transmission in households, especially when started within 36 hours of symptoms in the infected household member, with an adjusted odds ratio of 0.33 for transmission among those using facemasks and hand hygiene. However, adherence to the interventions was low. The findings suggest that nonpharmaceutical interventions may help mitigate pandemic and seasonal influenza if implemented early.
1) A randomized controlled trial compared the effectiveness of surgical masks vs N95 respirators in preventing laboratory-confirmed influenza among 446 nurses during the 2008-2009 influenza season.
2) Laboratory-confirmed influenza occurred in 50 nurses (23.6%) in the surgical mask group and 48 nurses (22.9%) in the N95 respirator group, showing noninferiority of surgical masks.
3) Among nurses in Ontario tertiary hospitals, use of surgical masks resulted in similar rates of laboratory-confirmed influenza as N95 respirators.
El documento describe la neurocisticercosis, una infección del sistema nervioso central causada por la larva del tenia Taenia solium. Explica que las manifestaciones clínicas más comunes en pediatría son las crisis convulsivas y el síndrome de hipertensión endocraneana. También describe los hallazgos en la tomografía computarizada y resonancia magnética, siendo esta última más útil para el diagnóstico cuando los hallazgos de la TC no son concluyentes.
Pathogenesis And Clinical Manifestations Of Juvenile Dermatomyositis And Poly...franklinaranda
This document provides an overview of juvenile dermatomyositis (JDM) and polymyositis (JPM), which are rare autoimmune disorders affecting children. It discusses the epidemiology, pathogenesis, clinical manifestations and complications of JDM and JPM. Key points include:
- JDM is more common than JPM and involves vascular damage in muscles, while JPM involves direct immune invasion of muscle fibers.
- JDM typically presents with a characteristic rash and proximal muscle weakness. Common rashes include heliotrope and Gottron's papules. Long term complications can include calcinosis and lipodystrophy.
- The cause is unknown but likely involves genetic susceptibility and
A Meta-analysis of the Effects of Oral Zinc in thefranklinaranda
Articulo publicado en el PEDIATRICS por Marek Lukacik, MDa, Ronald L. Thomas, PhDb, Jacob V. Aranda, MD, PhDb. sobre el uso de zinc en la diarrea aguda y persistente, donde se verifica que acorta la duracion de la enfermedad.
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
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2. 288 Gastrointestinal Infections
mation of Typhimurium DT104 isolates with nalidixic acid (a
quinolone antibiotic) resistance in enteritis acquired from
food animals [13•]. Nalidixic acid resistance may be a har-
binger of emerging quinolone (such as ciprofloxacin) resis-
tance, a development that would have significant clinical
implications [14].
The recommended treatment of Campylobacter enteritis
is generally a quinolone or macrolide, but quinolone resis-
tance has been rising rapidly around the world [10]. Qui-
nolone-resistant strains from diarrhea cases in Thailand
increased from 0% to 84% between 1990 and 1995 [15].
The most recent data indicate that resistance in Thailand is
over 95% (Tribble D, Personal communication). Quinolone
resistance has emerged in Europe and North America as
well. Resistance rates in Minnesota rose from 1.3% to 10.2%
between 1993 and 1998, and resistance rates in isolates
from Ireland have risen from 17.4% to 23% in recent years
[5•,16]. One recent study from Barcelona found that 12.5%
of Campylobacter isolates from travelers (mostly to India,
Africa, and Latin America) were resistant to ciprofloxacin,
but a stunning 88% of isolates from Spanish nontravelers
possessed ciprofloxacin resistance [17]. The Minnesota
study also found that 20% of retail chicken products were
contaminated with ciprofloxacin-resistant Campylobacter
organisms, strengthening the link between animal food
sources and spread of resistant diarrheal pathogens [5•].
