Chapter four
Faeco-oral transmitted Diseases
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Faeco-oral transmitted Diseases
• The transmission of causative organisms from
the faces of infected person to the GIT of a
susceptible host
Common features:
• The causative organisms are excreted in the
stools of infected person
• The portal of entry for these diseases is mainly
mouth
• Transmission mostly occurs through unapparent
fecal contamination of food, H2O, hands
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• In feco-oral transmission food takes the central
role b/c it can be contaminated via
– polluted water
– Dirty hands
– Contaminated soil
– Flies
• The five “5Fs” play an important role
(finger, flies, food, fomites and fluid)
classifications of feco-oral transmitted diseases
1. Diseases as a result of Facaly
contaminated Water and food
2. Diseases as a result of Feces Mainly in
Soil
classifications of feco-oral transmitted diseases
1. Diseases as a result of Facaly
contaminated Water and food
• The diseases in this group are mainly
transmitted through faecally contaminated
water and food
• Infective agents enter the body through
– Ingestion of contaminated food or water
– Using contaminated eating utensils
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1. Typhoid fever/ enteric fever
• Definition: A systemic infectious disease
characterized by high continuous fever, malaise
and involvement of lymphoid tissues.
• Acute infectious disease unique for human
• Caused by Salmonella Typhi
• In both endemic areas and in large outbreaks,
children and young adults are more affected
• Transmitted by ingestion of faecally contaminated
food or water
• The highest incidence (most large outbreaks) are
waterborne
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• S. Typhi causes disease only in humans; it
has no known animal reservoir
• Mode of transmission- By water and food
contaminated by feces of patients and
carriers. Flies may infect foods in which the
organisms then multiply to achieve an
infective dose.
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• Incubation period is usually 1-3 weeks
• Period of communicability
– From first week to throughout convalescence
– 10% continue shedding for three months
after the onset of symptoms
– 2–5% of infected people become chronic
carriers in the gall bladder
• Chronic carriers are greatly involved in the
spread of the disease
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Clinical features
• Daily increasing fever in step ladder
pattern for the first one week and then
become persistent
• headache, abdominal cramping
• Initial diarrhea followed by constipation
in adults
• Relative bradycardia
• Infected food handlers present the primary
hazard
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Diagnosis and management
• Diagnosis
– Isolation of S. Typhi by culture
– widal test (O and H antigens)
• O(somatic antigen– shows recent infection)
• H(flagellar antigen – may show past infection)
• Treatment
– Ampicillin or co-trimoxazole for carriers and mild
cases.
– Chloramphenicol or ciprofloxacin or ceftriaxone for
seriously ill patients.
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Prevention and control measures
• Health education on hand washing
• clean water(Chlorinating the water supply)
• Sanitary disposal of faeces and control of
flies
• Early detection and treatment of cases
• Promoting food hygiene should focus on
hand washing among food handlers
• Regular check up of food handlers
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2. Bacillary Dysentery (Shigellosis)
• Definition
– An acute bacterial disease involving the
large and distal small intestine, caused by
the bacteria of the genus shigella.
• acute bloody diarrhoea
• Shigella is the only cause of large-scale
epidemics of dysentery
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• Reservoir-Humans
• Mode of transmission-Mainly by direct or
indirect fecal-oral transmission from a
patient or carrier
• Incubation period-12 hours-4 days (1-3
days)
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Clinical features
• Begins with acute non-bloody diarrhoea
• Bloody diarrhoea with severe cramps, fever, vomiting,
and tenesmus (rectal pain)
• Uninterrupted excretion (10 to 30 times/day) of small
volume stools consisting of blood, mucus and pus
with increasing tenesmus and abdominal cramps
• In children, more exacerbated manifestation with
temperatures up to 40°–41°C and more severe
anorexia and watery diarrhea
• mild-moderate dehydration
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Diagnosis and treatment
• Based on clinical grounds(small,
oderless, dark stool)
• Stool microscopy (presence of pus cells)
• Stool culture confirms the diagnosis
• Treatment
1. Fluid and electrolyte replacement
2. Co-trimoxazole in severe cases or Nalidixic acid
in the case of resistance
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Prevention and control
• Detection of carriers and treatment of sick
• Hand washing after toilet
• Control of flies
• Adequate and safe water supply
• Proper excreta disposal
3. CHOLERA
• Definition
An acute illness caused by an enterotoxin
elaborated by vibrio cholerae
Symptoms: profuse watery ("rice water")
stools; occasional vomiting,
Severely ill patients are cyanotic, have
sunken eyes and cheeks, scaphoid
abdomen, poor skin turgor, and absent pulse,
rapid dehydration, and circulatory collapse
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• Reservoir
– Humans
• Source
– feces and vomitus of infected person
• Incubation period
– from a few hours to 5 days, usually 2-3
days.
