ACUTE
DIARRHOEAL
DISEASES
CLINICAL TYPES OF DIARRHOEAL
DISEASE
Epidemiology
• Diarrhoea is still a major killer of children under 5. although its toll has dropped by
a third over the past decade. It killed more than 1,300 children under 5 years of
age every day in 2016.
• It accounts for 8 per cent of all under-five deaths - a loss of more than 0.48 million
child lives jn 2016.
• Comparing estimates of the current global burden of diarrhoeal disease with
previously published estimates, highlights that the incidence of diarrhoea have not
changed much, although overall diarrhoeal mortality has declined.
• For children aged under 5 years, a median of 3 episodes of diarrhoea occurred per
child-year, which is similar to that reported previously. The current estimates in
under-five children suggest that there are about 1. 7 billion episodes of diarrhoea
per year with 123 million clinic visits annually and 9 million hospitalizations
worldwide, with a loss of 62 million disability-adjusted life years (DALYs)
Infections Causing Diarrhoea
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Mode of Transmission
Most of the pathogenic organisms that cause diarrhea and all the
pathogens that are known to be major causes of diarrhoea in many
countries, are transmitted primarily or exclusively by the faecal- oral
route.
Faecal- oral transmission may be water-borne; food-borne, or direct
transmission which implies an array of other faecal-oral routes such as
via fingers, or fomites, or dirt which may be ingested by young children
Assessment of
Dehydration
Interventions
Key measures to reduce the number of cases of diarrhoea include:
• Access to safe drinking water.
• Improved sanitation.
• Good personal and food hygiene.
• Health education about how infections spread.
Key measures to treat diarrhoea include:
• Giving more fluids than usual, including oral rehydration salts solution, to
prevent dehydration.
• Continue feeding.
• Consulting a health worker if there are signs of dehydration or other
problems.
Food
Poisoning
Cholera
Key Facts
• Cholera is an acute secretory diarrheal illness caused by toxin-producing strains of the gram-negative bacterium Vibrio
cholerae. Severe cholera is characterized by profound fluid and electrolyte losses in the stool and the rapid
development of hypovolemic shock, often within 24 hours from the initial onset of vomiting and diarrhea.
• V. cholerae is a diverse species and includes pathogenic and non-pathogenic variants. Only cholera toxin-producing
(toxigenic) strains of V. cholerae are associated with cholera. V. cholerae is classified serologically; of over 200
serological groups identified, only 2 (V. cholerae O1 and O139) have caused cholera epidemics.
• Cholera primarily occurs in settings where there is inadequate access to clean water and sanitation. Cholera is endemic
in approximately 50 countries (defined as having reported cholera cases in at least three of the five past years), mostly
in Africa and Asia
Transmission
• V. cholerae infection is primarily acquired by ingesting contaminated food or water. In endemic regions, V.
cholerae in the water are an important reservoir of the organism. Because V. cholerae can live on chitinous
plankton, filtration of water through coarse cloth can reduce the incidence of cholera in endemic areas;
• While exposure to environmental V. cholerae is important, direct person-to-person transmission is also
thought to play a role in transmission. Individuals with severe cholera can excrete as many as 10 10 to
1012 organisms per liter of stool.
• Organisms that were recently shed from infected individuals appear to be transiently more infectious than
organisms isolated from the aquatic environment;
• Mathematical models suggest that person-to-person transmission of human-shed, hyper-infectious V.
cholerae is essential for the rapid propagation of cholera that is observed during epidemics
CLINICAL
MANIFESTATIONS
Incubation period — Cholera has a typical incubation period of one to two days;
However, the incubation period of cholera varies with host susceptibility and inoculum size and can range
from several hours to as long as three to five days.
Diarrhea — While mild cases of V. cholerae infection may be clinically indistinguishable from other
causes of diarrheal illness, the profound and rapid loss of fluid and electrolytes mark severe cholera as
a clinically distinct entity. Cholera stools may contain fecal matter and bile in the early phases of
disease. However, the characteristic symptom of severe cholera ("cholera gravis") is the passage of
profuse "rice-water" stool, a watery stool with flecks of mucous;
In patients treated with proper rehydration, diarrhea is most severe during the first two days and ends after four to six
days. The total volume loss over the course of illness may be up to 100 percent of body weight
Mortality - The mortality of cholera in untreated patients may reach 50 to 70 percent Administration
of appropriate rehydration therapy can reduce the mortality of severe cholera to less than 0.5 percent
Most cases of cholera are presumptively diagnosed, based on consistent clinical
manifestations. Cholera is a potential cause of any case of severe watery diarrhea with or
without vomiting, especially in patients who develop rapid and severe volume depletion.
The diagnosis can be confirmed by isolation from stool cultures performed on specific
selective media. Rapid tests such as stool dipsticks or darkfield microscopy can support
the diagnosis in settings where stool culture is not readily available.
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PREVENTION
Preventing transmission — A clean water supply and appropriate sanitation are the cornerstones of
cholera prevention. However, these can be difficult to achieve in resource-limited settings. Over 2
billion people lack access to clean water or sanitation and are thus at risk for waterborne diseases
such as cholera .
Breastfeeding of young infants in endemic settings protects against cholera and other enteric
infections Additionally, filtering water through a sari cloth before drinking has been demonstrated to
be effective in preventing V. cholerae infection acquired from surface water sources;
For residents in endemic areas — WHO recommends the inclusion of oral cholera vaccines in cholera
control programs in endemic areas, in conjunction with other prevention and control strategies. WHO
also recommends that oral cholera vaccines be considered as part of an integrated control program in
areas at risk for a cholera outbreak. The optimal use of cholera vaccines after an outbreak remains an
area of active investigation, although observational data suggest that vaccination following the onset of
an epidemic is effective in reducing the risk of cholera, even if only a single dose can be given
