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405090079
Diarrhea
DEFINITION
Diarrhea is loosely defined as passage of
abnormally liquid or unformed stools at
an increased frequency.
For adults on a typical Western diet, stool
weight > 200 g/d can generally be
considered diarrheal.
Source: Harrisons ,17 th edition, vol 1,
page 247
ETIOLOGY
Enteral Infection
Infection
Caused
of diare
Helmin : Ascaris,
Trichuris, Oxyyuris,
Strongyloides
Fungal : Candida albicans
Incub
ation
Duratio
n
Vomiting
Fever
Abdomina
l Pain
1-7 d
4-8 d
Yes
Low
No
8-10 d
5-12 d
Delayed
Low
No
Norovirus
1-2 d
2d
Yes
No
No
Astrovirus
1-2 d
4-8 d
+/-
+/-
No
Calicivirus
1-4 d
4-8 d
Yes
+/-
No
Aeromonas
species
None
0-2 wk
+/-
+/-
No
Campylobact
er species
2-4 d
5-7 d
No
Yes
Yes
Variabl
e
Variable
No
Few
Few
1d
Mild
No
Yes
Organism
Rotavirus
Adenovirus
C difficile
Minima
C perfringens
l
Incubati
on
Duratio
n
Vomitin
g
Fever
Abdomina
l Pain
Enterohemor
rhagic E coli
1-8 d
3-6 d
No
+/-
Yes
Enterotoxige
nic E coli
1-3 d
3-5 d
Yes
Low
Yes
Plesiomonas
species
None
0-2 wk
+/-
+/-
+/-
Salmonella
species
0-3 d
2-7 d
Yes
Yes
Yes
Shigella
species
0-2 d
2-5 d
No
High
Yes
Vibrio
species
0-1 d
5-7 d
Yes
No
Yes
Yenterocoliti
ca
None
1-46 d
Yes
Yes
Yes
Giardia
species
2 wk
1+ wk
No
No
Yes
5-21 d
Months
No
Low
Yes
5-7 d
1-2+ wk
No
Yes
No
Organism
Cryptosporid
ium species
Entamoeba
Vibrio cholera
Salmonella
Shigella
Campylobacter jejuni
E. coli
1. E coli Enteropatogenik
(EPEC)
Cause by baby`s,especially in
developing country
Wattery diarhea,self-limited but can
be chronic diarhea
2. E coli Enterotoksigenik
(ETEC)
Traveller`s diarhea
Strain which produces eksotoksin which
hot resistantsubunit B binds at
brushborers epitelial intestine Gangliosida
dan facilitate influx subunit A into cell,then
activated adenil cyclaseincreased Camp
consentrationwater&clhypersecretionblocked natrium
reabsroptionintestine lumen
strachinghypermotilitydiarhea
2. E coli Enterotoksigenik
(ETEC)
Strain which produces
enterotoksin,hot resistant sTa(BM
1500-4000)
sTa activate Guanil cyclase in
enteric epitel cell and stimulate fluid
secretions
3. E coli Enterohemoragik
(EHEC)
Produces verotoxin
Caused colitic ulcerative, severe
diarhea, hemolitic uremic syndrom.
4. E coli Enteroagregratif
(EACE)
Caused acute and chronic diarhea et
developing country
Transmission by foods
Classification
Duration:
Patophysiology
Osmotic diarrhea
Secretory diarrhea
Inflammatory and Infectious Diarrhea
Diarrhea Associated with Deranged Motility
Diarrhea
Pathophysiology
1.Osmotic diarrhea
2.Secretory diarrhea
3.Inflammatory and Infectious Diarrhea
4.Diarrhea Associated with Deranged
Motility
Diarrhea
1.Osmotic Diarrhea
The Osmotic Diarrhea typically results
from one of two situations:
Ingestion of a poorly absorbed
substrate
Malabsorption
Diarrhea
Ingestion of a poorly absorbed
substrate
Ingested poorly absorbed substarte
Mannitol or sorbitol, epson salt
(MgSO4) and some antacids (MgOH2)
Diarrhea
Malabsorption:
Lactose intolerance.
