Category Archives: Gastroenteritis
Travellers Diarrhea (Turista)
Travellers diarrhea is a type of gastroenteritis which usually develops during travels to places with inadequately treated water supply. The illness, characterized by diarrhea, nausea, and vomiting, is also known as turista.
- Nausea and vomiting, as well as diarrhea accompanied by abdominal pain and cramping, are the usual symptoms, but the severity of the symptoms may vary.
- Traveler’s diarrhea may be caused by viral or bacterial infection. Parasites also may be responsible.
- The infection originates from food or drink consumed on a visit to developing countries with inadequate water purification measures.
- The illness can be prevented by certain precautions such as using only carbonated drinks and bottled water for drinking purposes as well as for brushing teeth.
- The gastroenteritis is treated with rehydration therapy and drugs to control diarrhea. Sometimes antibiotics are also used for the treatment of travellers diarrhea.
The occurrence of Traveler’s diarrhea is common in people who visit developing countries which do not have a water supply system of purified water. Lack of immunity to local microorganisms, due to lack of previous exposure, is the main reason for this type of gastroenteritis affecting visitors. Bacterial infection by Escherichia coli, or viral infection by norovirus, is the usual cause of the disease. Avoiding drinking water from local sources is not sufficient to prevent this disease. If ice cubes made from ordinary water is added to bottled water, it may get contaminated. Brushing the teeth with tap water or eating from dishes rinsed in ordinary water may lead to infection. Eating fresh fruits with skin, even after washing them, can result in infection. Occasionally, certain parasitic infestations also cause travellers diarrhea.
Symptoms and Diagnosis
Nausea and vomiting as well as diarrhea are the usual symptoms. Abdominal pain and cramping are usually present. Rumbling of the intestines may be audible. Severity of the symptoms may vary and they usually start within 12 hours to three days after the consumption of contaminated water or food. Travellers diarrhea due to noro virus infection typically has symptoms such as headache and muscular pain in addition to vomiting. Diagnostic tests are not usually done, and the illness is often mild, with the patient recovering in about 3-5 days without any treatment.
Prevention
Travellers diarrhea may be prevented by taking a number of precautionary measures on traveling to susceptible areas:
- Eating in reputed restaurants following proper food hygiene practices
- Drinking only bottled water and carbonated drinks
- Eating only freshly cooked hot food
- Eating fruits only after peeling the skin
- Using bottled water to wash food items, cutlery, and toothbrush, and for rinsing the mouth
- Avoiding food and drinks at roadside eateries
- Avoiding fresh vegetables and fruits in salads
- Not participating in buffets, open air food fests and feasts
As a preventive measure, an antibiotic drug may be taken by people with lower immunity when they visit areas known to cause travellers diarrhea. Ciprofloxacin is the antibiotic of choice in such situations.
Treatment
When gastroenteritis develops, plenty of water and other liquids should be taken to compensate for the fluid loss due to diarrhea. An antidiarrheal drug like loperamide may be taken to control diarrhea. However, loperamide should not be taken if fever is present or if stools are bloody. Children below 2 years are also not treated with antidiarrheal drugs. Travelers developing fever or passing bloody stools should get medical care as soon as possible.
Antibiotic therapy is started if diarrhea persists with more than 3 bowel movements in an 8 hour period. Azithromycin, ciprofloxacin, rifaximin, or levofloxacin are given to adult patients, while children above 2 years of age are usually treated with azithromycin
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Clostridium perfringens Food Poisoning
Clostridium perfringens food poisoning is caused by the consumption of food containing a high concentration of Clostridium perfringens bacteria. The bacterial toxin responsible for the symptoms is produced inside the small intestine.
In most cases, the food poisoning due to Clostridium perfringens causes mild or moderate illness which resolve without any treatment. However, certain strains cause severe illness, causing damage to the small intestine called necrotic enteritis, which may become fatal due to septicemia. Meat and meat products are the usual foods contaminated by Clostridium perfringens bacteria. Thorough cooking of the food items may destroy some strains of the bacteria but not all.
Symptoms
Severe watery diarrhea accompanied by abdominal pain and cramping is the usual symptom which appear within 6 hours to a day of eating food containing a large number of Clostridium perfringens bacteria. Distention of the abdomen due to gas accumulation may be present. Though the illness is often mild, severe dehydration resulting from frequent watery stools can lead to complications such as very low blood pressure, leading to shock. Usually the symptoms subside after 24 hours, without any treatment.
Diagnosis and Treatment
The diagnosis of Clostridium perfringens food poisoning follows the news of an outbreak in the local area. Testing of the stool samples and the suspected food samples may help in confirming the diagnosis.
Treatment involves rehydration therapy and rest. Antibiotics are not usually used to treat the illness. Clostridium perfringens food poisoning can be prevented by proper handling of cooked meat which is not consumed immediately. It should be refrigerated without delay and should be thoroughly reheated before consumption.
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Staphylococcal Food Poisoning
Staphylococcal food poisoning is caused by the toxins produced in the food contaminated by staphylococcal bacteria. It results in nausea, vomiting, and diarrhea, accompanied by abdominal cramps.
