Gastroenteritis , also known as diarrhea infection , is an inflammation of the gastrointestinal tract - the stomach and small intestine. Symptoms may include diarrhea, vomiting, and abdominal pain. Fever, lack of energy, and dehydration can also occur. This usually lasts less than two weeks. It is not related to influenza even though it has been called "stomach flu".
Gastroenteritis is usually caused by a virus. However, bacteria, parasites, and fungi can also cause gastroenteritis. In children, rotavirus is the most common cause of severe disease. In adults, norovirus and Campylobacter are common causes. Eating foods that are not prepared properly, drinking contaminated water, or close contact with an infected person can spread the disease. Treatment is generally the same as or without a definitive diagnosis, so testing for confirmation is usually unnecessary.
Prevention involves washing hands with soap, drinking clean water, proper disposal of human waste, and breastfeeding babies instead of using formula. Rotavirus vaccine is recommended as prevention for children. Treatment involves enough fluids. For mild or moderate cases, this can usually be achieved by taking oral rehydration solution (a combination of water, salt, and sugar). In those who were breastfed, breastfeeding continues to be recommended. For more severe cases, intravenous fluids may be necessary. Fluids may also be provided by nasogastric tubes. Zinc supplementation is recommended in children. Antibiotics are generally not necessary. However, antibiotics are recommended for children with fever and bloody diarrhea.
By 2015, two billion cases of gastroenteritis produce 1.3 million deaths worldwide. Children and those in developing countries are severely affected. In 2011, approximately 1.7 billion cases resulted in approximately 700,000 deaths among children under the age of five. In developing countries, children younger than two years often get six or more infections per year. It is rare in adults, partly because of immune development.
Video Gastroenteritis
Signs and symptoms
Gastroenteritis usually involves diarrhea and vomiting. Sometimes only one or the other is present. This may be accompanied by abdominal cramps. Signs and symptoms usually begin 12-72 hours after contracting an infectious agent. If due to virus, this condition usually disappears within one week. Some viral infections also involve fever, fatigue, headache, and muscle aches. If the stool is bleeding, the cause tends to be viral and more likely to be bacterial. Some bacterial infections cause severe abdominal pain and can persist for several weeks.
Children infected with rotavirus usually recover completely within three to eight days. However, in poor countries treatment for severe infections often can not be achieved and persistent diarrhea often occurs. Dehydration is a common complication of diarrhea. Severe dehydration in children can be recognized if the skin tone and position returns slowly when pressed. This is called "prolonged capillary refill" and "bad skin turgor". Abnormal breathing is another sign of severe dehydration. Recurrent infections are usually seen in areas with poor sanitation, and malnutrition. Stunted growth and long-term cognitive delays may occur.
Reactive arthritis occurs in 1% of people after infection with Campylobacter species . Guillain-BarrÃÆ'Â © Syndrome occurs in 0.1%. Haemolytic uremic syndrome (HUS) may occur due to infection by producing Shiga poison Escherichia coli or Shigella . HUS causes low platelet count, poor kidney function, and low red blood cell count (because of their damage). Children are more likely to get HUS than adults. Some viral infections can cause benign infantile seizures.
Maps Gastroenteritis
Cause
Viruses (especially rotavirus) and the Escherichia coli bacteria and Campylobacter species are the main causes of gastroenteritis. However, there are many other infectious agents that can cause this syndrome. Noninfectious causes are sometimes seen, but are less likely than virus or bacterial causes. The risk of infection is higher in children due to lack of immunity. Children are also at higher risk because they tend not to do good hygiene habits. Children living in areas without easy access to water and soap are particularly vulnerable.
Viral
Rotavirus, norovirus, adenovirus, and astroviruses are known to cause viral gastroenteritis. Rotavirus is the most common cause of gastroenteritis in children, and produces the same rate in developed and developing countries. The virus causes about 70% of diarrheal episodes of infection in the age group of children. Rotavirus is a less common cause in adults because of acquired immunity. Norovirus is the cause in about 18% of all cases.
Norovirus is the leading cause of gastroenteritis among adults in America, causing more than 90% of outbreaks. This local epidemic usually occurs when a group of people spend time in close physical proximity to each other, such as on a cruise ship, in a hospital, or in a restaurant. People may remain contagious even after their diarrhea is over. Norovirus is the cause of about 10% of cases in children.