Ingested lactose
Diarrhea
2. Secretory Diarrhea
Large volumes of water are normally secreted into the small intestinal lumen,
but a large majority of this water is efficienty absorbed before reaching the
large intestine.
Patophysioloy :
Example : Vibrio Cholerae infection
The Vibrio cholerae produces cholera toxin
Diarrhea
Diarrhea
Exposure to toxins from several other types of bacteria
(e.g. E. coli heat-labile toxin) induce the same series of
steps and massive secretory diarrhea .
In addition to bacterial toxins, a large number of other
agents can induce secretory diarrhea by turning on
the intestinal secretory machinery, including:
Some laxatives hormones secreted by certain types of
tumors (e.g. vasoactive intestinal peptide)
A broad range of drugs (e.g. some types of asthma
medications, antidepressants, cardiac drugs)
Certain metals
Organic toxins
Plant products (e.g. arsenic, insecticides, mushroom
toxins, caffeine)
Diarrhea
3. Inflammatory and Infectious Diarrhea
Examples of pathogens :
Bacteria :Salmonella, E. coli, Campylobacter
Viruses: Cytomegalovirus (immunocompromised)
Protozoa:,Entamoeba histolitica and Balantidium coli
Helminth: Schistosoma sp. ,Trichuris trichura
Patophysiology :
Infected of pathogens
Stimulate secretion
Inflammatory diarrhea.
Diarrhea
Disruption of the epithelium of the
intestine microbial or viral pathogens
infection exudation of serum and blood
into the lumen and associated with
widespread destruction of absorptive
epitheliumabsorption of water occurs
very inefficiently diarrhea.
Reactive oxygen species from leukocytes
damage or kill intestinal epithelial cells
replaced with immature cells deficient
in the brush border enyzmes and
transporters necessary for absorption of
Diarrhea
4. Diarrhea Associated with
Deranged Motility
In order for nutrients and water to be
efficiently absorbed, the intestinal
contents must be adequately
exposed to the mucosal epithelium
and retained long enough to allow
absorption.
Disorders in motility than accelerate
transit time decrease
D. Pathophysiology
Symptoms
Weepy
Anxious
Decreased appetite & weight
Frequent, loose, watery
stools
Abdominal cramps
Abdominal pain
Fever
Blood in the stool
Bloating
Dehydration signs (if lost
much fluid)
Nausea and vomiting
Physical
The following may be observed:
Dehydration
Dehydration is the principal cause of morbidity and mortality.
Assess every patient with diarrhea for signs, symptoms, and
severity.
Lethargy, depressed consciousness, sunken anterior fontanel, dry
mucous membranes, sunken eyes, lack of tears, poor skin turgor,
and delayed capillary refill are obvious and important signs of
dehydration.
Abdominal pain
Nonspecific nonfocal abdominal pain and cramping are common with
some organisms.
Pain usually does not increase with palpation.
With focal abdominal pain worsened by palpation, rebound
tenderness, or guarding, be alert for possible complications or for
another noninfectious diagnosis.
Diarrhea
F. Diarrhea Treat
Pharmacology
1.Opiate-like antidiarrheae agents
2.Absorbents
3.Colloidal bismuth compound
4.Bile salt binding resins
5.Hormon
6.Antibiotik
THERAPY
Absorbents
Absorbents are compounds that absorb
water. Absorbents that are taken orally
bind water in the small intestine and colon
and make diarrheal stools less watery.
They also may bind toxic chemicals
produced by bacteria that cause the small
intestine to secrete fluid; however, the
importance of toxin binding in reducing
diarrhea is unclear.
The two main absorbents are attapulgite
and polycarbophil, and they are both
available without prescriptions.
