Diarrhoea Illness

Question 1

How many children die per year from diarrhoea illness and where?

Answer 1

1/2 million
Mainy in India and Subsaharan Africa

Question 2

Average Incidence of diarrhoea in developing countries

Answer 2

Average 3 episodes per child per year
Peak between 6mths-18 months

Question 3

Main risk factors for diarrhoea in children?

Answer 3

1) age- mainly less than 5 but peak at 6-18months
2) Malnurtrition
3)Immunosuppression
4)Lack of breastfeeding–the most cost effective intervention
5)Measles
6)No immunisations
7)Lack of safe water, sanitation and hygiene

Question 4

Acute vs prolonged diarrhoea?

Answer 4

Acute is less than 7 days
Prolonged is 7-14days

Question 5

Osmotic vs secretory

Answer 5

Secretory is typically due to a pathogen, pulls electrolytes to the lumen

Question 6

Inflammatory vs non-inflammatory

Answer 6

Inflammatory is typically a bacterial infection (>50 faecal lecuocytes), will need abx
Most diarrhoea is viral

Question 7

Most important causes of diarrhoea in children?

Answer 7

Kids <1yr always think of rota virus
Shigella is typically>1yr
Always think of viruses in children
Rotavirus/adenovirus/St-ETEC, cryptosporidium and campylobacter

Question 8

What pathogen of E-Coli is typically associated with prolonged diarrhoea in children

Answer 8

EPEC

Question 9

What kind of Dirrhoea in ETEC? (Enteric toxogenic E-Coli)

Answer 9

Main pathogen in travellers diarrhoea
Water diarrhoea and can be very severe dehydration in children
High volume and vomiting
Think of diarrhoea

Question 10

Enterinvasive E-Coli (EIEC)

Answer 10

Brisk inflammatory response, very similar to Shigella
Bloody diarrhoea

Question 11

EAEC?

Answer 11

Associated with HIV positive children

Question 12

EHEC important considerations?

Answer 12

Causes HUS

Question 13

What to consider in acute water diarrhoea?

Answer 13

This can be any pathogen- shigella, salmonella and campylobacter are bloody typically but can also be watery

Question 14

Prolonged diarrhoea in children, what pathogen?

Answer 14

EAEC, EPEC, parasite (coccidia)

Question 15

Most important pathogens for dehydrating diarrhoea?

Answer 15

Rotavirus
ETEC
Cholera

Question 16

Main causes of bloody diarrhoea–most important one

Answer 16

Mainly Shigella
Salmonella
Campylobacter
STEC

Question 17

What are the most common diagnostic technique methods?

Answer 17

Microscopy–look at faecal lecuocytes and stain for coccidia– most important in resource limited
ELISA for shiga toxin, campylobacter, Rotavirus

Question 18

E-Coli diagnosis?

Answer 18

E-Coli can be normal flora, or can be pathogenic
Real time PCR looks for different toxogenic properties of E-Coli

Question 19

When do you use Film Array

Answer 19

Only in immunocompromised children
Identifies several different pathogens

Question 20

What do quantitative PCRs help with?

Answer 20

Measures the bacteria load
Higher bacteria load means infection rather than colonisation
Differentiates colonisation vs infection

Question 21

What are the three critical signs of dehydration in diarrhoea
What other important signs

Answer 21

Thirst
Sensorium- irritable or comatose
Skin turgor: slow, very slow

Sunken eyes/dry mucous membranes/Absent tears

Question 22

What weight loss categories of dehydration?

Answer 22

Mild is up to 5% weight loss
Moderate 6-10%
Severe >10%

Question 23

What is rehydration plan A?

Answer 23

Education and prevention of diarrhoea
ORS ad libitum
Give ORS drop by drop, as will vomit otherwise
Need ORS with low osmolality

Question 24

What is rehydration Plan B?

Answer 24

Observed rehydration
Ad libitum rehydration
100cc/kg in 4-6hrs

Question 25

What is rehydration plan C?

Answer 25

This is for severe dehydration If patient shocked-- need blous of saline If not shocked, 100cc/kg in 3-6hrs with ploy-electrolyte solution or ringers lactate

Question 26

IV rehydration treatment for severe diarrhoea in baby <12 months

Answer 26

Administer 30ml/kg in 1hr Then 70ml/kg in 5hrs Nacl 0.9% plus dextrose 5% plus KCL

Question 27

IV rehydration in children >12months?

Answer 27

Administer 30ml/kg in 30 mins Then administer 70ml/kg in 2.5hrs

Question 28

What are the new key components to ORS?

Answer 28

**Low osmolality ORS** Use of zinc for 10-14days in children >6months Do not give loperamide in children can lead to translocation Can give ondansetron if you are sure vomiting is due to diarrhoea illness Not v much evidence for probiotics

Question 29

When do you give abx?

Answer 29

Consider in bloody diarrhoea and fever and faecal lecuocytes >50 Antibiotics should cover shigella

Question 30

When do you hand wash?

Answer 30

Preparing food Feeding baby After changing nappy

Question 31

Why breastfeed infants?

Answer 31

Especially in first 6months of life, reduces incidence and mortality of diarrhoea Right nutrients and passage of maternal antibodies