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Transmission
• Ingestion of food or water contaminated
with feces or vomitus of cases
• occasionally feces of carriers
• Consumption of raw or improperly cooked
seafood, and other foods contaminated
with seawater
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In untreated cases
• Rapid dehydration
• Acidosis
• circulatory collapse
• hypoglycemia in children
• renal failure can rapidly lead to death
within a few hours of onset
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Diagnosis
• clinically
• Confirmed by culturing V. cholerae
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Specific treatment
• Death from cholera is due to hypovolemic shock
• The cornerstone of treatment is timely and
adequate rehydration
• Prompt replacement of fluids and electrolytes
– Rapid IV infusions of large amounts
– Isotonic saline solutions alternating with isotonic sodium
bicarbonate or sodium lactate.
• Antibiotics like tetracycline dramatically reduce the
duration and volume of diarrhea resulting in early
eradication of vibrio cholerae.
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Prevention and control
1. Case treatment
2. Safe disposal of human excreta and
control of flies
3. Safe public water supply
4. Handwashing and sanitary handling of
food
5. Control and management of contact cases
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4. AMOEBIASIS(Amebic dysentery)
• Definition
– An infection due to a protozoan parasite
that causes intestinal or extra-intestinal
disease.
• Infectious agent
– Entamoeba histolytica, a parasitic
organism
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• Reservoir—Humans
• Mode of transmission— ingestion of
faecally contaminated food or water
containing chlorine resistant amoebic
cysts
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Clinical features
• Starts with a prodormal episode of diarrhea,
abdominal cramps, nausea, vomiting and
tenesmus.
• With dysentery, feces are generally watery,
containing mucus and blood.
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Diagnosis
• Demonstration of etamoeba histolytica
cyst or trophozoite in stool
Treatment
• Metronidazole
• Tinidazole
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Preventive measures
1) Educate on personal hygiene, particularly
in
sanitary disposal of feces
Hand washing after defecation and before
preparing or eating food
2) Disseminate information regarding the
risks involved in eating unclean or
uncooked fruits and vegetables and in
drinking water of questionable purity
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3) Protect public water supplies from fecal
contamination
Sand filtration of water removes nearly all
cysts
Water of undetermined quality can be made
safe by boiling for 1 minute (at least 10
minutes at high altitudes)
Chlorination of water as generally practiced in
municipal water treatment does not always kill
cysts
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5. GIARDIASIS
• Definition
A protozoan infection principally of the upper
small intestine
• Agent
G. lamblia
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Clinical Manifestations
• Most infected persons are asymptomatic
• In some pts fulminant diarrhea and
malabsorption
• Symptoms may develop suddenly or gradually
• Infection principally involves upper small bowel
• Prominent early symptoms include abdominal
pain, bloating, belching, flatus, nausea, vomiting
;frequent, loose, pale, fatty, malodorous stools,
• Malabsorption of fats or of fat-soluble
vitamins
• Although diarrhea is common, upper
intestinal manifestations such as nausea,
vomiting, bloating, and abdominal pain
may predominate
• Diarrhea is not necessarily prominent, but
increased flatus, loose stools, belching,
and weight loss usually occurs
Reservoir—Humans
Mode of transmission—Person-to-person
transmission occurs by hand-to-mouth
transfer of cysts from the feces
• More often from faecally contaminated
food
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• Chlorine used in routine water treatment
do not kill Giardia cysts
Incubation period—Usually 3–25 days or
longer
Period of communicability—Entire
period of infection
Diagnosis: Microscopic examination of
fecal specimens
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Dx and treatment
• Diagnosis
Demonstration of Giardia lamblia cyst or
trophozoite in feces
• Treatment
Metronidazole or Tinidazole
Methods of control
A. Preventive measures
1) Educate families in personal hygiene and
the need for washing hands before
handling food, before eating and after
toilet use
2) Filter public water supplies exposed to
human or animal fecal contamination
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3) Protect public water supplies against
contamination with human and animal
feces
4) Dispose of feces in a sanitary manner
5) Boil emergency water supplies
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6. VIRAL HEPATITIS A
• Infectious agent—Hepatitis A virus (HAV)
• Reservoir—Humans
• Mode of transmission—Person-to-person
by the fecal-oral route
• Incubation period—Average 28 –30 days
Period of communicability— maximum
infectivity --the later half of incubation
• Most cases are probably noninfectious after
the first week of jaundice
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Clinical manifestation
• Abrupt onset of fever, malaise, anorexia,
nausea and abdominal discomfort,
followed in few days by jaundice.