Bismuth compounds.
Many bismuth-containing preparations are
available around the world. Bismuth subsalicylate
(Pepto-Bismol) is available in the United States.
It contains two potentially active ingredients,
bismuth and salicylate (aspirin). It is not clear how
effective bismuth compounds are, except in
traveler's diarrhea and the treatment of H. pylori
infection of the stomach where they have been
shown to be effective.
It also is not clear how bismuth subsalicylate
might work. It is thought to have some antibioticlike properties that affect bacteria that cause
diarrhea. The salicylate is anti-inflammatory and
could reduce secretion of water by reducing
inflammation.
Bismuth also might directly reduce the secretion
of water by the intestine.
Tetracycline (Sumycin)
Treats gram-positive and gram-negative organisms as well as mycoplasmal,
chlamydial, and rickettsial infections.
Vancomycin (Vancocin)
Effective treatment (when PO) for antibiotic-associated colitis due to C difficile.
Quinacrine (Atabrine)
Very effective antiparasitic against Giardia species.
Non-pharmacology
Try a clear liquid diet (one that includes water,
weak tea, apple juice, peach nectar, clear broth,
popsicles, and gelatin with no solids added) as
soon as diarrhea starts or when you feel that its
going to start.
Avoid acidic drinks, such as tomato juice, citrus
juices, and fizzy soft drinks.
When the diarrhea starts to improve, try eating
small amounts of foods that are easy to digest
such as rice, bananas, applesauce, yogurt,
mashed potatoes, low-fat cottage cheese, and dry
toast. If the diarrhea keeps getting better after a
day or 2, start small regular meals.
Rotavirus vaccine: active immunization to
increase resistance to infection rotavirus
Complications
Dehydration and electrolyte
imbalance
(abnormal amounts of sodium,
potassium, and acid in the blood)
Weight loss
Seizures
Patient Education
Fever
and general
malaise,
Clinical
Symptoms
may evolve
sometimes
without
GI symptoms
Fever
and general
malaise,
sometimes without GI symptoms
When present, GI symptoms include
bloody
diarrhea,
and
When
present,
GI abdominal
symptoms pain
include
weightdiarrhea,
loss.
bloody
abdominal pain and
weight loss.
Campylobacter: Diagnostics
Campylobacter bacilli found in stool
culture
Campylobacter
Campylobacter
Entamoeba histolytica
Colitis
Bloody stools
Cramps
Can be asymptomatic
Entamoeba histolytica
Diagnostics
Entamoeba histolytica
Management and Treatment
Entamoeba histolytica
Unique features, Caveats
Giardia lamblia
Enteritis
Watery diarrhea malabsorption
Bloating
Flatulence
Giardia lamblia
Diagnostics
Giardia lamblia
Management and Treatment
Giardia lamblia
Unique features, Caveats
Isospora belli
Giardia lamblia
Diagnostics
Giardia lamblia
Management and Treatment
Microsporidium
Giardia lamblia
Diagnostics
Fresh stool microscopy with modified
trichrome stain
Spores present in stool exam
Giardia lamblia
Unique features, Caveats
Helminthic infection:
Strongyloides stercoralis
Presenting Signs and Symptoms
Clinical Symptoms may evolve
Strongyloides stercoralis
Diagnostics
Strongyloides stercoralis
Management and Treatment
Ivermectin 12 mg daily for 3 days. This drug
is also the drug of choice for the treatment
of systemic strongyloidiasis
An alternative treatment is albendazole 400
mg bid x 5 days
Strongyloides stercoralis
Unique features, Caveats
In immuno-compromised patients,
strongyloides can cause overwhelming
infection.This serious complication is called
strongyloides hyper-infection syndrome
and has a high case-fatality rate
Disseminated strongyloidiasis and heavy
worm loads can occur in patients with HIV,
but the full-blown hyper-infection syndrome is
less common
The likelihood of developing the hyperinfection syndrome is also increased in
patients taking high-dose steroids
Viral infectious
ROTAVIRUS
Most common cause of viral gastroenteritis.
