Acute Infectious Diarrhea An overview

2. Acute Infectious DiarrheaAn overview By Professor Dr Intekhab Alam Faculty of Medicine Khyber Medical University PGMI, Lady Reading Hospital, Peshawar.

3. Introduction Food poisoning (Acute Infectious Diarrhea) denotes gastrointestinal diseases caused by micro-organism transmitted in food or by microbial toxins preformed in the food. Worldwide impact of food poisoning is great, responsible for increasing childhood mortality and their physical and mental growth retardation. The commonest bacterial pathogens responsible for bacterial gastroenteritis in the world are Enterobacteriaceae (E.coli, Salmonella and Shigella) in underdeveloped and Compylobacter in the industrialized world.

7. Management Take history: recent fast food or dining in a restaurant. onset, frequency, consistency of stools, colic, tenemus, vomiting and fever. Examine and assess: Conscious state, Hydration status, postural drop, icterus and abdominal tenderness. collect stool sample for physical examination and if indicated send for C/S. Secure two wide bored IV lines and send blood for S.Electrolytesa and S. Creatinine and keep strict intake-output record and commence IV hydration. Pass CV line if pt is in shock and peripheral IV access is difficult. Keep hourly BP/Pulse record.

10. Differential Diagnosis of Acute Diarrhea Food intolerance e.g. Lactose intolerance, Inorganic agents like Sodium nitrite, Organic substances like Mushrooms and shellfish, Drugs e.g. Laxatives and Antibiotics, Emotional stress. finally Infectious agents including Bacteria, Viruses and Protozoal agents.

11. Prevention All agents responsible for food poisonings are transmitteed through oro-fecal route. First principal is personal hygiene and handwashing before handling food, eating and attending the toilet provides 80-90% safety against the transmission of these agents. It is of paramount importance to wash the food with plenty of fresh and clean water before consumption, especially the raw food consumption like lettuce and salad. Production of safe food rests on evidence based practical technologies and management systems; HACCP (Hazard Analysis and Critical Control Points). This system identifies the Hazards and the points in a process whwere and when they can occur and decides which points are critical to control to ensure consumers’ safety, e.g. Pasteurization of the milk in which critical points are, a)Temperatures reeached during heating, b)its duration and c)to prevent subsequent contamination Good sanitation and sewerage system and safe water supply

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