• Complete recovery without sequel or
recurrence as a rule.
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Dx and management
• Diagnosis
– Based on clinical and epidemiological grounds
– Demonstration of IgM (IgM anti-HAV) in the serum
of acutely or recently ill patients.
• Treatment
– There is no specific treatment for viral hepatitis
and some individuals recover naturally
– Symptomatic: rest, diet, rehydration, tranquillizers
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Preventive measures
1. Educate the public careful hand washing
and sanitary disposal of feces
2. Provide proper water treatment
(chlorination) and sewage disposal
3. There are at least 4 inactivated vaccines
on the market
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2. Feces Mainly in Soil
• The diseases in this category are mainly
transmitted through fecal contamination
of soil
• These infections are acquired through
man’s exposure to faecally contaminated
soil
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1. Ascariasis
• Definition
– A helminthic infection of the small intestine
generally associated with few or no symptoms
• Infectious agent: Ascaris lumbricoides
• Reservoir—Humans; ascarid eggs in soil
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Mode of transmission
Ingestion of infective eggs from soil
contaminated with human feces or
from uncooked vegetables contaminated with
soil containing infective eggs
but not directly from person to person or
from fresh feces
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• Incubation period-4-8 weeks
• Period of communicability-As long as
mature fertilized female worms live in the
intestine
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Clinical Manifestation
• Live worms, passed in stools or from the
mouth, anus, or nose first sign
• Migrant larvae may cause itching,
wheezing, dyspnea, fever, cough
productive of bloody sputum
• Heavy parasite burdens may aggravate
nutritional deficiency
• Abdominal pain may arise from bowel
obstruction by a bolus of worms
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Diagnosis and Rx
• Microscopic identification of eggs in feces
• Adult worms passed from anus, mouth or
nose
Treatment
1. Albendazole or
2. Mebendazole or
3. Piperazine or
4. Levamisole
Prevention and control
1. Treatment of cases
2. Educate on latrine construction for
sanitary disposal of feces
3. Prevent soil contamination in areas
where children play
4. Promote good personal hygiene (hand
washing)
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2. Strongyloidiasis
Definition
An often asymptomatic helminthic infection
of the duodenum and upper jejunum.
Infectious agent: Strongyloides stercolaris
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• Period of communicability-As long as
living worms remain in the intestine; up to
35 years in cases of auto-infection
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• Reservoir-Human and soil
• Mode of transmission-Infective
(filariform) larvae develop in feces or moist
soil contaminated with feces
• penetrate the skin and enter the venous
circulation
• Incubation period-2-4 weeks
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Transmission and life cycle of Strongyloides stercoralis
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Clinical manifestation
• Pneumonia occurs during heavy larval
migration.
• Mild peptic ulcer like epigastric discomfort to
severe watery diarrhea.
• Heavy infection may result in malabsorption
syndrome.
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Dx and Tx
Diagnosis
• Identification of larvae in stool specimen
Treatment
1. Albendazole or
2. Thiabendazole
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Prevention and control
1. Proper disposal of human excreta (feces)
2. Personal hygiene including use of
footwear
3. Case treatment
3. Hookworm disease
Definition
• A common chronic parasitic infection with
a variety of symptoms usually in proportion
of the degree of anemia
Infectious agent
• Ancylostoma duodenale and
• Necator americanus
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• Reservoir-Humans
• Mode of transmission-Through skin
penetration by the infective larvae
• Incubation period- a few weeks to many
months depending on intensity of infection
and iron intake of the host
• Period of communicability- contaminate
the soil for several years
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Transmission and life cycle of Hookworms
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Clinical Manifestation
The clinical manifestation is related to:
1. Larval migration of the skin
– Produces transient, localized maculopapular rash
– associated with itching called ground itch
2. Migration of larva to the lungs.
– Produces cough, wheezing and transient pneumonitis
3. Blood sucking
– Light infection-no symptoms
– Heavy infection-result in symptoms of peptic ulcer disease like
epigastric pain and tenderness
– major impact of hookworm infection is on nutritional status
– The daily losses of blood, iron, and albumin can lead to anemia
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Diagnosis and Rx
Demonstration of eggs in stool
specimen.
Treatment
1. Mebendazole
2. Albendazole
3. Levamisole
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Prevention and control
1. Sanitary disposal of feces
2. properly cleaning and cooking food,
hand washing
2. Wearing of shoes
3. Case treatment
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Thank you so much!!!
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