Usually occurs between 3 months and 3yrs of age.
Although most common during wintermonths, it may
occur year round.
Clinical manifestations:
Diarrhea
Fever and vomiting.
Blood is not usually found in stools
Usually lasts for few days and up to 1 wk.
Viral infectious
ADENOVIRUS
Adenoviruses may be associated with acute gastroenteritis,
especially in children <2 yrsof age.
Illness usually occurs during summer.
Diagnosed by: stool viral culture.
NORWALK-VIRUS
Usually cause epidemics in school-aged children or adults.
Infection usually comes from contaminated wateror food.
Clinical manifestations: (usually last several days)
Cramping abdominal pain
vomiting,and low-grade fever
Diagnosed by: stool viral culture.
Ascaris lumbricoides
Clinical manifestations:
Can be asymptomatic
Mild diarrhea
Intermittent epigastric pain
Anorexia
Vomiting
Hookworm Infection
Adult hookworms (N. americanus and A. duodenale)
Clinical manifestations:
Red, pruritic lesions on feetor between toes where larvae
penetrate.
Diarrhea
Vomiting
Abdominal pain
Anemia from GI blood loss
Peripheral eosinophilia.
Trichuris trichiura
T. trichiura,4-cm long whipworm, occurs most commonly
in tropical areas but is also found in subtropical areas
(e.g., southern U.S.).
Clinical manifestations:
Fungal Infections
Oral candidiasis is a fungal infection
of the oral mucosa.it is most
common in newborn & infants.
Fungal infectious
Candida sp
C. albicans is most common cause of Candida enteritis
Characterized by watery diarrhea and abdominal pain.
Predisposing factors :prolonged antibiotic or
immunosuppressive therapy yeast forms are
ubiquitous and occur in fecal flora of normal persons, their
presence alone is not diagnostic.
Definitive diagnosis requires demonstration of intestinal
mucosal invasion by Candida on biopsy or isolation of
Candida from ulcerative lesions.
Red Flags
Symptoms of dehydration - excessive thirst, verydry
mouth, very little or no urination
Severe abdominal pain
Severe rectal pain
Blood in the stools, the stools are black
Temperature is over 39C (102 F)
A baby has not wet the diaper in over three hours
A child/baby is very sleepy, irritable, or unresponsive
A child/baby has a sunken abdomen
A child/baby has sunken eyes and/or cheeks
The child's/baby's skin does not flatten after being pinched
Typhoid fever
Transmission
S typhi has no nonhuman vectors. The
following are modes of transmission:
Oral transmission via food or beverages handled
by an individual who chronically sheds the
bacteria through stool or, less commonly, urine
Hand-to-mouth transmission after using a
contaminated toilet and neglecting hand hygiene
Oral transmission via sewage-contaminated water
or shellfish (especially in the developing world)
Epidemiology
With an estimated
1633 million cases
of annually
resulting in
216,000 deaths in
endemic areas
Its incidence is
highest in children
and young adults
between 5 and 19
years old
Incidence of typhoid
fever
Strongly endemic
Endemic
Sporadic cases
Mortality/Morbidity
With prompt and appropriate antibiotic therapy,
typhoid fever is typically a short-term febrile
illness requiring a median of 6 days of
hospitalization. Treated, it has few long-term
sequelae and a 0.2% risk of mortality.17
Untreated typhoid fever is a life-threatening
illness of several weeks' duration with longterm morbidity often involving the central
nervous system. The case fatality rate in the
United States in the pre-antibiotic era was 9%13%.20
Race
Typhoid fever has no racial predilection.
