Report on Treatment principles of Diarrhea

Pg - 1 Report on Ethiological structure, Pathogenesis, Clinic, the treatment principles of the food poisonings. Definition - Food poisoning is if acute illness with mainly gastrointestinal or neurologic manifestations that results from eating food that is contaminated either by bacteria or bacterial toxins or by chemicals. Symptoms usually commence 1-24 hours after ingestion and include vomiting, diarrhoea, abdominal pain and nausea. Can be divided in to (a) microbial (b) Chemicals of nonmicrobial origin. (a) Microbial Food Poisoning IP Bacteria Tosxins/mechanismo location Symptoms & recovery time Diagnosis Source 1-6hrs 8-16hrs 1.Staphyloc-occus aureus 2.Bacillus cereus (emetic form) 1.Cl. perfringes 2.B.cereus (diarrhoea form) -Noninflam matory (enterotoxine) -Proximal small bowel " " Noninflammatory (enterotoxins) -Proximal small bowel " " A/ 1 Diarrhoea, 2 vomiting 3 dehydration 4 shock B/ Recovers rapidly (few hours) A/ Same clinics B/ Recovers rapidly A/1.Watery diarrhoea 2.Cramping pain B/Recovery 2-3days A/Clinics as watery diarrhoea & cramp B/Recovery rapid -Culture organism in vomit or remaining food -No faecal leukocytes -Culture organism in foeces & food -No faecal leukocytes -Culture in faeces & food -No faecal leukocytes " " -Contaminated food usually by human. -Milk, sweet corn, mayonnaise, egg, salad, ham, cream -Spores in food (often rice) survives boiling -Fried rice -Spores in food survives boiling -Beet, poultry legumes -Spores in food survives boiling -Meats, vegetables, dried beans, cereals pg - 2 IP Bacteria Toxins/mechanisms. location Symptoms & recovery time Diagnosis Source >16hrs 16-48hrs 16-72hrs 18-36hrs 1.Salmonella 2.Shigella 3.Enterotoxigenic E.Coli 4.Campylobacter jejuni Vibrio paraheamolyticus Cl. botulinum -Inflammatory (Invasion or cytoxin) -Colon or distal small bowel -Inflammatory (Invasion or cytotoxic) -Colon or distal small bowel Preformed toxin neurotoxic A/1.Fever, malaise 2Abdominal cramps, pain 3.Diarrhoea+RBC,WBC & mucus 4.Vomiting-salmonella B/Recovery some days (2-5days salmonella & c.jejuni 3-5 days) A/1Watery dearrhoea "Abdominal cramps 3Vomiting B/Recovers in days (1-3d) A/1Nausea 2Vomiting 3Dearrhoea 4Paralysis B/Recovers in 10-14d (Paralysis laryngeal pharyngeal later generalized Resp. insu -Culture organism in stools -Feacal PMN leulcocytes -Stools & rectal swabs for culture & fresh stools for motile organisms -No feacal leucocytes -Demonstration of the organism or its toxins in vomitus, gastric fluid, stool. -Isolation of organism from food -Bowels of animals -Salads, cheese, meats, eggs, dairy, proclucts, patato, raw vegetables, lettuce ,beef shell fish & other sea food -Canned food -Bottled food 1 Preformed toxins 1 Toxin production in vivo -Staph. aureus - C.perfringes - B cereus - B.cereus - Cl. botulinum - ETEC - V.cholera 3 Tissue invasion 4 Toxin production &/or Tissue invasion - Salmolella - V.parahaemolyticus - ETEC - Y.enterocolitica - Shgella - C.jejuni pg - 3 (b) Chemicals of non microbial origin (1) Food - mushrooms, shellfish Salivation sweating, vomiting, abdominal pain/cramps, diarrhea, vertigo, confusion, coma. (p) May die within few hours but complete recovery in 24 hrs usual with appropriate therapy (2) Others - Organophosphates, heavy metals Pb, Hg etc. Summary of symptoms M:O Diarr hoea Vomiting Nausea Fever Abdominal cramps Paralysis 1 2 S.aureus} B.cereus}   3 4 C.perfringens} B.cereus}  (watery)  5 6 7 8 Salmonella Snigella C.jejuni ETEC    9 10 V.cholera ETEC  (watery)   11 C.botulinum     Treatment (a) Microbial - I Rehydrahon - oral in mild or moderate Parenteral if severe II Antibiotics - If shigella, cholera (b) Chemical - I Gastric lavage - Inducing vomiting is contraindicated. General principles: 1 Supportive treatment 2 Rehydration with glucose, electrolyte solution orally if mild - moderate dehydration (even if vomiting - small sips should be taken to replace volume) 3 If vomiting is severe antiemetic (chlorpromazine >25-100mg/d IM) may be beneficial. 4 Meperidine 50mg Im - severe abdominal cramps. 5 When (p) can tolerate fluids without vomiting semisolid food (cereals, gelatin, bananas, toast) may be added. 6 Antibiotics - shigellosis, cholera 7 In botulinism - maintain adequate respiration with assisted ventilation in addition to I/V administration of antitoxins. Guanidine hydrochloride 15-40 mg/kg. Improves botulism induced paralysis by reversing intramuscular blockade (Botulinum leads to marked neuromuscular blockade). Report on Ethiological structure, Pathogenesis, Clinic, the treatment principles of the food poisonings Report prepared by 1. Sajid Mahmood, Accident & Emergency Department, NHS Liverpool United Kingdom, 2. Adnan Akram, Infectious Diseases Department. University Hospital Riga Latvia.3. Aftab Ahmed, Infection Control Department, Kaunas Medical University Clinic. Lithuania.contact: publications@infekcijas.eu