( ACUTE DIARRHEA)

..

(acute diarrhea)

1. (Infective diarrhea)

1.1 (food poinsoning)
(enterotoxin)
(incubation period )

- 1-4

48

Clostidium
botulinum, Staphylococcus, Clostidium perfringens,
Bacillus cereus

1.2

(bacteria) (virus)
(parasite).

(Vibrio cholera),
(Vibrio parahemolyticus),

(shigella), salmonella,
Enteropathogenic Eschericia coli(EPEC),
Yersinia enterocolitica Campylobacter.

Rota virus, Norwalk agent,
Echo virus




(Acquired Immune Deficiency
Syndrome)
(leukemia)

candida,

cryptosporirium

(Entamoeba histolytica),
Giadia lamblia, Capillaria philippinensis


(Amebic
liver abscess)

2. (non-infective diarrhea)


(colchicin),
(digitalis), (erythromycin,
tetracyclin) (magnesium sulfate)

Pseudomembranous enterocolitis


Clostidium perfringen enterotoxin

Necrotizing enterocolitis
- Bacterial Food poisoning (Harrisons Textbook
of Medicine, 13th edition)
- Gastrointestinal pathogens causing acute
diarrhea (Harrisons Textbook of Medicine, 13th
edition)

:
-

1-4
-


-

(laboratory investigations):

1.


2.
(supportive)
(specific treatment)

1.

:
-

-
-

-

- (stool exam)


(shooting appearance)

- (electrolytes)
-

-

- Enterotoxin enterotoxin
Clostidium perfringen, staphylococcus
- (complete blood count)
(shigellosis)
(acute appendicitis),
(peritonitis)
- (plan abdomen)

3. (severe dehydration)

(poor skin turgor)


8-10

(acid-base imbalance):

(potassium)
(bicarbonate)
hypokalemic acidosis metabolic acidosis

3. (supportive)
(specific treatment)

2.
:

(dehydration)
1. (mild dehydration),

3-5

2. (moderate dehydration)



5-7

:




24

CHOLERA
- Tetracycline 50mg/kg/d in 4 divided doses for 2-3 days
500 mg q.i.d. for 2-3 days or
- Furazolidone 5 mg/kg/d in 4 divided doses for 2-3 days
100 mg q.i.d. for 3 days
- Erythromycin 30 mg/kg/d in 3 divided doses for 3 days
250 mg in divided doses for 3 days
SHIGELLA
- Ampicillin 100 mg/kg/d in 4 divided doses for 5 days
- TMP/SMX TMP 10 mg/kg/d in 2 divided doses for 5
days
- TMP 160 mg/kg/d in 2 divided doses for 5 days or
- Nalidixic acid 55 mg/kg/d in 4 divided doses for 5 days
(all ages)
- Tetracycline 50 mg/kg/d in 4 divided doses for 5 days
(all ages)

750 ( )

Acute Intestinal

- Metronidazole 30 mg/kg/d in 4 divided doses for 5-10 days

- Amoebiasis 750 mg/kg/d in 3 divided doses for 5-10 days
:
- Acute Giardiasis Metronidazole 15 mg/kg/d in 4 divided
doses for 5 days 250 mg/kg/d in 3 divided doses for 5 days
tetracyclin metronidazole

REFERENCES:
Harrisons Textbook of Medicine, 13th edition 1994
WHO/CDD/SER/80.2 REV. 1 (1984)
ANTIMICROBIALS USED IN THE

TREATMENT OF SPECIFIC CAUSES OF

ACUTE DIARRHEA
Organism Drug Dose

Mechanism

Location Illness

Proximal
Noninflammatory
Watery
small
(enterotoxin)
diarrhea
bowel

Stool findings

Examples of pathogens involved

Vc
ETEC(LT and/or ST)
Clos perfringens
Bacillus cereus
Stap aureus
A hydrophila
No fecal leukocytes
P shigelloides
Rotavirus
Norwalk-like viruses
Enteric adenoviruses
Giardia lamblia
Cryptosporidium

Inflammatory
(invasive or
cytotoxic)

Colon

.shigella sp.
Salm enteritidis
Camp jejuni
EHEC
Fecal
EIEC
Dysentery polymorphonuclear
Vp
leukocytes
C difficile
? A hydrophila
? P shigelloides
E histolytica

Penetrating

Distal
small
bowel

Enteric
fever

Fecal mononuclear Salm typhi

leukocytes
Yersinia enterocolitica

Organisms

Symptoms

Common food sources

1 - 6 hours incubation
Staphylococcus aureus
Bacillus cereus

Ham, poultry, potato and egg salad, mayonnaise, cream

Nausea, vomiting, diarrhea
pastries
Nausea, vomiting, diarrhea
Fried rice

8 - 16 hours incubation

Clostidium perfringens
Bacillus cereus

Abdominal cramps,
diarrhea (vomiting rare)
Abdominal cramps,
diarrhea (vomiting rare)

Beef, poultry, legumes, gravies

Meats, vegetables, dried beans, cereals

Watery diarrhea
Watery diarrhea
Inflammatory diarrhea
Dysentery
Dysentery

Shelfish
Salads, cheese, meats, water
Beef, poultry, eggs, dairy products
Potato and egg salad, lettuce, raw vegetables
Mollusks, crustaceans

16 hours incubation
Vibrio cholera
Enterotoxigenic E. coli
Salmonella sp.
Shigella sp.
Vibrio parahemolyticus