Brief description. General features. Aspects of differentiation. Diagnostic and therapeutic approach.

1. Epidemiological Characteristics
of Respiratory and Enteric
Infections
ASSOC. PROF., DR. ANIUTA SYDORCHUK MD, PHD
DEPARTMENT OF INTERNAL MEDICINE & INFECTIOUS DISEASES
HIGHER STATE EDUCATIONAL ESTABLISHMENT OF UKRAINE BUKOVINIAN STATE MEDICAL
UNIVERSITY
CHERNIVTSI
BSMU

2. Respiratory infections
• Respiratory tract infection (RTI) is
defined as any infectious disease of the
upper or lower respiratory tract.
Upper respiratory tract infections (URTIs)
include the common cold, laryngitis,
pharyngitis/tonsillitis, acute rhinitis, acute
rhinosinusitis and acute otitis media.

3. Causative agents of ARI
(acute respiratory infections)
• Rhinoviruses and coronaviruses account for the majority
of acute coryzal illnesses.
• Other causes include influenza, human parainfluenza
viruses (HPIVs), respiratory syncytial.
• Adenoviral infection can be transmitted both ways –
respiratory and fecal-oral
• Such agents like Chlamydia psittaci caused Psittacosis
or orhnitosis
• Mycoplasma hominis – caused respiratory
mycoplasmosis
• Legionella pneumophila caused Legionellosis
(sapronosis)

4. SEASONALITY
Disease Common season
Influenza Winter
COVID19 Autumn, winter,
spring
Diphtheria Winter, spring

5. Common features
• Transmit by droplet
way, air-borne from
sick human
(mainly)
• Short incubation
period
• Acute onset
• Rhinitis
• Fever
• Nasal discharges
• Sore throat
• Cough
• Bacterial co-infection
- pneumonia

6. Clinical
presentation
1. Crying baby face – influenza
2. Scleritis – influenza
3. Adenoviral infection –
conjunctivitis with fever with
diarrhea
4. Hoarsening voice –
parainfluenza
5. Pseudomembranes on URT
(tonsils, pharynx, larynx) –
respiratory diphtheria
6. Maculo-popular rash with
ARI signs and conjunctivitis
– measles
7. All mentioned above =
occipital lymphadenopathy –
check for rubella
Tonsils and faucial structures covering by
pseudomembranes
(Grey colour, dense, is badly taken out, slimy under her
bleeds), leaving for limits of tonsills (on aerofoils, uvula, soft
palate)

7. Diagnostic and therapeutic
approach to ARI
• Ask attentively about
contact with somebody
sick
• For detection of agent –
use swab in PCR, culture
testing, microscopy
• If suspect flu, adeno- or
C19 – do serological test
• Bed rest if high
grade fever
• Fluids intake
• Vitamins C
• May use INF nasal
drops
• Gargling sore throat
• If flu - oseltamivir

8. Preventive measures in the focus
of ARI depend on type of agent
• In the focus of diphtheria we will use:
 Medical observation after contact persons 7 days
 Bacteriological examination
 Sanation of the detected carriers
 Final disinfection
 Revaccination
• Aeration and ultra-violet lighting of puttings, wet cleaning with usage
of 2/3-basic salt of perchloron, calcium of hypochlorite, 3 % of
solution of chloraminum, 1 % of solution amfolan.
• Sputum, the outwashes from a nasopharynx hash with double quantity
of solutions, exposition 2 hours. The tableware is boiled in 2 %
potassium solution 30 mines.
• Bed-clothes and clothes if necessary to decontaminate in desinfection
camera.

9. Specific prevention -
immunization
• Vaccines against influenza for vulnerable
people as elderly and comorbid
• Adenoviral vaccines – recommended for
military staff
• Measles, mumps, rubella – MMR vaccine
and revaccination in time.
• The most others – no vaccines.

10. Enteric infections
• Enteric diseases are caused by micro-
organisms such as viruses, bacteria and
parasites that cause intestinal illness. These
diseases most frequently result from
consuming contaminated food or water and
some can spread from person to person.

