Epidemiology and Management of Diarrheal Diseases - PowerPoint PPT Presentation

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Epidemiology and Management of Diarrheal Diseases

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Title: Epidemiology and Management of Diarrheal Diseases


1
Epidemiology and Management of Diarrheal Diseases
  • Amal Mitra, MD, MPH, DrPH
  • Professor
  • University of Southern Mississippi
  • Readings Diarrhoeal Diseases

2
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

3
TYPES OF DIARRHEA
4
COMMON CAUSES OF DIARRHEA- BACTERIA
  • Vibrio cholera
  • Shigella
  • Escherichia coli
  • Salmonella
  • Campylobacter jejuni
  • Yersinia enterocolitica
  • Staphylococcus
  • Vibrio parahemolyticus
  • Clostridium difficile

5
COMMON CAUSES OF DIARRHEA- VIRUS
  • Rotavirus
  • Adenoviruses
  • Caliciviruses
  • Astroviruses
  • Norwalk agents and Norwalk-like viruses

6
COMMON CAUSES OF DIARRHEA- PARASITE
  • Entameba histolytica
  • Giardia lamblia
  • Cryptosporidium
  • Isospora

7
COMMON CAUSES OF DIARRHEA-OTHERS
  • Metabolic disease
  • Hyperthyroidism
  • Diabetes mellitus
  • Pancreatic insufficiency
  • Food allergy
  • Lactose intolerance
  • Antibiotics
  • Irritable bowel syndrome

8
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

9
SEASONALITY
10
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

11
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

12
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/vo
    l9no7/02-0760.htm

13
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/fact
    sheets/HGIC3663.htm

14
TYPES OF SHIGELLA
  • The major serotypes of Shigella that cause
    diarrhea are
  • Dysenteriae type 1 or Shigella shiga
  • Shigella flexneri
  • Shigella sonnei
  • Shigella boydii

15
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 O157H7)
  • Enteroaggregative E. coli (EAggEC)
  • Diffuse adherent E. coli (DAEC)

16
CLINICAL FEATURE CHOLERA
  • Rice-watery stool
  • Marked dehydration
  • Projectile vomiting
  • No fever or abdominal pain
  • Muscle cramps
  • Hypovolemic shock
  • Scanty urine

17
CLINICAL FEATURE E. COLI DIARRHEA
  • Watery stools
  • Vomiting is common
  • Dehydration moderate to severe
  • Fever often of moderate grade
  • Mild abdominal pain

18
CLINICAL FEATUREROTAVIRUS 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

19
CLINICAL FEATURESHIGELLOSIS
  • 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

20
CLINICAL FEATUREAMEBIASIS
  • Offensive and bulky stools containing mostly
    mucus and sometimes blood
  • Lower abdominal cramp
  • Mild grade fever
  • No dehydration

21
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

22
ASSESSMENT OF DEHYDRATION
23
ASSESSMENT OF DEHYDRATION (contd.)
24
ASSESSMENT OF DEHYDRATION (contd.)
25
TREATMENT
  • Rehydration replace the loss of fluid and
    electrolytes
  • Antibiotics according to the type of pathogens
  • Start food as soon as possible

26
COMPOSITION OF ORS
27
AMOUNT OF SALT LOSS DURING DIARRHEA
28
ANTIMICROBIAL AGENTS
29
COMPLICATIONSWATERY DIARRHEA
  • Dehydration
  • Electrolyte imbalances
  • Tetany
  • Convulsions
  • Hypoglycemia
  • Renal failure

30
COMPLICATIONSDYSENTERY
  • Electrolyte imbalances
  • Convulsions
  • Hemolytic uremic syndrome (HUS)
  • Leukemoid reaction
  • Toxic megacolon
  • Protein losing enteropathy
  • Arthritis
  • Perforation

31
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 has been
    withdrawn recently from the market.

32
PREVENTION
  • Safe drinking water and food
  • Boil it, cook it, peel it, or forget it. "
  • Hand washing
  • Proper sanitation
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