Introduction – Diarrhoeal Diseases

Diarrhoea is a condition in which loose stools, watery stools occur more frequently than usual.

Diarrhoea is a major health problem among children under 5 years of age.

Diarrhoea is defined as the passage of frequent three or more loose or liquid stools per; more frequent passage than is normal.

Diarrhoea is usually a symptom of an infection in the intestinal tract, which can be caused by bacteria, viral and parasitic organisms.

This infection is spread through ingesting contaminated food or drinking-water, or from person to person as a result of poor hygiene.

Traveler’s diarrhea – caused by a bacterial infection or a parasite, or even food poisoning, more prone to traveller. Bacteria are a common risk factor of Traveler’s diarrhea, caused by drinking water or eating foods that are contaminated.

Clinical Classification of Diarrhoeal Diseases

Clinical clarification of Diarrhoeal Diseases are classified into –

1. Acute diarrhoea  

2. Chronic diarrhoea

1. Acute Diarrhea – Major risk factor for acute diarrhea exposure to Infectious agents.

Acute watery diarrhoea – Watery diarrhea are caused by viruses (viral gastroenteritis) is an intestinal infection. Occurs lasts several hours or days, and includes cholera.

The most common infection causes vomiting and diarrhea in children are rotavirus and in adults are norovirus.

Acute diarrhoeal diseases are treated by fluid and electrolyte replacement by ORS.

Acute bloody diarrhoea – also called dysentery; and

Persistent diarrhoea – lasts 14 days or longer

2. Chronic Diarrhea – Chronic bloody diarrhea may occur due to malabsorption, inflammatory bowel disease (IBD); ulcerative colitis or crohn’s disease. These illness will be treated according to etiology.

What Bacteria Causes Diarrhoea?

Through ingesting contaminated food or water various types of bacteria can enter body that cause diarrhea. Common bacteria are include Campylobacter, E. coli (Escherichia coli), Salmonella, and Shigella.

What Virus Causes Diarrhea?

Viruses that can cause diarrhea include norovirus, enteric adenoviruses, cytomegalovirus and viral hepatitis. 

Rotavirus causes acute childhood diarrhea, common among children.

What Parasite Causes Diarrhoea?

Amebiasis is a parasitic infection of the intestines caused by the Entamoeba histolytica.  Amebiasis is cause of acute diarrhea and Amebic dysentery.

Epidemiology Triad

Agent – The causative agent of diarrhoea are;

Bacterias  – Esherichia soli, Shigella, salmonella, vibrio cholera, campylobacter jejuni

Viruses- Coronavirus, rotavirus, enterovirus

Parasites  – Cryptosporidium, Amoeba, Giardia intestinalis

Host factor –  Among children under 5 years of age especially between 6 months and 2 years. The incidence is the highest during weaning period (6 months to 11 months).

Occurs individual having low immunity

Environment-  External and internal environment of human being are responsible for causing diarrhoea.

Internal environment such as error of metabolism, celiac disease, cause diarrhoea.

External factors such as poverty, lack of domestic hygiene, malnutrition, can cause diarrhoea.

Bacterial diarrhoea is more frequent in the warm season and viral diarrhoea is particularly peak during the winter season.

Mode of Transmission

Transmitted directly or indirectly by faeco-oral route.

1. Bacteria and viruses are usually transmitted by the fecal-oral route, can be ingested by water, food, fingers, fomites or direct contact.

2. Spread from person to person as with infected person as result of poor hygiene.

Incubation Period

The incubation period is usually from a few hours to 5 days after exposure for bacterial diarrhoea and 1 to 3 days for viral diarrhoea.

Clinical Manifestation

There are three clinical types of diarrhoea:

1. Acute watery diarrhoea – It occurs within lasts several hours or days, and includes cholera.

2. Acute bloody diarrhoea – Also called dysentery

3. Persistent diarrhoea – Occurs lasts 14 days or longer

During a diarrhoeal episode, water and electrolytes (sodium, potassium, chloride and bicarbonate) are imbalanced because of lost through liquid stools, vomit, sweat, urine and breathing.

Sign and symptom are-

1. Frequent loose, watery stools

2. Dehydration

3. Abdominal cramps

4. Abdominal pain

5. Restlessness, irritability

6. Sunken eyes

7. Drinks eagerly, thirsty

8. Dizziness 

9. Dry mucous membranes

10. Vomiting

Laboratory Diagnosis

1. Stool sample

2. Blood tests

Treatment of Diarrhoeal Diseases 

Most diarrhoea infection can be treated with oral-rehydration and zinc.

Treating Acute Diarrhea

1. Take plenty of fluid with sugar and salt to avoid dehydration and episodes of dehydration or take ORS (oral rehydration Ssolution). Salt and sugar liquid help your intestine absorb fluids.

Note– Milk or dairy products should be avoided for 24 – 48 hours, it can  make diarrhea worse.

2. Anti-diarrheal drug therapy – Helpful to control severe diarrheal symptoms, such as bismuth subsalicylate and antimotility agents such as loperamide. 

3. Antibiotics – Take if have high fever, dysentery, or moderate to severe traveler’s diarrhea. Some bacterial infections such as Shigella always require antibiotic therapy.

Treatment of chronic diarrhea

Chronic diarrhea  treatment depends on the etiology of the chronic diarrhea.

Prevention and Control of Diarrhoeal Disease

1. Diagnosis and treatment of diarrhoea

2. Antibiotics- Given in case of diarrhoea, where the cause of diarrhoea is Shigella, cholera or typhoid.

3.  Sanitary measures

4. Provision for better maternal and child health care

5. Fly control measure

6. Safe drinking-water

7. Adequate sanitation and hygiene

8. Hygienic measure- personal and environmental

9. Proper disposal of waste, stool, and excreta

10. Handwashing with soap

11. Breastfeeding infants

Pediatric Diarrheal Diseases

Diarrhoeal disease is the second leading cause of death in children under five years old. It is both preventable and treatable.

Diarrhea may be –

1. Acute Diarrhea occurs for short-term, usually lasting several days, usually exposure to bacterial or viral infections.

2. Chronic Diarrhea occur for long-term, lasting longer than four weeks, occur due to irritable bowel syndrome, or due to chronic diseases such as ulcerative colitis, Crohn disease, or celiac disease.  Giardia infection  may also cause chronic diarrhea.

What Causes Diarrhea in Children?

Diarrhea in children may be caused by following condition-

1. Bacterial infection

2. Viral infection

3. Parasites infection

4. Food allergies or food intolerances

5. Drug Reaction

6. Intestinal disease –  inflammatory bowel disease

7. Bowel disorder – irritable bowel syndrome

8. Result of surgery – stomach or gallbladder surgery

Symptom of Diarrhea in Children

If child is less than 6 months of age, observe the any of the following symptoms –

1. Abdominal pain

2. Blood in the stool

3. Frequent vomiting

4. Frequent diarrhea

5. Weight loss

6. Dry, sticky mouth

7. Urinates less frequently

8. High fever

9. Extreme thirst

10. Depressed fontanelle on infant’s head

11. No tears when crying