11. DEFINITION
• Watery Diarrhea: 3 or more liquid or watery
stools in 24 h
• Dysentery: Presence of blood and/or mucus
in stools
• Persistent Diarrhea: Diarrhea lasting for 14
days or more

12. TYPES OF DIARRHEA
Rota virus diarrhea
E. coli diarrhea
Cholera
Watery diarrhea
Shigellosis
Amebiasis
Dysentery
Causes are mostly unknown
Persistent diarrhea
Diarrhea

13. COMMON CAUSES OF
DIARRHEA- BACTERIA
– Vibrio cholera
– Shigella
– Escherichia coli
– Salmonella
– Campylobacter jejuni
– Yersinia enterocolitica
– Staphylococcus
– Vibrio parahemolyticus
– Clostridium difficile

14. COMMON CAUSES OF
DIARRHEA- VIRUS
• Rotavirus
• Adenoviruses
• Caliciviruses
• Astroviruses
• Norwalk agents and Norwalk-like viruses

15. COMMON CAUSES OF
DIARRHEA- PARASITE
• Entameba histolytica
• Giardia lamblia
• Cryptosporidium
• Isospora

16. COMMON CAUSES OF
DIARRHEA-OTHERS
• Metabolic disease
Hyperthyroidism
Diabetes mellitus
Pancreatic insufficiency
• Food allergy
Lactose intolerance
• Antibiotics
• Irritable bowel syndrome

17. TRANSMISSION
• Most of the diarrheal agents are transmitted
by the fecal-oral route
• Some viruses (such as rotavirus) can be
transmitted through air
• Nosocommial transmission is possible
• Shigella (the bacteria causing dysentery) is
mainly transmitted person-to-person

18. SEASONALITY
Disease Common season
Cholera Winter
Rotavirus diarrhea Winter
Shigellosis Dry summer

19. PERSON-AT-RISK
• Cholera: 2 years and above, uncommon in
very young infants
• Shigellosis: more common in young
children aged below 5 years
• Rotavirus diarrhea: more common in young
infants and children aged 1-2 years
• E. coli diarrhea: can occur at any age
• Amebiasis: more common among adults

20. TYPES OF VIBRIO CHOLERA
• Two major biotypes of Vibrio cholera that
cause diarrhea are:
Classical
ElTor
• Two common serotypes of Vibrio cholera
that cause diarrhea are:
Inaba
Ogawa

21. Vibrio cholerae O139
• Vibrio cholerae in O-group 139 was first isolated
in 1992 and by 1993 had been found throughout
the Indian subcontinent. This epidemic expansion
probably resulted from a single source after a
lateral gene transfer (LGT) event that changed the
serotype of an epidemic V. cholerae O1 El Tor
strain to O139.
• More information:
http://www.cdc.gov/ncidod/EID/vol9no7/02-
0760.htm

22. Vibrio vulnificus
• The organism Vibrio vulnificus causes wound infections, gastroenteritis
or a serious syndrome known as "primary septicema."
• V. vulnificus infections are either transmitted to humans through open
wounds in contact with seawater or through consumption of certain
improperly cooked or raw shellfish.
• This bacterium has been isolated from water, sediment, plankton and
shellfish (oysters, clams and crabs) located in the Gulf of Mexico, the
Atlantic Coast as far north as Cape Cod and the entire U.S. West
Coast.
• Cases of illness have also been associated with brackish lakes in New
Mexico and Oklahoma.
• For more information:
http://hgic.clemson.edu/factsheets/HGIC3663.htm

23. TYPES OF SHIGELLA
• The major serotypes of Shigella that cause
diarrhea are:
Dysenteriae type 1 or Shigella shiga
Shigella flexneri
Shigella sonnei
Shigella boydii

24. TYPES OF E. COLI
• Six major types of Escherichia coli cause
diarrhea:
Enterotoxigenic E. coli (ETEC)
Enteroinvasive E. coli (EIEC)
Enteropathogenic E. coli (EPEC)
Enterohemorrhagic E. coli (E. coli O157:H7)
Enteroaggregative E. coli (EAggEC)
Diffuse adherent E. coli (DAEC)

25. CLINICAL FEATURE:
CHOLERA
• Rice-watery stool
• Marked dehydration
• Projectile vomiting
• No fever or abdominal pain
• Muscle cramps
• Hypovolemic shock
• Scanty urine