Diagnostic Approach
Diagnosis and specific therapy in diarrheal illness should
be directed at certain goals: alleviation of symptoms, pre-
vention of secondary transmission, reduction of morbid-
ity and mortality, and detection and control of outbreaks
[2••]. The diagnosis of bacterial diarrhea is relatively labor
intensive, with low yield and return of results only after 24
to 72 hours. Because most cases of diarrhea are self-lim-
iting and require no specific therapy, diagnostic effort
should be focused on patients who have symptomatic,
physical, or epidemiologic findings suggesting that spe-
cific diagnosis and treatment are warranted.
The diagnosis of infectious diarrhea begins with a thor-
ough history and physical examination, the importance of
which cannot be underestimated. Historical and physical
findings can target patients who are likely to benefit from
further laboratory investigation or empiric therapy, such as
those with inflammatory diarrhea or a history of immuno-
compromising disease. Excellent reviews of important
diagnostic clues are available in the guidelines of the Infec-
tious Diseases Society of America and the American Col-
lege of Gastroenterology [2••,18].
The need for stool culture can often be established using
simple and rapid laboratory tests. Visual identification of
gross blood or a positive test for occult blood suggests an
inflammatory diarrhea (especially enterohemorrhagic Escheri-
chia coli [EHEC]) and is an indication for culture [2••]. In one
study, gross blood increased the yield of culture from 5.6% to
20.1% [19]. Microscopic examination of fresh stool with
methylene blue staining can be used to look for polymorpho-
nuclear lymphocytes (PMNs), a relatively sensitive test for
inflammatory diarrhea [19–21]. Stool may also be examined
by commercial latex agglutination assay for lactoferrin, a
surrogate marker for PMNs. A study of this type of assay for
lactoferrin found excellent correlation with microscopic
examination for fecal leukocytes, a sensitivity of greater than
95% for confirmed Clostridium difficile or Shigella infection,
and specificity of 94%and 100%, respectively [21].
Stool culture for infectious diarrhea has changed very lit-
tle in the past several decades and remains the gold standard
for diagnosis of bacterial enteritis. However, it is a relatively
expensive test with a low yield. Studies of stool culture yields
have typically resulted in positive rates below 10% and as low
as 1.5%[22,23]. The cost per positive culture fromthese stud-
Table 1. Common bacterial causes of diarrheal illness
Organism Comment
Campylobacter species Most common bacterial cause of diarrhea in United States
Salmonella (nontyphoidal) species Most common bacteria associated with foodborne outbreaks in United States
Shigella species More prevalent in daycare setting or homosexual males
Clostridium difficile Common cause of antibiotic-associated diarrhea
Escherichia coli
Enterohemorrhagic (EHEC) Common cause of infectious hemorrhagic colitis in United States, associated
with hemolytic-uremic syndrome
Enterotoxigenic (ETEC) Common causes of traveler’s diarrhea and diarrhea of developing countries
Enteropathogenic (EPEC)
Enteroinvasive (EIEC) Causes dysentery-like illness
Yersinia enterocolitica May cause mesenteric adenitis that can be confused with appendicitis
Vibrio species V. cholerae mostly in developing countries; non-cholera species associated with
seafood consumption in United States
Aeromonas Recent increased recognition as cause of diarrheal illness
Treponema pallidum Can cause colitis and proctitis in persons engaging in receptive anal intercourse
Neisseria gonorrheae
Chlamydia trachomatis
3. Diagnosis and Treatment of Bacterial Diarrhea • Lawler and Wallace 289
ies ranges from $136 to $1200. Reserving stool culture for
patients with evidence of inflammatory diarrhea or with
other special indicationscansignificantlyimprove theyieldof
the culture. In one prospective study, stool culture performed
only on patients with the presence of fecal leukocytes resulted
in an improved recovery rate of 76.7% [22]. Avoiding routine
stool culture in patients developing diarrhea more than 72
hours after hospital admission(the “3-day rule”) can improve
the yield as well. Rohner et al. [24] studied the results of
almost 14,000 stool cultures at a university hospital in Swit-
zerland and found positive cultures in 12.6% versus 1.4%
(P<0.001) before and after 3 hospital days.