Bacteria
In developed countries Campylobacter jejuni is the main cause of bacterial gastroenteritis, with half of these cases linked to poultry exposure. In children, bacteria are the cause in about 15% of cases, with the most common types being Escherichia coli, Salmonella, Shigella, and < i> Campylobacter species. If food is contaminated with bacteria and stays at room temperature for several hours, bacteria multiply and increase the risk of infection in those who consume food. Some foods commonly associated with illness include raw meat, poultry, seafood, and eggs; raw sprouts; unpasteurized milk and soft cheeses; and fruit and vegetable juices. In developing countries, especially sub-Saharan Africa and Asia, cholera is a common cause of gastroenteritis. These infections are usually transmitted by contaminated water or food.
Toxigenic Clostridium difficile is an important cause of diarrhea that is more common in older people. Babies can carry these bacteria without developing symptoms. This is a common cause of diarrhea in those hospitalized and is often associated with antibiotic use. Staphylococcus aureus infectious diarrhea may also occur in those who have used antibiotics. Acute travelers' diarrhea is usually a type of bacterial gastroenteritis, whereas persistent forms are usually parasitic. Acidic suppressants appear to increase the risk of significant infection after exposure to a number of organisms, including Clostridium difficile , Salmonella and Campylobacter species.. The risk is greater in those taking proton pump inhibitors compared with H2 antagonists.
Parasitic
A number of protozoa can cause gastroenteritis. Giardia lamblia is the most common, but Entamoeba histolytica , Cryptosporidium spp., and other species have also been involved. As a group, these agents comprise about 10% of cases in children. Giardia occurs more commonly in developing countries, but this type of disease can occur almost everywhere. This happens more often in people traveling to areas with high prevalence, children attending child care, men who have sex with men, and following disasters.
Transmission
Transmission can occur due to drinking contaminated water or when people share a private object. Water quality usually worsens during the wet season and outbreaks are more common nowadays. In areas with four seasons, infections are more common in winter. Around the world, bottle feeding in infants with unanimate bottles is a significant cause. The rate of transmission is also associated with poor hygiene, (especially among children), in dense households, and in those with malnutrition status. Adults who have developed immunity may still carry certain organisms without symptoms. Thus, adults can be a natural reservoir of certain diseases. While some agents (such as Shigella ) only occur in primates, others (such as Giardia) can occur in different types of animals.
Not contagious
There are a number of causes of infectious gastrointestinal tract infections that are not contagious. Some of the more common include drugs (such as NSAIDs), certain foods such as lactose (in those who are intolerant), and gluten (in those with celiac disease). Crohn's disease is also a source of gastroenteritis (often severe) that is not contagious. Secondary diseases of toxins can also occur. Some food related conditions associated with nausea, vomiting, and diarrhea include: ciguatera poisoning due to consumption of contaminated predator fish, scombroid associated with consumption of certain spoiled fish species, tetrodotoxin poisoning from bloated fish consumption, and botulism. usually because the food is not properly preserved.
In the United States, the level of emergency use for non-communicable gastroenteritis fell by 30% from 2006 to 2011. Of the twenty most common conditions seen in the emergency department, non-communicable gastroenteritis rates had the greatest drop in visits during that time period.
Pathophysiology
Gastroenteritis is defined as vomiting or diarrhea due to inflammation of small or large intestine, often due to infection. Changes in the small intestine are usually not inflammatory, while those in the colon are inflammatory. The number of pathogens required to cause infection varies from at least one (to Cryptosporidium ) to as much as 10 8 (for Vibrio cholerae ).
Diagnosis
Gastroenteritis is usually diagnosed clinically, based on signs and symptoms of a person. Determining the exact cause is usually not necessary because it does not change the management of the condition.
However, fecal cultures should be performed on those who have blood in the stool, those who may have been exposed to food poisoning, and those who have recently traveled to developing countries. It may also be suitable for children over 5 years old, older people, and those with poor immune function. Diagnostic tests can also be performed for monitoring. Because hypoglycemia occurs in about 10% of infants and young children, measuring serum glucose in this population is recommended. Electrolytes and kidney function should also be checked when there are concerns about severe dehydration.
Dehydration
Determining whether a person is dehydrated is an important part of the assessment, with dehydration usually divided into mild (3-5%), moderate (6-9%), and severe (> = 10%) cases. In children, the most accurate moderate or severe dehydration signs are prolonged capillary refills, poor skin turgor, and abnormal breathing. Other useful findings (when used in combination) include sunken eyes, decreased activity, lack of tears, and dry mouth. Normal urine output and oral fluid intake are assured. Laboratory testing is of little clinical benefit in determining the degree of dehydration. So the use of urine or ultrasound tests is generally not necessary.
