Diarrhoea – Infectious Agents
·
= Acute Enterocolitis
·
Symptoms & Signs:
o Dysphagia (e.g. Candida)
o Flatulence, colic, distension, diarrhoea (watery, fatty, bloody)
o Vomiting, fever
·
Investigations
o Blood: eosinophilia, HIV
o Faecal microscopy, parasitology, culture
o H2 breath test
o Endoscopy/Colonoscopy +/- biopsy
·
Pathology: Red, oedematous bowel
(all look the same), microscopically non-specific inflammation
·
Differential
o Drug induced diarrhoea: laxatives, magnesium compounds, diuretics
o Severe alcohol intake
o Diabetic autonomic neuropathy
o IBD
o Malabsorption: coeliac, lactose intolerance, lymphoma, pancreatitis,
bilary/liver disease
·
Management:
o Rehydration
o Investigate cause
o Monitor complications: anaemia (due to haemorrhage), septicaemia, perforation,
appendicitis
o Strict food hygiene
o Avoid milk ® ¯secondary hypolactasia
o Antibiotic treatment
·
Bacterial enteroinvasive:
o Campylobacter Jejuni
§ Poultry
§ Haemorrhagic colitis
§ Erythromycin (used to be ciprofloxacin but it‟s been put in chicken feed
® Âresistance)
o Escheria Coli
§ Enterotoxic subspecies
§ Travellers diarrhoea
o Salmonella/Shigella: Poultry
·
Bacterial enterotoxins:
o Vibrio Cholerae
o Staph Aureus: Food poisoning (eg cream buns)
o Clostridium Botulinum
o Some subtypes of E Coli
·
Protozoa
o Giardia
§ Trophozoites reside mainly in duodenum, also small bowel
§ Cysts in faeces
§ Small bowel diarrhoea ® diarrhoea during night (large bowel „sleeps‟)
o Entamoeba histolytica: causes amoebic dysentery (colitis)
·
Cryptosporidium
o Common in kids
o Is chronic in immunocompromised
o No effective antibiotic treatment
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