26. CLINICAL FEATURE:
E. COLI DIARRHEA
• Watery stools
• Vomiting is common
• Dehydration moderate to severe
• Fever– often of moderate grade
• Mild abdominal pain

27. CLINICAL FEATURE:
ROTAVIRUS DIARRHEA
• Insidious onset
• Prodromal symptoms, including fever,
cough, and vomiting precede diarrhea
• Stools are watery or semi-liquid; the color is
greenish or yellowish– typically looks like
yoghurt mixed in water
• Mild to moderate dehydration
• Fever– moderate grade

28. CLINICAL FEATURE:
SHIGELLOSIS
• Frequent passage of scanty amount of
stools, mostly mixed with blood and mucus
• Moderate to high grade fever
• Severe abdominal cramps
• Tenesmus– pain around anus during
defecation
• Usually no dehydration

29. CLINICAL FEATURE:
AMEBIASIS
• Offensive and bulky stools containing
mostly mucus and sometimes blood
• Lower abdominal cramp
• Mild grade fever
• No dehydration

30. LABORATORY DIAGNOSIS
• Stool microscopy
• Dark field microscopy of stool for cholera
• Stool cultures
• ELISA for rotavirus
• Immunoassays, bioassays or DNA probe
tests to identify E. coli strains

31. ASSESSMENT OF
DEHYDRATION
Dehydration
Mild Moderate Severe
Appearance irritable,
thirsty
irritable,
very
thirsty
lethargy,
coma, or
unconscious
Anterior
Fontanelle
normal depressed markedly
depressed
Eyes normal sunken sunken

32. ASSESSMENT OF
DEHYDRATION (contd.)
Dehydration
Mild Moderate Severe
Tongue normal dry very dry,
furred
Skin normal slow
retraction
very slow
retraction
Breathing normal rapid very rapid

33. ASSESSMENT OF
DEHYDRATION (contd.)
Dehydration
Mild Moderate Severe
Pulse normal rapid and
low
volume
feeble or
imperceptible
Urine normal dark scanty
Weight
loss
< 5% 6 - 9% 10% or more

34. TREATMENT
• Rehydration– replace the loss of fluid and
electrolytes
• Antibiotics– according to the type of
pathogens
• Start fluids as soon as possible – ORS, etc

35. COMPOSITION OF ORS
Ingredient Amount (g/liter)
Sodium chloride 3.5
Trisodium citrate or
Sodium bicarbonate
2.9 or
2.5
Potassium chloride 1.5
Glucose 20.0

36. AMOUNT OF SALT LOSS
DURING DIARRHEA
Salt (mmol/L)Diarrhea
Na K Cl HCO3
Cholera
(child)
88 30 86 32
Cholera
(adult)
135 15 100 45
E. coli 53 37 24 18
Rota
virus
37 38 22 6

37. ANTIMICROBIALAGENTS
Type of diarrhea Antimicrobial agent
Cholera Tetracycline,
Doxycycline,
Ciprofloxacine
Shigellosis Pivmecillinam
(Selexid), Nalidixic
acid, Ciprofloxacin,
Ceftriaxone
Amebiasis Metronidazole

38. COMPLICATIONS:
WATERY DIARRHEA
• Dehydration
• Electrolyte imbalances
• Convulsions
• Hypoglycemia
• Renal failure
• Hypovolemic shock

39. COMPLICATIONS:
DYSENTERY
• Electrolyte imbalances
• Convulsions
• Hemolytic uremic syndrome (HUS)
• Leukemoid reaction
• Toxic megacolon
• Protein losing enteropathy
• Arthritis
• Perforation

40. VACCINES
• An oral cholera vaccine is available, which
gives immunity to 50-60% of those who
take the vaccine, and this immunity lasts
only a few months.
• No vaccines are available against shigellosis
• A vaccine against rotavirus diarrhea
RotaRix and RotaTeq for vulnerable groups.

41. PREVENTION
• Safe drinking water and food
“Boil it, cook it, peel it, or forget it. "
• Hand washing
• Proper sanitation
• Cooking well
• Avoid street food and street eating
• Before traveling to endemic zone read
carefully and follow precautions.

42. THANKS FOR VISITING
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sidorchuk@bsmu.edu.ua