Culture should be performed on fresh stool. Rectal swabs
are generally inferior. If stool cannot be plated within2 hours,
it should be refrigerated or placed in a transport medium
[20,23]. Routine stool culture in most US laboratories con-
sists of selective and differential agar plates capable of isolat-
ing Salmonella, Shigella, and, if all non–E. coli gram negatives
are routinely identified, Aeromonas and Plesiomonas. Most
laboratories also include a Campylobacter-selective medium
incubated in microaerophilic conditions to detect Campylo-
bacter species [20,23]. Other organisms require special media
for culture diagnosis. Suspicion for EHEC, Yersinia, and Vibrio
should prompt culture in sorbitol-MacConkey (SMAC),
cefsulodin-ingrasan-novobiocin (CIN), and thiosulfate-cit-
rate-bile-sucrose (TCBS) agars respectively to isolate these
organisms. Turnaround time for stool culture is at least 24
hours, and frequently 48 hours for organisms such as Campy-
lobacter species.
Advances in rapid stool diagnostics
Rapid detection methods, such as the enzyme immunoassay
(EIA), are routinely used for several bacterial pathogens, and
tests for others are in development. Commercially available
assays for C. difficile toxin have become a standard tool in
most microbiology laboratories. Most kits detect only C. diffi-
cile toxin A, but kits to test against toxins A and B are available
[25]. Although a small proportion of C. difficile organisms
produce only toxin B, significant C. difficile–associated disease
missed by assay for toxin A has been reported [26]. Measured
sensitivities andspecificities of these EIAs vary widely depend-
ing on the study and the kit. Most studies have found excel-
lent specificity but sensitivity that is somewhat less than that
of the cell culture assay [25].
Rapid EIA tests can reduce the diagnostic delay with
Campylobacter organisms from 48 hours to less than 3 hours.
Studies with a commercially available kit found a sensitivity
of 80% to 96% and specificity of 99% to 100% [27,28,29•].
In the proper clinical setting, this type of test results in excel-
lent positive and negative predictive values. Some laboratories
have replaced culture with EIA for the diagnosis of Campylo-
bacter enteritis.
Rapid tests are also available for diagnosis of EHEC
infection. Commercial latex agglutination kits for detec-
tion of the O157 or H7 antigens are reliable, but they fail
to identify shiga-like toxin production [30]. Although less
sensitive than cytotoxicity assays, EIAs are commercially
available for detection of shiga-like toxins produced by
Shigella and EHEC [30,31]. Such tests can be performed
directly on stool, but sensitivity increases (to 100% in one
study) if stool is incubated in broth culture overnight
before the EIA is performed [32]. The advantage of this
type of test is the detection of all shiga toxin–producing E.
coli organisms, regardless of sorbitol fermentation.
Methods for rapid detection of Salmonella and Shigella
organisms are also being developed. Many immunologically
based commercial kits are already used in food products, and
some have been tested in human stool specimens. A study of
multiple kits for the detection of various Shigella and Salmo-
nella species in Thailand reported sensitivities and specificities
between 94% and 100% [33]. A kit available in Europe for
detection of serum IgM against Salmonella typhi was recently
tested for the diagnosis of Salmonella serotype enteritidis in
Polish children with diarrhea [34•]. The sensitivity and speci-
ficity of this assay were 92.6% and 94.8%, respectively, with
positive and negative predictive values of 94.7% and 92.9%
when patients were compared with control subjects. Such
immunoassays are likely to appear in diagnostic microbio-
logic laboratories in the United States in the near future.
Rapid molecular diagnostic techniques such as poly-
merase chain reaction (PCR) have made their way into sev-
eral areas of clinical microbiology. PCR assays have been
used to detect C. difficile toxin genes, Shigella, enteroinva-
sive E. coli (EIEC), Campylobacter, and Vibrio organisms in
stool with impressive accuracy [35–38]. Amplified DNA
detection is likely to be useful in the future. However, a sig-
nificant amount of fine tuning may be required before it is
available for commercial use because the presence of DNA
polymerase inhibitors in human feces often interferes with
these tests [33].