Sex
Fifty-four percent of typhoid fever cases in the
United States reported between 1999 and 2006
involved males.17
Pathophysiology
patogene
ingestio
n
stomach
Small
intestine
phagocytizat
ion
Intralumin
al
dendritic
cell
Macrophages
(whitin
intestinal
mucosa)
Ephitelia
M cell
Presentation to
..
Ordinary
ephitelia
cell
Macrophages
(whitin intestinal
mucosa)
Latency &
multiplication
thoraci
s
Lymph
nodes
Mesenteric
lymph nodes
splee
n
Bone
narrow
Systemic desease
Blood
stream
Target
organ
hepar
transmission
Stool
Gallblader
Urine
Incubat Week 1
ion
Week 2
Week 3
Systemic
Steplad
der
fever
pattern
or
insidiou
s onset
fever
Very
commo
na
Very common
Acute
high
fever
Very
rareb
Chills
Almost allc
Rigors
Uncommon
Anorexi
a
Almost all
Week 4
Post
Recover
y phase
or death
(15% of
untreate
d cases)
10%20%
relapse;
3%-4%
chronic
carriers;
longterm
neurolo
gic
sequela
e
(extrem
ely
rare);
gallblad
der
Diaphor
Very common
cancer
esis
Table 1. Incidence and Timing of Various Manifestations of Untreated
(RR=16
Typhoid Fever
7;
Gastrointestinal
Incubation
Week 1
Week 2
Constipation
Very
common
Common
Diarrhea
Rare
Bloating
with
tympany
Very
common
(84%)[30]
Diffuse mild
abdominal
pain
Very
common
Sharp right
lower
quadrant
pain
Rare
Gastrointest
inal
hemorrhage
Very rare;
usually
trace
intestinal
perforation
Hepatosplen
Week 3
Very common
Rare
Common
ETIOLOGY
Salmonella
Salmonella
Salmonella
Salmonella
typhi
Paratyphi A
paratyphi B
chloreasuis
Diagnose
Diagnose
LAB diagnose
Rutine check
WIDAL TEST
TUBEX test
Typhidot
TEST
IGM dipstick
test
Blood culture
Therapy
Non farmaco
Rest and therapy
Diet
farmaco
DOSIS
ES
Anemia aplastik
tiamfenikol
4x500 mg/Hari
Anemia aplastik
klotrimoksaz
ole
ampisilim
50-150 mg/KgBB
sefalosporin
Complication
Complicatio
n
-Bleeding intestinal
Intestinal
-Perforation
Non intestinal Hepatitis tifosa
Pankreatitis tifosa
Complication hematology
Miokarditis
neuropsikiatrik
PREVENTION
1 capsule
per oral
0.50 mL
ViCPS Intramuscul
ar Injection
2 weeks
2 weeks
Dosing
interval
2 days
Booster
Minimum
Needed
Age
Every...
6 years
5 years
2 years
Treatment of complication
3. Toxic myocarditis:
bed rest
cardiac muscle protection drugs,
dexamethasone, digoxin.
Differentials
Abdominal Abscess
Amebic Hepatic Abscesses
Appendicitis
Brucellosis
Dengue Fever
Influenza
Leishmaniasis
Malaria
Rickettsial diseases
Toxoplasmosis
Tuberculosis
Tularemia
Typhus
Malaria
Malaria, which predominantly occurs
in tropical areas, is a potentially lifethreatening disease caused by
infection with Plasmodium protozoa
transmitted by an infective female
Anopheles mosquito vector.
Causes
The 4 Plasmodium species known to
cause malaria include
P falciparum (the most deadly),
P vivax,
P ovale, and
P malariae.