Differential diagnosis
Other potential causes of signs and symptoms resembling those seen in gastroenteritis that need to be excluded include appendicitis, volvulus, inflammatory bowel disease, urinary tract infections, and diabetes mellitus. Pancreatic insufficiency, short bowel syndrome, Whipple disease, celiac disease, and laxative abuse should also be considered. The differential diagnosis can be somewhat complicated if the person shows only vomiting or diarrhea (not both).
Appendicitis may present with vomiting, abdominal pain, and a small amount of diarrhea up to 33% of cases. This is different from the large amount of diarrhea that is typical of gastroenteritis. Lung or urinary tract infections in children can also cause vomiting or diarrhea. Classical diabetic ketoacidosis (DKA) presents with abdominal pain, nausea, and vomiting, but without diarrhea. One study found that 17% of children with DKA were initially diagnosed with gastroenteritis.
Prevention
Lifestyle
Uncontaminated water supply and easily accessible sanitation practices are essential for significantly reducing clinically significant rates of infection and gastroenteritis. Personal measures (such as washing hands with soap) have been found to lower the rate of gastroenteritis in the developing and developing world by as much as 30%. Gel-based alcohol may also be effective. Food or beverages considered contaminated should be avoided. Breastfeeding is important, especially in places with poor hygiene, such as general hygiene improvement. Breast milk reduces the frequency of infection and its duration.
Vaccinations
Due to its effectiveness and safety, in 2009 the World Health Organization recommended that rotavirus vaccine be offered to all children globally. Two commercial rotavirus vaccines exist and some are under development. In Africa and Asia, these vaccines reduce severe illness among infants and countries that have implemented national immunization programs have seen a decrease in the severity and severity of the disease. This vaccine can also prevent illness in unvaccinated children by reducing the number of circulating infections. Since 2000, the implementation of rotavirus vaccination program in the United States has substantially reduced the number of cases of diarrhea by 80 percent. The first dose of vaccine should be given to infants between the ages of 6 and 15 weeks. Cholera oral vaccine has been found to be 50-60% effective for 2 years.
Management
Gastroenteritis is usually an acute and self-limiting disease that does not require treatment. The preferred treatment in those with mild to moderate dehydration is oral rehydration therapy (ORT). For children at risk of dehydration due to vomiting, taking a dose of metoclopramide or ondansetron, can help, and butylcopolamine is useful for treating colic.
Rehydration
The main treatment of gastroenteritis in children and adults is rehydration. This is preferably achieved by drinking a rehydration solution, although intravenous administration may be necessary if there is a decrease in the level of consciousness or if severe dehydration. Drink replacement therapy products made with complex carbohydrates (made from wheat or rice) may be superior to simple sugars. Extremely high drinks in simple sugars, such as soft drinks and fruit juices, are not recommended in children under the age of 5 because they can increase diarrhea. Ordinary water can be used if a more specific ORT preparation is not available or the person will not drink it. A nasogastric tube can be used in young children to provide fluids if needed. In those who need intravenous fluids, the value of one to four hours is often enough.
Diet
It is recommended that breast-fed infants continue to be treated in the usual way, and formula-fed infants continue their formulas immediately after rehydration with ORT. Lactose-free or lactose-less formulas are usually unnecessary. Children should continue their diet during diarrheal episodes with the exception that a simple high-sugar diet should be avoided. The BRAT diet (bananas, rice, apple sauce, toast and tea) is no longer recommended, as it contains insufficient nutrients and has no benefit compared to normal feeding.
Some probiotics have proven beneficial in reducing the duration of disease and the frequency of the stool. They may also be useful in preventing and treating antibiotic-related diarrhea. Fermented milk products (such as yogurt) are also beneficial. Zinc supplementation appears to be effective in treating and preventing diarrhea in children in developing countries.
Antiemetics
Antiemetic drugs may be useful for treating vomiting in children. Ondansetron has several uses, with a single dose being associated with less need for intravenous fluids, less hospitalization, and decreased vomiting. Metoclopramide may also be helpful. However, the use of ondansetron may be associated with increased rates of return to hospital in children. Preparation of intravenous ondansetron may be given orally if clinical assessment is warranted. Dimenhydrinate, while reducing vomiting, does not appear to have significant clinical benefit.