Treatment
Most diarrheal illness is self-limited and requires no specific
intervention other than hydration [10]. Loperamide is recom-
mended for symptomatic treatment as long as the illness is
not severe or dysenteric [18]. The appropriate use of antimi-
crobial agents is a challenging aspect of treatment because
antibiotics have the potential for serious deleterious effects.
Antibiotic therapy may prolong carriage of enteric Salmonella
organisms, probably through alteration of normal flora [14].
Antibiotic treatment of EHEC may induce toxin production
and exacerbate hemolytic-uremic syndrome (HUS) [31]. Anti-
biotic use is the major predisposing factor for C. difficile infec-
tion [25]. Finally, unnecessary use of antibiotics worsens the
problemof rapidly emerging antibiotic resistance among bac-
teria that cause enteric infection [6].
Despite these drawbacks, antimicrobial therapy has a
definite role in the management of diarrhea caused by certain
pathogens. The benefit of standard antibiotic therapy for
diarrhea caused by Shigella, Vibrio, C. difficile, and enterotoxic
E. coli (ETEC) infection is firmly established [1,2••,10,11].
4. 290 Gastrointestinal Infections
Although ETECis not routinely diagnosed inclinical microbi-
ology laboratories, it can be suspected with history of travel to
areas of high prevalence, or it can be diagnosed in research
laboratories. Treatment of ETEC is generally TMP-SMX or
ciprofloxacin for 5 days [31]. A 3-day course of TMP-SMX also
appears to be effective, showing even better outcomes with
the addition of loperamide [39]. Although mild to moderate
Vibrio infections do not usually require antibiotic therapy,
antibiotics used in severe cases (as with V. cholerae) can reduce
duration of illness, stool frequency, and fecal shedding [10].
Tetracycline has long been the drug of choice for such infec-
tions, but fluctuating geographic patterns of resistance have
been seen [6]. Furazolidone and erythromycin have been
used successfully in lieu of tetracycline [6,40]. More recently,
single-dose quinolones have been shown to be at least as
effective as the more traditional regimens, and quinolone
resistance among Vibrio species is rare [10,41].
Cessation of antibiotics and re-establishment of normal
fecal flora remains the most effective treatment for C. difficile–
associated diarrhea. This strategy leads to resolution in
approximately 20% of patients [42]. Ten-day courses of oral
vancomycin and metronidazole are equivalent when anti-
microbial treatment is warranted [43]. The recommended
dosages are vancomycin, 125 mg four times daily, and met-
ronidazole, 500 mg three to four times daily [42]. Many alter-
native therapies have been examined, but they are generally
less effective and are beyond the scope of this review.
Antibiotic resistance, especially among S. dysenteriae type
I, has made treatment of shigellosis increasingly difficult. As
mentioned previously, quinolones are the only drugs with
proven efficacy in the developing world, and although TMP-
SMX sometimes works in developing countries, resistance
rates are rapidly increasing. Concerns remain regarding the
administration of quinolones to children and pregnant
women because of cartilage toxicity in animal models, but
arthropathy has not been seen in clinical trials of quinolo-
nes in children [44]. Third-generation cephalosporins are
active against Shigella organisms in vitro, but results of clini-
cal trials have not been convincing [10]. An important recent
development in the treatment of bacillary dysentery has
been the use of short-course therapy (1–3 days). Table 2 out-
lines the results of two studies of short-course treatment in
children with cholera [44,45]. Clinical outcome was similar
in the two studies. The microbiologic cure rate was 100% in
both groups in the ZIMBASA study, whereas the study by
Vinh et al. [45] found a significant reduction in the duration
of shedding in the short-course group. Thus, a shortened
course of quinolones appears to be effective for treatment of
dysenteric illness from Shigella infection.
Many experts recommend antibiotic treatment for cul-
ture-proven Campylobacter enteritis [2••,18], although this
opinionis not universal. Several well-constructed studies have
shown statistically significant clinical improvement with qui-
nolone therapy. These studies also suggest that therapy may
reduce the duration of fecal shedding [46–49]. Some of the
studies that did not show statistically significant improve-
ment may have been handicapped because early therapy for
Campylobacter infection appears to be most efficacious [50].