A fifth species, P knowlesi, has recently
been identified in Southeast Asia as a
clinically significant pathogen in humans
P vivax
P ovale
P malariae
Yes
No
No
No
Multiplyinfected
RBCs
Often
Occasionally
Rare
Rare
Age of
infected
RBCs
RBCs of all
ages
Young RBCs
Young RBCs
Old RBCs
No
Yes
Yes
No
Findings
Only early
forms
present in
peripheral
blood
Schffner
dots
Other
features
Cells have
thin
Late
Infected
trophozoites RBCs
Bandlike
trophozoites
Malaria treatment
The following is a summary of general
recommendations for the treatment of malaria:
P falciparum malaria
Quinine-based therapy - Quinine (or quinidine) sulfate plus
doxycycline or clindamycin or pyrimethamine-sulfadoxine
Alternative therapies - Artemether-lumefantrine, atovaquoneproguanil or mefloquine
Dengue
Dengue is transmitted by mosquitoes
of the genus Aedes, which are widely
distributed in subtropical and tropical
areas of the world, and is classified
as a major global health threat by
the World Health Organization
Causes
Dengue infection is caused by 1 of
the 4 dengue viruses (ie, DENV-1,
DENV-2, DENV-3, DENV-4) and is
transmitted to humans by the bite of
an infected mosquito.
Physical
The PAHO has developed the
following case definitions for the
diagnosis of dengue fever and
dengue hemorrhagic fever or
dengue shock syndrome
Dengue fever
The clinical description of dengue fever is
an acute febrile illness of 2-7 days duration
associated with 2 or more of the following:
Severe headache
Retroorbital pain
Severe myalgias
Arthralgia
Characteristic rash
Hemorrhagic manifestations
Leukopenia
Imaging test:
Chest radiography: Right-sided pleural effusion is typical
Ultrasonography
Lab test :
Basic metabolic panel findings include : Hyponatremia,
Metabolic acidosis, Elevated BUN levels
Complete blood cell count findings include the following:
Leukopenia, often with lymphopenia, is observed near the end
of the febrile phase of illness.
A hematocrit level rise of greater than 20% is a sign of
hemoconcentration and precedes shock.
Thrombocytopenia has been demonstrated in up to 50% of
dengue fever cases.
Other Tests
Arterial blood gas should be assessed
in patients with severe cases to
assess pH, oxygenation, and
ventilation.
Medication
Aspirin, nonsteroidal antiinflammatory drugs (NSAIDs), and
corticosteroids should be avoided.
Analgesics/antipyretics
The treatment of dengue fever is
symptomatic and supportive in nature.
Bedrest and mild analgesic-antipyretic
therapy are often helpful in relieving
lethargy, malaise, and fever associated
with the disease.
Example :
Acetaminophen (Tylenol, Feverall)
Contraindications : Hypersensitivity, Hepatitis or
hepatic/renal dysfunction, alcoholism
Volume expanders
Plasma volume expanders are used in the treatment of
intravascular volume deficits or shock to restore
intravascular volume, blood pressure, and tissue perfusion.
Example:
Dextran 40 (Macrodex, LMD) ,
Contraindications: Hypersensitivity to dextran or corn products,
Pulmonary edema, severe bleeding disorders, severe CHF, severe
oliguria/anuria d/t renal dz, significant hemostatic defects, cardiac
decompensation
Hepatitis
Hepatitis (plural hepatitides) is the
inflammation of the liver and
characterized by the presence of
inflammatory cells in the tissue of
the organ.
Causes
Acute
Viral hepatitis: Hepatitis A, B, C, D, and E, Yellow fever, KIs-V,
adenoviruses
Non-viral infection : toxoplasma, Leptospira, Q fever, rocky
mountain spotted fever
Alcohol
Toxins : Amanita toxin in mushrooms, carbon tetrachloride,
asafetida
Drugs : Paracetamol, amoxycillin, antituberculosis medicines,
minocycline
Ischemic hepatitis
Pregnancy
Auto immune conditions, e.g., Systemic Lupus Erythematosus (SLE)
Metabolic diseases, e.g., Wilson's disease
Chronic
Alcohol
Drugs :
methyldopa
nitrofurantoin
isoniazid
ketoconazole
Symptoms
Complications
Esophageal varices (enlarged veins
in the wall of the esophagus that can
cause life-threatening bleeding)
Hepatic encephalopathy (confusion
and coma) and
Hepatorenal syndrome (kidney
dysfunction).