Antibiotics
Antibiotics are usually not used for gastroenteritis, although it is sometimes recommended if symptoms are severe or if susceptible bacteria are isolated or suspected. If antibiotics are used, macrolides (such as azithromycin) are preferred over fluoroquinolone because of higher resistance levels for the latter. Pseudomembranous colitis, usually caused by antibiotic use, is managed by stopping the causative agent and treating it with metronidazole or vancomycin. Bacteria and protozoa that can receive treatment include Shigella Salmonella typhi , and Giardia species. In those with the species Giardia or Entamoeba histolytica , tinidazole treatment is recommended and superior to metronidazole. The World Health Organization (WHO) recommends the use of antibiotics in children with bloody diarrhea and fever.
Antimotility agent
Antimotility drugs have theoretical risk of causing complications, and although clinical experience has shown this to be unlikely, these drugs are discouraged in people with bloody diarrhea or diarrhea complicated by fever. Loperamide, an opioid analog, is commonly used for the treatment of symptomatic diarrhea. Loperamide is not recommended in children, however, as it can cross the adult blood-brain barrier and cause toxicity. Bismuth subsalicylate, the insoluble complex of trivalent bismuth and salicylate, can be used in mild to moderate cases, but salicylate toxicity is theoretically possible.
Epidemiology
There are an estimated two billion cases of gastroenteritis that result in 1.3 million deaths globally by 2015. Children and those in developing countries are most frequently affected. In 2011, in those less than five, there were about 1.7 billion cases resulting in 0.7 million deaths, with most occurring in the poorest countries of the world. More than 450,000 of these casualties are caused by rotavirus in children under 5 years of age. Cholera causes about three to five million cases of disease and kills about 100,000 people each year. In developing countries, children younger than two years often get six or more infections a year resulting in significant gastroenteritis. This is less common in adults, partly because of the development of acquired immunity.
In 1980, gastroenteritis from all causes caused 4.6 million deaths in children, with the majority occurring in developing countries. The death rate decreased significantly (about 1.5 million deaths annually) in 2000, largely due to the introduction and use of extensive oral rehydration therapy. In the US, infection causes gastroenteritis to be the second most common infection (after a common cold), and they produce between 200 and 375 million cases of acute diarrhea and about ten thousand deaths each year, with 150 to 300 deaths in children less than five year.
History
The first use of "gastroenteritis" was in 1825. Prior to that time, commonly known as typhoid fever or "cholera morbus", among others, or less specifically as "guts," "surfeit", "flux", "colic" bowel complaints ", or one of a number of other archaic names for acute diarrhea. Cholera morbus is a historical term used to refer specifically to gastroenteritis rather than cholera.
Society and culture
Gastroenteritis is associated with many everyday names, including "Montezuma retaliation", "Delhi stomach", "la tourista", and "sprint back door", among others. It has played a role in many military campaigns and is believed to be the origin of the term "no guts no glory".
Gastroenteritis is the main reason for 3.7 million visits to doctors a year in the United States and 3 million visits in France. In the United States the overall gastroenteritis is believed to generate a cost of 23 billion USD per year with it because rotavirus alone produces an estimated cost of 1 billion USD per year.
Research
There are a number of vaccines against developmental gastroenteritis. For example, vaccines against Shigella and enterotoxigenic Escherichia coli (ETEC), two of the major bacterial causes of gastroenteritis worldwide.
Other animals
Many of the same agents cause gastroenteritis in cats and dogs as in humans. The most common organisms are Campylobacter , Clostridium difficile , Clostridium perfringens , and Salmonella . A large number of toxic plants can also cause symptoms.
Some agents are more specific to a particular species. Transmission of coronavirus gastroenteritis (TGEV) occurs in pigs that cause vomiting, diarrhea, and dehydration. It is believed to be introduced to pigs by wild birds and no special treatments are available. It is not transmitted to humans.
References
- Notes
- Dolin, Raphael; Mandell, Gerald L.; Bennett, John E., eds. (2010). Mandell, Douglas, and Bennett's principles and practice of infectious diseases (7th ed.). Philadelphia, PA: Churchill Livingstone/Elsevier. ISBNÃ, 0-443-06839-9.
External links
- Gastroenteritis in Curlie (based on DMOZ)
- Diarrhea and Vomiting Caused by Gastroenteritis: Diagnosis, Assessment, and Management in Younger Children from 5 Years - NICE Clinical Guide, No. 84.
Source of the article : Wikipedia
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