Quinolones and macrolides can be used to treat Campylo-
bacter infection, but emerging quinolone resistance is a grow-
ing problem. In areas with high levels of endemic resistance,
such as Southeast Asia, a macrolide may be more appropriate;
azithromycin (500 mg/d for 3 days) has proven efficacy [51].
Rifaximin may be very useful in such cases and is discussed
later in this review.
Antimicrobial therapy in uncomplicated nontyphoidal
Salmonella enteritis is somewhat controversial. Trials of
most antibiotics have shown no clinical benefit, and in fact
have sometimes shown prolonged fecal shedding of the
offending bacteria [10]. Some studies have shown that
quinolones may shorten the duration of illness with non-
typhoidal Salmonella, although carriage is probably not
shortened [14]. Despite the lack of evidence of efficacy in
uncomplicated diarrhea, patients at risk for disseminated
disease should probably be treated, because extraintestinal
Salmonella infection is associated with significant morbid-
ity and mortality [2••]. The recommended empiric anti-
biotics for Salmonella infection are quinolones or third-
generation cephalosporins because of increased resistance
to other traditional agents [14].
Empiric antimicrobial therapy
Because rapid diagnostic capability for bacterial diarrhea is
limited, almost all antimicrobial treatment is initially
empiric. Suspected cases of severe C. difficile colitis may war-
rant empiric therapy with metronidazole if a toxin assay can-
not be performed in a timely manner, especially if fecal
leukocytes are present. In the absence of risk factors for C.
difficile infection, inflammatory diarrhea may be caused by
organisms that respond well to treatment, such as Campylo-
bacter, Shigella, and EIEC. Bloody diarrhea in the absence of
fever or in a child should raise a clinical suspicion of EHEC,
and empiric antibiotics should not be used in these patients
to avoid potentially precipitating HUS [30]. Patients with
inflammatory diarrhea who have a predisposing risk for
severe or disseminated infection, including those with an
immunocompromising condition, diabetes, cirrhosis,
advanced age, intestinal hypomotility, or hypochlorhydria,
are candidates for empiric treatment. On a case-by-case basis,
empiric treatment may be prudent for a variety of reasons, for
example ina patient whois at risk of spreading disease to oth-
ers (eg, health-care worker or food handler) or whena specific
pathogen is suspected (eg, raw seafood consumption or con-
tact with a known case). Finally, empiric treatment of trav-
eler’s diarrhea is generally appropriate because treatment in
this instance has been shown to reduce the duration of illness
from3 to 5 days to less than 1 to 2 days [2••].
Quinolones have become the drug of choice for empiric
treatment of acute bacterial diarrhea in adults. They remain
highly active against almost all of the usual pathogens,
achieve high fecal concentrations, and are generally tolerated
well [52]. A number of randomized, placebo-controlled stud-
5. Diagnosis and Treatment of Bacterial Diarrhea • Lawler and Wallace 291
ies from Europe and the United States have demonstrated
successful treatment of acute diarrhea with ciprofloxacin and
norfloxacin. Pichler et al. [48,53] published two reports on
treatment with ciprofloxacin (500 mg twice daily for 5 days)
in 50 and 85 patients, respectively. In the first study, ciproflox-
acin reduced the duration of diarrhea from 2.6 to 1.4 days
(P<0.01) and decreased the number of positive cultures after
48 hours of therapy from 24 to 25 to 0 to 24 (P<0.001). Sim-
ilar results were found in the second study, and the mean
duration of fever was also reduced in a statistically significant
manner from 3.1 to 1.3 days. Studies by Goodman et al. [49],
Wistrom et al. [54], and Dryden et al. [46] found a 1- to 2.4-
day reduction in days with diarrhea, compared with results in
the placebo group, along with significantly reduced daily
symptoms and total duration of illness. These studies repre-
sented varied populations. Campylobacter or Salmonella were
the predominant organisms isolated, but a large proportion
of patients (49% and 71% in two of the studies) had no
positive culture, perhaps reflecting a high incidence of patho-
genic E. coli. Three of these studies mention travel history in
patients, with incidence rates of 1%, 25%, and 70% [46,49,
54]. Studies that specifically examined quinolones for the
treatment of traveler’s diarrhea have demonstrated similar
reductions in days of diarrhea and illness [52]. These findings
appear to be independent of the predominant organisms
isolated; the same effect is present with a predominance of
pathogenic E. coli, Salmonella, or Campylobacter [47,55].
