travellers diarrhoea Flashcards
TD definition
diarrhoea-loose watery stools 3 or more with possibly cramps, pain, vomiting, fever, urgency associated with TRAVELLING
in 24 hours
KEY THING to watch out for
other things to look for
maintain haemodynamics- maintain hydration and prevent loss of fluid
overlapping symptoms - appenditicitis, obstruction and ectopic pregnancy
may also present as part of sepsis
differential diagnosis
norovirus
food poisoning
incidence
10-40% of travelling seen more commonly in young people failure of hygiene 12-46 have to change plans due to TD Africa Asian and south America increased risk streffen 2015
risk factors
where youre travelling food - what type, how its handled water contaminated risky behaviour afew genetic problems which predispose risk
causes
rare 2
hill 2010
50-75 due to E.coli
shigella and salmonella 0-15%
norovirus on cruise ships, small no. due to parasites, food poisoning
areomona spp fresh water-contaminated very rare
and shellfish- also rare and associated with severe symptoms -often outbreaks
how many days
complications percentage
self limiting
3-5 days
can cause severe symptoms
only 3% complications - can lead to post infection BS (2%)
E.coli pathiogenesis
most common cause in gut
various strains hence why an injection would be not so effective
some have virulence factors thus patogensis
causing gi symptoms but can also affect rest of body
hard to diagnosis due to multiple strains and need PCR for identification of these
most common ecoli type in TD
enterotoxigenic with heat labile/stable toxins
FO route and often outbreak in children
triggers excess clorhoide and water loss from cells
activate adenylate cylase
responds to loperamide
ciprofloxacin and azithromycin also good but increase resistance of former in SE asia
how do heat labile and heat stable toxins work?
heat labile - ganglioside binds to brush border, activated adenylate cyclase and then protein kinase, activates increase cAMP, cl- pump, cl out of cell, na out of cell, then water follows
heat stable - CFTR activation delivery of cl and hco3 increase cGMP
activated PDE3 PKG2
dyysunctional in CF thus protective
enteroaggressive ecoli
fimbrae-adhesion to mucosa
thick mucosa layer
production of cytotoxic toxins -> inflammation
stacked brick appearance
enteropathogenic ecoli
no toxin
injection of ecoli into cell with intinimin membrane protein and type 3 screotry system which pinches hole
rolling of membrane
enterohaemorrhagic ecolli
rare production of verotoxin bloody stools animals out break in 2011 Germany killed 50 5 HUS, 12% of HUS will go onto ESRF or death
shigella
four types
boydii, flexneri -outbreaks in areas of low hygein eg refugee camps soniee and dysenteraiae- first most severe, soniee mild , schools
most infectious
ivades M cells direction invasion results in fluid loss
HUS TMC complications
fever
ciprofloxacin and zithromycin treatment
campylobacter
fever, headache myaglasia 24 hr before gi onselt
10-20% longer than a week
severe colitis complication
gulliain barre syndrome - motor neuropathy
can cause pseuappendictis and confused with IBD
treatment ciproflaxciin and macrolides
5% relapse