Shigella sp.
Group A: Shigella dysenteriae (or Shiga
bacillus, 13 serotypes) developed
country
Group B: Shigella flexneri (6 serotypes,
15 subtypes)
Group C: Shigella boydii (18 serotypes)
Group D: Shigella sonnei (1 serotype)
Epidemiology
International
Shigellosis occurs worldwide, and it tends to
occur whenever war, natural calamities (eg,
earthquakes, floods), or unhygienic living
conditions result in overcrowding and poor
sanitation.
S boydii and S dysenteriae occur more
commonly internationally.
Disease from Shigella species causes an
estimated 1 million deaths and 165 million
cases of diarrhea annually worldwide.
Invasion of the
Underlying Tissue
Causes
S sonnei and S flexneri cause 90% of
the cases of shigellosis.
S dysenteriae has produced epidemic
shigellosis.
Physical
Laboratory Test
Fecal leukocytes and erythrocytes
Mildly elevated hematocrit, sodium,
and urea nitrogen are indicative of
volume depletion in cases of
shigellosis.
Leukocytosis is rare.
Positive findings on stool culture of a
fresh fecal specimen
Gastroenteritis
Gastroenteritis is a condition that causes
irritation and inflammation of the stomach
and intestines
It can be transferred by contact with
contaminated food and water.
The inflammation is caused most often by
an infection from certain viruses or less
often by bacteria, their toxins (e.g. SEB),
parasites, or an adverse reaction to
something in the diet or medication.
Epidemiology
Every year, worldwide, rotavirus in
children under 5 causes 111 million
cases of gastroenteritis and nearly
half a million deaths.
82% of these deaths occur in the
world's poorest nations
Caused
Virus : norovirus, rotavirus, adenovirus,
astrovirus, parvovirus
Bacteria : Escherichia coli, Clostridium
difficile, Salmonella, Shigella and
Campylobacter
Parasites and Protozoans :
Cryptosporidium (Crypto), giardia
Chemical toxins, most often found in
seafood, food allergies,
antibiotics
Diagnosis
Gastroenteritis is often self-limiting,
and the care is supportive to control
symptoms and prevent dehydration.
Tests may not be needed.
If the symptoms persist for a
prolonged period of time, the health
care practitioner may consider blood
and stool tests to determine the
cause of the vomiting and diarrhea.
Complications
Dehydration
Diarrhea
Malabsorption of lactose
Leptospirosis
Leptospirosis is a disease known to
cause heating up and causing
redness of the hands.
It is caused by infection with bacteria
of the genus Leptospira, and affects
humans as well as other mammals,
birds, amphibians, and reptiles.
Epidemiology
Annual rates of infection vary from
0.02 per 100,000 in temperate
climates to 10 to 100 per 100,000 in
tropical climates.
Etiology
Leptospirosis is caused by a
spirochaete bacterium called
Leptospira spp.
There are at least five serovars of
importance in the United States and
Canada, all of which cause disease in
dogs (Icterohaemorrhagiae, Canicola,
Pomona, Grippotyphosa, and
Bratislava).
Complications
meningitis,
extreme fatigue,
hearing loss,
respiratory distress,
azotemia, and
renal interstitial tubular necrosis,
which results in renal failure and
often liver failure
Symptoms
High fever,
Severe headache,
Chills,
Muscle aches, and
Vomiting , and
may include jaundice, red eyes,
abdominal pain, diarrhea, and rash.
Diagnosis
Enzyme-Linked Immunosorbent
Assay (ELISA) and
Polymerase chain reaction (PCR).
Serological testing, the MAT
(microscopic agglutination test), is
considered the gold standard in
diagnosing leptospirosis.