Alternatives to quinolones for empiric treatment may be
appropriate for children and patients with sensitivity to
quinolones or in areas where quinolone-resistant organisms
are prevalent. TMP-SMX is a reasonable alternative that is
commonly used in children with traveler’s diarrhea [2••].
Among travelers in Thailand, where quinolone-resistant
Campylobacter predominates, azithromycin or another mac-
rolide is an appropriate choice for empiric therapy [51].
Finally, local epidemiology of diarrheal illness and resis-
tance patterns should always be considered in choosing an
empiric antibiotic, and a thorough knowledge of these data
may prevent future complications.
Rifaximin
Increasing antimicrobial resistance, combined with the
side effects and potential toxicity of absorbed antibiotics,
have renewed interest in nonabsorbed antibiotics for the
treatment of diarrhea. Prior studies with oral aztreonam
and bicozamycin have proven the efficacy of this approach,
although neither of these drugs was pursued for marketing
[56]. Studies of rifaximin, a nonabsorbed rifamycin deriva-
tive, in the treatment of traveler’s diarrhea are a new and
exciting development.
Rifaximin is a semisynthetic relative of the rifamycins
with activity against a broad spectrum of gram-positive and
gram-negative organisms. It is currently licensed in several
European, Latin-American, and Asian countries. Less than
1% of oral rifaximin is absorbed systemically, but stool
concentrations reach levels several hundred times the min-
imal inhibitory concentration for 90% (MIC90) of most
enteric pathogens [56,57]. As would be expected with a
nonabsorbed drug, studies to date have revealed an excel-
lent safety profile with a 1% incidence of gastrointestinal
side effects and very rare episodes of urticaria [57].
To date, two randomized clinical trials examining the
use of rifaximin in traveler’s diarrhea have been published.
The first trial compared rifaximin (200, 400, and 600 mg
three times a day) to a standard dose of TMP-SMX in 72
adult US students studying abroad in Mexico [58]. Overall,
the mean duration of diarrhea after treatment in all rifaxi-
min groups was 43.1 hours, compared with 55.7 hours for
TMP-SMX (a nonsignificant difference). These results were a
statistically significant improvement over historical placebo
controls from a similar population. Although sample size
prevented statistical significance, the 200-mg dose of rifaxi-
min appeared to be as effective as the higher doses. In fact,
all of the microbiologic failures (four of 20 isolated patho-
gens from the combined rifaximin groups) occurred in the
400- and 600-mg groups (Table 3). The second study com-
pared rifamixin (400 mg twice a day) with ciprofloxacin in a
similar population in Mexico (n=163) and in tourists in
Jamaica (n=24) [59••]. Results in the two groups were simi-
lar, with a time to last unformed stool of 25.7 versus 25.0
hours in the rifaximin and ciprofloxacin groups, respec-
tively. These results were similar for patients with and with-
out specific microbiologic diagnosis. Differences in side
effects appear to be clinically insignificant. A third random-
ized, controlled study comparing rifaximin with placebo
was presented at a recent scientific meeting [56]. In this
study rifaximin (200 and 400 mg three times a day) cut the
time to last unformed stool in half, compared with placebo.
Conclusions
Diarrheal illness from bacterial pathogens continues to be
a disease of global significance. Rapidly evolving organ-
isms and rapid emergence of antimicrobial resistance are
expanding threats to the treatment advances of the past few
decades. To counter these threats, new tools have recently
been added to the diagnostic and therapeutic armamentar-
ium, and promising additions are on the horizon. The next
decade should bring interesting changes in the manage-
ment of this important disease.
7. Diagnosis and Treatment of Bacterial Diarrhea • Lawler and Wallace 293
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