12. SYMTOMS & SIGNS
TOXIGENIC INFLAMMATORY VIRAL
No systemic upset Systemic upsetAbdminal Systemic upset
Small number pain, tenesmus, fever . URTI
Large volume Stool Fever nausea
Stool no RBCs no Large number Frequent Myalgia
leukocytes. Small volume blood -stain Stool
mucus, pus cells Voluminous, watery
Mechanism Mechanism
Invasion of enterocytes Osmatic or secretory
leading to mucosal cell
death and inflammatory
response
13. APROACH TOwith diarrhea
Approach to pt PATIENTS
( entrotoxin ( a febrile- 1
potentially invading( Fever + blood or – 2
( dysentery
completely invading ( fever + bactreamia- 3
Diarrhea with GI bleeding- 4
Investigation
Rectal swab, stool general , Stool c/s , toxin-
assay ,elisa, PCR
14. entrotoxin ( a febrile ) - 1
2 – potentially
invading( Fever + blood or
dysentery )
3- completely invading ( fever
+ bactreamia
4- Diarrhea with GI bleeding
Investigation
- Rectal swab, stool general ,
Stool c/s , toxin assay
,elisa, PCR
15. DIARRHEA CLINICS
PRIMARY CARE CENTER-
SEASONAL CENTER-
HOSPITALS-
EACH CLINIC-
Doctor
Nurse
Health supervisor
Necessary requirements
Supervision -
Regional Infection control Committee + Preventive -
.Medicine Dept
16. OUT PATIENT MANAGEMENT
FOR MILD DIARRHEA
SAUDI -
RESIDENTS -
HAJI WITH PROPER EASILY TRACED -
ADDRESS
18. HAJ NON HAJ
:Name
SURVEY SHEET OF HOSPITALIZED INFECTIOUS DIARRHEA CASES IN
.MEDINA MUNAWARAH DURING HAJ
:Age Years Sex: M/F Nationality
:History of
Fever Nausea Vomiting
Tenesmus Headache Colic
( Mayalgia Other (specify
:Stools
Frequent >6/day Volume Large Actual amount >1/2 liter
day small >1/2 liter/6 <
Blood Mucus Consistency Formed
Semi formed
Watery
(Other( specify
Contacts: One person involved
Group with common food source
:Examination
.Temp. Pulse BP Resp
Dehydration Mild Level of consciousness Drowsy
Moderate Semiconscious
Severe Comatosed
21. TREATMENT OF MOST COMMON
.GASTROINTESTINAL PATHOGENS
S. aureus Hydration Self limited
B. cereus Hydration Self limited
C. perfringeus Hydration Self limited
V.cholrae Tetrcycline’s Ampicilin & TMP-SMX
So effective
Salmonella TMP-SMX Ampicilin
Shigella TMP-SMX Quinolon
,Yersinia TMP-SMX Tetracyclines
.minoglycosides in severe cases
Campylobacter Erythromycin Quinolones
E. coli Hydration Self limiting
v. parahaemolyticus Tetracyclines TMP-SMX
Rotavirus Hydration No specific treatment
Norwalk virus Hydration No specific treatment
TNIDAZOLE Me tronidazole G. lambia
E. histolytica Me tronidazole
22. حال ت الهسهال منطقة المدينة المنورة
1341 --- 2341 حتى شعبان
23. حال ت الهسهال منطقة المدينة
المنورة
2341 حتى شعبان
6747
312
24. MANAGEMENT
MANAGEMENT OF INFECTIOUS
DIARRHEA
1. REHYDRATION REHYDRATION 1.
ORS ORS
IV IV FLUIDS
FLUIDS SHOCK SHOCK
SEVERE VOMITING SEVERE VOMITING
DEPRESSED MENTAL STATE
DEPRESSED MENTAL
2. INDICATIONS FOR ANTIMICROBIALS STATE
a( Parasitic infections E. histililytica
INDICATIONS FOR ANTIMICROBIALS. 2
a) Parasitic infections G. lambia
E. histililytica
Other parasitic infection
G. lambia
b(. V.cholerae Cases
Other parasitic infection
Carriers
b). V.cholerae Cases
discharge after 3 consecutive negative post treatment samples
c(. Carriers
Salmonella Infants
discharge after 3 consecutive negative post treatment samples
c). Salmonella Infants