Acute infectious diarrhea
The article assesses the incidence of the main types of infectious diarrhea, the cost of microbiological diagnosis, a diagnostic algorithm depending on the nature of the diarrhea, antibiotic therapy methods and programs.
The incidence of infectious diarrhea in the United States is 1.4 episodes per person per year, causing 900,000 hospitalizations and 6,000 deaths per year.
According to FoodNet and the Centers for Disease Control and Prevention (CDC), based on an analysis of the etiology of infectious diarrhea in 37 million people in 9 states of America in the North, the incidence rate for the main species (per 100,000 inhabitants) was: salmonellosis - 16.1; campylobacteriosis - 13.4; shigellosis - 10.3; Escherichiosis O157 - 1.7; cryptosporidiosis - 1.4.
According to the results of 6 studies over the period 1980-1997. the frequency of obtaining fecal culture varied from 1.5 to 5.6%, and the cost of obtaining a positive fecal culture was $ 952 to $ 1,200.
Most diarrheal diseases are resolved on their own or are viral, about half of them last less than a day. Symptoms that persist for more than 24 hours usually require examination to determine the etiology. The most common causes of diarrhea in winter are noroviruses (sporadic intrafamily cases or epidemics) and rotaviruses in children. Typically, these infectious diarrheas last 1 to 3 days and go away on their own.
The sensitivity and specificity of fecal analysis for the presence of leukocytes with inflammatory diarrhea are 0.7 and 0.8, and the test for fecal lactoferrin is 0.9 and 0.8, respectively.
In the presence of bloody diarrhea, the presence of Entamoeba histolytica is assumed in patients arriving from endemic regions or producing shiga toxin E. coli.
Inflammatory diarrhea associated with Shigella, Salmonella, Campylobacter jejuni, Clostridium difficile or E.histolytica.
In most cases, adults are advised to recommend supplemental intake of liquid and salt, salt soups and crackers. In case of severe dehydration, an infant formula or a standard formula recommended by WHO is used to reduce blood osmolarity. Consumption of dairy products should be avoided due to the development of a transient lactase deficiency.
It is only for loperamide, bismuth subsalicylate and kaolin that evidence of efficacy and safety has been obtained. The preferred antiperistaltic drug is loperamide, which has advantages over other opiates that do not enter the central nervous system due to the lack of ability to cause drug dependence.
These drugs are contraindicated in shigellosis, C. difficile infection (the complication is a toxic dilation of the colon) and escherichiosis E.coli O157 (risk hemolytic uremic syndrome).
Assessment of the degree of dehydration, the duration (presence of symptoms for more than a day) and objective signs of "inflammatory" diarrhea (fever, blood in the stool, tenesmus).
Immediate rehydration. Consider prescribing bismuth subsalicylate or loperamide if the diarrhea is not accompanied by a blood mixture and is not inflammatory in nature.
Planning of activities based on epidemiological data (food, antibiotics, sexual activity, travel, visits to kindergartens, concomitant pathology, epidemics, season) and the existing clinical symptom complex (bloody diarrhea, abdominal pain, dysenteric syndrome, exhaustion , markers of inflammation in feces).
In the case of severe diarrhea, with a blood mixture, of an inflammatory, persistent nature, appearing in the epidemic focus, the following options should be considered:
Cholera, Cryptosporidium, Giardia, Salmonella, Shigella, E. coli O157. During epidemics, keep epidemically important cups, isolates and food and water (-70 ° C).