CMT05102
Diarrhea disease
Objectives
• a) Define diarrhoea diseases (Dysentery, Cholera,Giardiasis,
Isosporiasis, Cryptosporidiosis)
• b) Explain risk factors/aetiology of diarrhea diseases
• C) Explain clinical features and complications of diarrhoea diseases
• d) Perform clinical assessment for a patient with diarrhoea diseases
• e) Establish provisional and differential diagnoses
Objectives
• f) Determine appropriate investigations to be performed to patients
with diarrhea diseases
• g) Treat, conduct follow up and refer patients with diarrhoea diseases
as appropriate
• h) Provide preventive measures to patients with diarrhoea diseases
Definition
• Diarrhea is passage of 3 or more loose stools per day
• There are many causes of diarrhea both infectious and non
infectious
• Infectious cause can be viral, bacterial, protozoan
• Common causes includes cholera, dysentery, giardiasis,
isosporiosis,cryptosporidiosis
Giardiasis
Giardiasis
• It is the infestation of the upper small intestine caused by the
flagellate protozoan Giardia lamblia (or G. intestinalis), cytopathic
effects of which leads to malabsorption and diarrhea.
• It is more common in immune compromised individuals and is
acquired through ingestion of contaminated water and food.
Clinical features
• After an incubation period of 1–3 weeks, there is diarrhoea, Crampy
abdominal pain, malaise, weight loss, anorexia, nausea and vomiting.
• On examination, abdominal distension and tenderness.
• Chronic diarrhoea and malabsorption may occur, with bulky stools
that float
INVESTIGATIONS
• Evidence of Giardia intestinalis trophozoites or cysts on serial
3 samples of stool examination
• Serological evidence of G. Intestinalis trophozoites antigen or
antibody
• Evidence of G. Intestinalis in duodenal aspirates or biopsy
specimen
TREATMENT
• Pharmacological Treatment
metronidazole (PO) 400–800mg 8hourly for 5days
OR
tinidazole (PO) 2g once daily for 3days
OR
nitazoxanide 500 mg orally twice daily for 3 days.
Cholera
Cholera
• Cholera is an acute gastrointestinal infection caused by Vibrio
cholerae.
• Infection occurs through ingestion of contaminated water or
food by Vibrio cholerae leading to severe diarrhoea and
emesis associated with body fluid and electrolyte depletion.
• Risk factors include poverty and lack of access to safe food,
water and adequate sanitation
Clinical features
Clinical Presentation
• A sudden onset of painless watery diarrhea(rice water) that
may quickly become severe with profuse watery stool,
vomiting, severe dehydration and muscular cramps, leading
to hypovolemic shock and death
• Abdominal discomfort
• Electrolyte imbalance
Investigations
Specimen: Liquid stool or rectal swab
• Diagnostic test: Isolate V. cholerae from stool culture and
determine O1 serotype using polyvalent antisera for V.
cholerae O1. If desired, confirm identification with Inaba and
Ogawa antisera.
• If specimen is not serotypable, consider, V. cholerae O139
• Antibiotic Susceptibility Testing before provision of
antibiotics
• Follow up 48 -72 hours after antibiotic initiation
Treatments
• Pharmacological Treatment Cholera requires immediate treatment
because the disease can cause death within hours. There are three
elements of treatment:
Rehydration, Antibiotic Treatment, Zinc and Folic Acid Supplements.
Rehydration • Assess the patient's level of dehydration as per National
Guidelines for Prevention and Control of Cholera. It is of paramount
importance to make correct diagnosis and administer the right treatment.
plan A: No dehydration,
plan B: Moderate dehydration and
plan C: Severe dehydration.
Antibiotic therapy
• Adults (Not for pregnant women) : doxycycline (PO) 300 mg or
5mg/kg stat then 200mg (PO) 12 hourly for 7 days OR ciprofloxacin
(PO) 1g stat then 15mg/kg 12 hourly for 7 days or 500mg (PO) 12
hourly for 7 days OR azithromycin (PO) 500mg once a day for 7 days
• Expectant mothers: A: erythromycin (PO) 500mg 8 hourly for 7 days
Zinc and folate supplements
• Zinc (PO) 20mg once daily decreases diarrhea and shortens the
duration of illness in children with cholera.
• Folic acid (PO)2.5mg once daily for children < 6 months, or 5mg once
daily for children >6 months for the duration of the treatment.
Prevention
• Drink treated or boiled water from safe sources (taps,
decontaminated deep wells, bottles)
• Boil water or treat to kill bacteria and make it safe for drinking and for
other domestic uses
• Wash hands with liquid soap and running water after visiting the
toilet, before preparing foods, and before eating
• DO NOT eat uncooked food from the street and do not eat cooked
food that is no longer hot
• DO NOT eat street prepared fruits. Always eat home prepared fresh
fruits
Dysentery
Dysentery
• Clinical syndrome characterized by bloody diarrhea caused by various
infectious disease.
• Common causes of dysentery includes; shigelosis(shigella dysentery),
salmonella, campylobacter ,E. coli and amebiasis
• Transmission : fecal oral route through ingestion of contaminated
foods and water
Clinical presentation
• Acute abdominal cramping,
• high-grade fever,
• emesis and large-volume watery diarrhea
• Tenesmus, urgency, fecal incontinence, mucoid bloody diarrhea
• Severe headache, lethargy, meningismus, delirium, and convulsion
• Hemolytic uremic syndrome (HUS), microangiopathic hemolytic
anemia, thrombocytopenia, and renal failure
• Profound dehydration and hypoglycemia
Investigations
• Laboratory evidence of microscopic isolation of the bacteria from
stool or rectal swabs specimens
• Stool culture for suspected cases in early course of infection
• An enzyme immunoassay (ELISA) for shiga toxin detection in stool for
S. dysenteriae type
• Stool for ova of E. histolytica
Treatment
• ciprofloxacin (PO) 500mg 12hourly for 5days OR A: erythromycin
(PO) 500mg 6hourly for 5days.(shigellosis, campylobacter and e. coli)
• Tabs metronidazole for amebiasis
Isosporiasis and
cryptosporidiosis
Isosporiasis and cryptosporidiosis
• Caused by protozoan isospora belli and cryptosporidium parvum
respectively
• Transmitted by fecal oral route through ingestion of contaminated
foods and water
• The illness is self-limiting but in immunocompromised patients,
especially those with HIV, the illness can be devastating, with persistent
severe diarrhoea and substantial weight loss
Clinical presentation
• Abdominal pain
• Chronic watery diarrhea
• Wasting syndrome
• Dehydration
Investigation
• Stool microscopy to visualize the oocytes of cryptosporidium and
isospora
Treatment
• Evaluate and treat dehydration as per protocols
• Specific treatment
Cryptosporidiasis -200 mg bid for 3 days or 400mg od for 3 days
Isosporidiosis –cotrimoxazole 960 mg bid for 10 days
Referral and follow up of diarrhea disease
• Refer when develop complication of diarrhea
• Follow up : come to hospital when notice features of
dehydration(increased thirsty, decreased urine output, dry mucosa
membranes, altered mental status
Thank you
