اسهال المسافرين والنزلات المعويه

[Dr Ali]

Traveler's diarrhea & Gastroenteritis

Traveler's diarrhea

Introduction " it commonly occur in travelers to areas of the world with poor water purification. The organisms most likely to cause traveler's diarrhea are the types of Escherichia coli (E. coli) and some viruses such as norovirus,

Symptoms and Diagnosis

Nausea, vomiting, intestinal rumbling, abdominal cramping, and diarrhea can occur in any combination and with any degree of severity. These symptoms begin 12 to 72 hours after ingesting contaminated food or water. Vomiting, headache, and muscle pain are particularly common in infections caused by norovirus. Most cases are mild and disappear without treatment within 3 to 5 days. Diagnostic tests are rarely needed.

Treatment

. antidiarrheal drugs (such as loperamide) [ not used in children < 2 y ]

antibiotics : for adults, ciprofloxacin, levofloxacin, azithromycin or rifaximin;

for children, azithromycin)

Travelers are seek medical care if they develop fever or blood in the stool.

Clinical pharmacology of loperamide & ciprofloxacin will be provided

Gastroenteritis

is inflammation of the lining of the stomach and small and large intestines..” About 3 to 6 million children around the world die each year from infectious gastroenteritis

• ...Causes

Infectious gastroenteritis may be caused by viruses, bacteria, or parasites. Chemical toxins and drugs can also cause gastroenteritis. Most infections are spread by contaminated food, drink and person to pirson transmission

Viruses: include rotavirus, calicivirus (predominantly the norovirus), and less commonly, astrovirus, and enteric (intestinal) adenovirus.

Bacteria: common causes : certain strains of Escherichia coli [E. coli], Campylobacter, Shigella, and Salmonella). toxin from certain bacteria e.g as Staphylococcus aureus, Bacillus cereus, and Clostridium perfringens

Certain intestinal parasites, particularly Giardia lamblia and. Entamoeba histolytica

Chemical Gastroenteritis: chemical toxins. Produced by a plant, such as poisonous mushrooms, or by certain kinds of seafood. can also occur after ingesting water or food contaminated by chemicals such as arsenic, lead, mercury, or cadmium.. Eating large amounts of acidic foods, such as citrus fruits and tomatoes, gives some people gastroenteritis.

Gastroenteritis may occurs as a Side Effect of Drugs

diarrhea may be a side effects of many drugs., chemotherapy drugs, radiation therapy, colchicine (for gout), digoxin etc ; clindamycin ;

Symptoms

vary according to the person's resistance. ; age ; severity of. Diarrhea is the most common symptom and may be accompanied by visible blood and mucus.. The person may have a fever, aching muscles and extreme exhaustion.

dehydration may occurs ( weakness, decreased frequency of urination, dry mouth, low Low blood pressure and a rapid heart rate can also develop. Water and electrolyte imbalances are potentially serious, especially in the young, the old, and people with chronic diseases. Shock and kidney failure can occur in severe cases.

Diagnosis

usually obvious from the symptoms . History, e.g Recent travel, especially to certain foreign countries, and recent antibiotic use may give clues as well.

If the symptoms are severe or last for more than 48 hours, stool samples may be cultured and examined in a laboratory for white blood cells and bacteria, viruses, or parasites.

Prevention

A rotavirus vaccine given by mouth is now available that is safe and effective against most strains of rotavirus. For infants, a simple and effective way to prevent gastroenteritis is breastfeeding.. Other measures e.g good hand washing with soap and water after a bowel & Only pasteurized dairy products and pasteurized apple juice should be used; meat and eggs should be ********ed thoroughly etc

Treatment

Usually the only treatment needed for gastroenteritis is getting bed rest and drinking an adequate amount of fluids.

. If vomiting or diarrhea is prolonged or the person becomes severely dehydrated, intravenous fluids and electrolytes may be needed.

Because children can become dehydrated more quickly, they should be given fluids with the appropriate mix of salts and sugars. (rehydration solutions) are satisfactory.

. Drugs that control severe vomiting are not generally given to young children. For adults, a doctor may give a drug, either as an injection or as a suppository, to control severe vomiting.

A. If the diarrhea continues for 24 to 48 hours and there is no blood in the stool to indicate a more serious bacterial infection, the doctor may prescribe a drug to control the diarrhea, such as diphenoxylate, or loperamide

. Again, these drugs usually are not given to children under the age of 5.

Because antibiotics can cause diarrhea and may encourage the growth of organisms resistant to antibiotics, they are rarely appropriate, even when a known bacterium is causing gastroenteritis.

Antibiotics may be used, however, when certain bacteria, such as Campylobacter, Shigella, and Vibrio, are the cause, ciprofloxacin , doxycycline and for people who have traveler's diarrhea. Enterotoxigenic Escherichia coli (causes traveler's diarrhea) (for example, ciprofloxacin , levofloxacin ); azithromycin is given to children )

Parasitic infections are treated with antiparasitic drugs such as metronidazole and nitazoxanide. – ( will be discussed in details under parasitic infection )

The use of probiotics, such as lactobacillus is generally safe and may relieve symptoms. They can be given in the form of yogurt with active cultures.