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