by Deepanksha datta
Thendrals’06
DIARRHOEA
DEFINITION
The passage of loose , liquid or watery stools
More than 3 times a day
ImportantThe recent change in the consistency and
the character of the stool
TYPES Distinction between the ACUTE and
CHRONIC is ARBITRARY
CHRONIC – lasting for 3 weeks or more ACUTE ( WHO / UNICEF DEFINITION)
Attack of sudden onset , lasting for 3 to 7 days – may upto 10 -14 days
Mainly due to infectionsGASTROENTRITIS – described as Diarrhoeal
Disease
PROBLEM STATEMENTEquals RESPIRATORY INFECTIONS in
the morbidity worldwideWHO – Diarrhoeal Diseases Control
Programme 1980
ORS ADMINISTRATION
COURTESY – WHO SITE
RESULTS Mortality of the diarrhoeal diseases NO CHANGE IN THEOVERALL INCIDENCE
OF THE DISEASE
INDIA Major health problem among children of age
under 5 years
NATIONAL DIARRHOEAL DISEASE CONTROL PROGRAMME
EFFECTS OF THE DIARRHOEAL DISEASE
ECONOMIC BURDEN ON HEALTHSERVICES
WHO 2005 SURVEY
COMPARISON B/T COUNTRIES(WHO)
EPIDEMIOLOGICAL DETERMINANTS
AGENT FACTORS
RESERVOIR OF INFECTION
HOST FACTORS
ENVIRONMENTAL FACTORS
MODE OF TRANSMISSION
AGENT FACTORS
In the developing countries - INFECTIOUS in origin
VIRAL BACTERIAL
OTHERS
VIRAL AGENTSRota virusAstro virusAdeno virusCalci virusCorona virusNorwalk virusEntero virus
BACTERIAL AGENTSCampylobacter jejuniEscherichia coliShigellaSalmonellaVibrio choleraVibrio parahemolyticusBacillus cereus
OTHER INFECTIOUS AGENTSEntameoba histolytica
Giardia intestinalis
Trichuriasis
Cryptosporidium
Intestinal worms
ROTAVIRUS
Leading cause of SEVERE , DEHYDRATING DIARRHOEA IN CHILDREN < 5 YEARS .
First Episode Developing countries – ¾ children – before
12 months Developed countries – 2 – 5 years
ROTAVIRUS (cont)ReinfectionPrimary infection – significantTemperate – WinterTropical – year roundHigh concentration shed in – stool and vomitTransmission – faeco- oral route person – person contaminated food
BACTERIAL
ETEC (ENTEROTOXIGENIC E . COLI)Acute watery diarrhoea in adults & childrenMost common cause of the TRAVELLER’S
DIARRHOEA Heat labile and heat stable toxins – cholera
toxins
BACTERIAL (CONT)C . Jejuni – no toxin
Salmonella – inflammation of the bladder
Shigella - high mortality %age – 69% among young children
OTHERS INFECTIOUS AGENTSParasites – in the duodenum and the jejunumMost important CRYPTOSPORIDIUMImportant and the undiagnosed cause of
the death among the infantsImmunodeficient patientsDomestic animals
PARENTRAL INFECTIONSNon digestive origin ENT INFECTIONS RESPIRATORY INFECTIONS URINARY TRACT INFECTIONS MALARIA MENINGITIS TEETHING
MALNUTRITION
INBORN ERRORS OF METABOLISM - Health gap – developed countries- enzyme deficiency, severe infection
who definition of aids for children
an episode of diarrhoea more than 30 days of duration
RESERVOIRS OF INFECTION
MAN ANIMALETEC C. JEJUNISHIGELLA SALMONELLAE.COLI CHOLERAPARASITES
HOST FACTORSDIARRHOEA- 6 MONTHS- 2 YEARSHighest incidence – 6 – 11 months REASONSDecreased maternal AbLack of the acquired immunityContaminated foodCrawling initiation
Malnutrition – vicious circlePoverty PrematurityReduced gastric acidityImmunodeficiencyLack of personal & domestic hygiene
ENVIRONMENTAL FACTORSDistinct seasonal variationsTEMPERATE REGIONS Bacterial – warm season Viral - winterTROPICAL REGIONS Bacterial – warmer , rainy Viral - dry , cold
MODE OF TRANSMISSIONFaecal – oral route Water – borne Food – borne
OTHERS Direct – fomites , fingers, dirt – mainly for tye
children.
BOOGIE FEVER
REFRENCESWHO SITE WHO JOURNAL 2005 ISSUESPARK AND PARKGOOGLE.COMCARTOONSTOCK.COM
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