The staphylococci bacteria are commonly found in the nose, mouth as well as the throat of people. They are present in the skin too, occasionally causing boils and other infections. They may grow in food, especially in milk, custard, fish and meat. Rather than the bacteria; it is the toxins made by the organism which are responsible for food poisoning. The contamination usually starts with unhygienic handling of food, especially by those with skin infections harboring staphylococcal bacteria. The bacteria multiply rapidly in undercooked food, and in cooked food remaining long at room temperature, producing the toxins which cause food poisoning.
Symptoms and Diagnosis
Nausea and severe vomiting are the usual symptoms of staphylococcal food poisoning and they usually appear within 2-8 hours of consuming food contaminated by staphylococcal bacteria. Abdominal pain and cramping as well as diarrhea are often present. Some people may develop symptoms such as fever and headache too. Dehydration due to severe vomiting may lead to low blood pressure, and eventually shock, if the water and electrolytes lost are not replenished effectively. In some cases, especially in very young children and among those who are already weak from illnesses and old age, staphylococcal food poisoning may have fatal consequences. But otherwise, people completely recover from the illness within 12 hours of the onset of symptoms.
The typical symptoms of gastroenteritis alert the doctor to the possibility of Staphylococcal food poisoning. A lab test can detect staphylococci in the food suspected to have caused the food poisoning, but it is not often necessary. If other people who have consumed the same food have developed similar symptoms, it may be considered as confirmation of staphylococcal food poisoning. Large scale infections originating from public sources such as restaurants are investigated further for public safety.
Prevention and Treatment
Staphylococcal food poisoning can be avoided by practicing good hygiene measures while preparing and preserving food. People who have skin lesions or infected sores should refrain from handling food till the infection clears off completely. Prepared food should not be left at room temperature for long. If prepared food is not consumed immediately, it should be cooled down fast, and refrigerated, to avoid the growth of staphylococcus.
Treatment involves rehydrating the body by plenty of fluid consumption. Since bacterial infection is not the cause of illness, but the ingestion of toxins produced by the bacteria, antibiotics are not needed. If nausea and vomiting are severe, the doctor may prescribe a suppository or give an injection to reduce them. Intravenous administration of fluids may be necessary to combat severe fluid loss.
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Hemorrhagic Colitis
Hemorrhagic colitis is an acute form of gastroenteritis resulting from a bacterial infection in the large intestine caused by a specific strain of Escherichia coli. It is a self limiting disease characterized by bloody diarrhea accompanied by abdominal cramps, and occasionally low grade fever.
This illness mostly affects children below 5 years as well as older people, but it may occur at any age. The strain E. coli O157:H7 is the usual cause of Hemorrhagic colitis in North America. Cattle are natural reservoirs of these bacteria and the infection does not produce any symptoms in them. The bacteria infect people when they consume under cooked beef, especially ground meat, or unpasteurized milk. Water and juice contaminated by the infective organism also can cause infection. An infected individual can transmit the disease through person to person contact and often an infection leads to an outbreak of hemorrhagic colitis. It usually spreads rapidly among young children who are in diapers.
Damage to the intestinal lining caused by the toxins produced by E. coli is the cause of the diarrhea. If the toxins reach the blood, other organs may be affected, mainly the kidneys.
Symptoms Of Hemorrhagic colitis
The onset of the disease is marked by sudden diarrhea accompanied by severe abdominal pain and cramping. Low grade fever may be present, but in many cases it is absent. Temperatures above 1020 F are rare. The stools are watery but traces of blood may not be seen in the first one or two days. But by the third day, the stools may have become bloody and it may remain like that for up to 8 days after which it resolves by itself.
Hemolytic-uremic syndrome is a serious complication which arises in 2% to 7% of patients who have developed hemorrhagic colitis. The symptoms of developing hemolytic-uremic syndrome are thrombocytopenia or low platelet count, excessive breakdown of red blood cells called hemolytic anemia as well as the usual symptoms of anemia such as weakness, giddiness and fatigue. It may lead to sudden kidney failure. Hemolytic-uremic syndrome in some cases may lead to further complications such as strokes or seizures due to nerve damage or damage to the brain. An increase in fever as the illness enters the second week may be an indication of complications developing. Complications like hemolytic-uremic syndrome usually develop in young children below the age of 5 years. It is frequent in older people also. Hemorrhagic colitis can have a fatal outcome in older people even when they have not developed hemolytic-uremic syndrome or other complications arising from it.
Diagnosis
Diarrhea with bloody stools is the typical symptom which alerts the doctor to the possibility of hemorrhagic colitis. Stool samples are tested for the presence of E. coli bacteria. The stool may be tested for the specific toxin (shiga toxin) which the E. coli bacteria produce. If any other reason for bloody diarrhea is suspected, a viewing test called colonoscopy may be done to examine the interiors of the large intestine.
Treatment
Keeping the patient rehydrated is the most crucial part of the treatment. The fluid lost through frequent watery bowel movements should be replenished as much as possible. In case of severe dehydration, intravenous administration of electrolyte solution may be necessary. Antibiotic therapy to treat the infection is not advisable as the chances of developing complications like hemolytic-uremic syndrome may be increase by those drugs. Intensive care treatment and kidney dialysis may be necessary for patients developing this complication.