dr.

SJ

Diarrhea (from the Greek meaning "flowing through"), is the condition of having three or more loose or liquid bowel movements per day. It is a common cause of death in developing countries and the second most common cause of infant deaths worldwide. The loss of fluids through diarrhea can cause dehydration and electrolyte imbalances.

In 2009 diarrhea was estimated to have caused 1.1 million deaths in people aged 5 and over and 1.5 million deaths in children under the age of 5. Oral rehydration salts and zinc tablets are the treatment of choice and have been estimated to have saved 50 million children in the past 25 years.

Definition
Diarrhea is defined by the World Health Organization as having 3 or more loose or liquid stools per day, or as having more stools than is normal for that person.

Differential diagnoss
Diarrhea is most commonly due to viral gastroenteritis with rotavirus, which accounts for 40% of cases in children under five. In travelers however bacterial infections predominate. Various toxins such as mushroom poisoning and drugs can also cause acute diarrhea.

Infections
There are many causes of infectious diarrhea, which include viruses, bacteria and parasites. Norovirus is the most common cause of viral diarrhea in adults, but rotavirus is the most common cause in children under five years old. Adenovirus types 40 and 41, and astroviruses cause a significant number of infections.

The bacterium Campylobacter is a common cause of bacterial diarrhea, but infections by Salmonellae, Shigellae and some strains of Escherichia coli (E.coli) are frequent. In the elderly, particularly those who have been treated with antibiotics for unrelated infections, a toxin produced by Clostridium difficile often causes severe diarrhea.

Management
In many cases of diarrhea, replacing lost fluid and salts is the only treatment needed. This is usually by mouth oral rehydration therapy or, in severe cases, intravenously. Medications such as loperamide (Imodium), bismuth subsalicylate may be beneficial, however they may be contraindicated in certain situations.

Alternative therapies
A Cochrane systematic review found that zinc supplementation benefits children suffering from diarrhea in developing countries, but only in infants over six months old. This supports the World Health Organisation guidelines for zinc, but not in the very young.

A 2010 systematic review determined the effectiveness of probiotics in treating acute infectious diarrhea. The study demonstrated that the use of probiotics reduced the duration of symptoms by one day and reduced the chances of symptoms lasting longer than four days by 60%.

The probiotic lactobacillus can help prevent antibiotic associated diarrhea in adults but possibly not children. For those who with lactose intolerance, taking digestive enzymes containing lactase when consuming dairy products is recommended.

dr. SJ

Dysentery
Generally, if there is blood visible in the stools, it is not diarrhea, but dysentery. The blood is trace of an invasion of bowel tissue. Dysentery is a symptom of, among others, Shigella, Entamoeba histolytica, and Salmonella.

Dysentery (formerly known as flux or the bloody flux) is an inflammatory disorder of the intestine, especially of the colon, that results in severe diarrhea containing mucus and/or blood in the feces with fever and abdominal pain. If left untreated, dysentery can be fatal.

There are differences between dysentery and normal bloody diarrhea. While diarrhea caused by dysentery is typically of small volume, very bloody, and containing many PMNs and RBCs; normal bloody diarrhea is more watery and may not contain any PMNs or mucus.

Symptoms normally present themselves after one to three days and are usually no longer present after a week. The frequency of urges to defecate, the volume of feces passed, and the presence of mucus and/or blood depend on the pathogen that is causing the disease.

Temporary lactose intolerance can occur, which, in the most severe cases, can last for years. In some caustic occasions, vomiting of blood, severe abdominal pain, fever, shock, and delirium can all be symptoms.

Prevention
To reduce the risk of contracting dysentery the following precautions are suggested:
Washing one's hands after using the toilet, after contact with an infected person, and regularly throughout the day. Washing one's hands before handling, cooking and eating food, handling babies, and feeding young or elderly people. Keeping contact with someone known to have dysentery to a minimum. Washing laundry on the hottest setting possible.

Avoiding sharing items such as towels and face cloths.

Treatment
If shigella is suspected and it is not too severe, the doctor may recommend letting it run its course usually less than a week. The patient will be advised to replace fluids lost through diarrhea. If the shigella is severe, the doctor may prescribe antibiotics, such as ciprofloxacin or TMP-SMX (Bactrim). However, many strains of shigella are becoming resistant to common antibiotics.

Amoebic dysentery usually calls for a twopronged attack. Treatment should start with a 10day course of the antimicrobial drug metronidazole (Flagyl). To finish off the parasite, the doctor will sometimes prescribe a course of diloxanide furoate (available only through the Centers for Disease Control and Prevention), paromomycin (Humatin), or iodoquinol (Yodoxin).