Diarrhoea: Infections spread by food and water ICDS Supervisor Exam|ICDS Supervisor Kerala PSC
In this post Diarrhoea, one of the Infections spread by food and water is explained. The Types of Diarrhoea and the pathogens of Diarrhoea are explained in detail. Other Infections spread by water are Typhoid, Paratyphoid fever, Poliomyelitis, Hepatitis A and Hepatitis E. Those will be explained in next post. Immunization and Vaccines are important topics for ICDS Supervisor Exam.
Kerala PSC and other states PSC's are conducting Exams for ICDS Supervisor. Study materials are available for other topics also like Home Science, Food and Nutrition, Psychology, Physiology, Microbiology, Sociology and Nutrition and Health for ICDS Supervisor Kerala PSC Exam
Infections spread by food and water
1. Diarrhoea
Annually, up to 1500 million episodes of diarrhoea occur worldwide in children aged five years and under, and an estimated 4 million children die each year from it.
About 80% of deaths occur in the first two years of life.
Dehydration is the main cause of death from acute diarrhoea although other important causes are septic shock, peritonitis and malnutrition.
The patient with diarrhoea not only eats less but also has an inability to absorb nutrients at a time when nutrients are more in demand as a result of the infection.
When diarrhoeal attacks are repeated and prolonged, the natural growth of a child is affected.
Diarrhoea is also an economic burden on developing countries; working days are lost and expensive hospitalization for treatment may be required.
Definition of Diarrhoea
Diarrhoea is a clinical syndrome in which there is frequent passage of unusually loose or watery bowel movements, usually three or more in a 24 hour period, sometimes accompanied by vomiting and fever, abdominal pain or cramps, faecal urgency, tenesmus, or the passage of bloody or mucoid stools.
Mode of transmission of Diarrhoea
Infectious diarrhoea is spread by the faecal-oral route.
The most common sources are contaminated food and water, person-to-person contact and direct contact with infected faeces.
Enteropathogens survive in ice and untreated swimming pools. Protozoan parasites can survive as cysts even in water that seems adequately chlorinated.
Seawater, heavily contaminated with sewage and faecal microorganisms is another source.
Factors that increase the risk of diarrhoea include:
• Failing to breastfeed exclusively for the first 6 months of life: the risk of developing severe diarrhoea is many times greater in non-breast-fed infants than in breastfed infants; the risk of death from diarrhoea is also substantially greater.
• Failing to continue breastfeeding until at least one year of age: prolonged breastfeeding reduces the incidence or severity of certain types of diseases causing diarrhoea, such as shigellosis and cholera.
• Using infant feeding bottles: these easily become contaminated
with faecal bacteria and are difficult to clean.
When milk is added to an unclean bottle it becomes contaminated and if it is not consumed immediately, further bacterial growth occurs.
• Allowing an infant or child to crawl, or play in an area where human or animal faeces are present.
• Storing cooked food at room temperature: when food is cooked and then saved to be used later, it may easily be contaminated, for example, by contact with contaminated surfaces or containers.
If food is kept for several hours at room temperature, bacteria in it can multiply many times.
• Drinking water that is contaminated with faecal bacteria: water may be contaminated at its source or during storage in the home.
• Contamination in the home may occur when a storage container is not covered, or when a contaminated hand comes into contact with water while collecting it from a container.
• Failing to wash hands before handling food, after defecation, or after handling faeces.
• Failing to dispose of faeces (including infant faeces) hygienically. It is often believed that infant faeces are harmless, whereas they may actually contain large numbers of infectious viruses or bacteria such as rotaviruses or enterotoxin E. coli.
• Animal faeces can transmit enteric infections such as salmonella to humans.
Host factors also increase susceptibility to diarrhoea and are associated with increased incidence, severity or duration of diarrhoea.
• Undernutrition: the frequency, severity, duration and risk of death from diarrhoea are increased in undernourished children, especially those with severe undernutrition.
• Current or recent measles: diarrhoea and dysentery are more frequent or severe in children with measles or in children who have had measles in the four weeks prior to infection.
This presumably results from immunological impairment caused by
measles.
• Immunodeficiency or immunosuppression: this may be a temporary effect of certain viral infections (for example, measles), or it may be prolonged, as in persons with the acquired immunodeficiency syndrome (AIDS).
When immunosuppression is severe, diarrhoea can be caused by unusual pathogens and may also be prolonged.
Aetiology
Diarrhoea can result from viral, bacterial or parasitic infections. Until a few years ago, pathogenic organisms could be identified in the faeces of only about 25% of patients with acute diarrhoea.
Today, using new techniques, experienced laboratories can identify pathogens in about 75% of cases seen at a treatment facility and up to 50% of milder cases detected in the community.
Important pathogens of Diarrhoea
Several of these pathogens are important causes of acute diarrhoea in all developing countries:
• Rotavirus
• Enterotoxigenic Escherichia coli
• Shigella
• Campylobacter jejuni
• Cryptosporidium
Rotavirus
Rotavirus is the most common cause of severe, life-threatening
diarrhoea in children under 2 years of age worldwide.
There are four serotypes of human rotavirus; infection with one serotype causes a high level of immunity to that serotype, and partial protection against the other serotypes.
Nearly all children are infected at least once before the age of 2 years, and repeat infections are common. For the most part, only the first rotavirus infection causes significant illness.
About one-third of children under 2 years of age experience an episode of rotavirus diarrhoea.
Rotavirus is usually spread from person to person and possibly also through respiratory secretions as well as faeces.
Enterotoxigenic E. coli (ETEC)
ETEC is an important cause of acute watery diarrhoea in adults and children in developing countries.
ETEC does not invade the bowel mucosa and the diarrhoea it causes is toxin-mediated; there are two ETEC toxins – heat-labile
(LT) and heat-stable (ST).
Some strains produce only one type of toxin, some both.
The LT toxin is closely related to the cholera toxin.
ETEC is usually spread via contaminated food and water.
Shigella
Shigella is the most common cause of dysentery, present in about 60% of all episodes, and in nearly all severe episodes; watery diarrhoea may also occur.
There are four serogroups: S. sonnei, S. boydii, S. flexneri and S. dysenteriae. S. flexneri is the most common serogroup in developing countries, but S. dysenteriae type 1, which occurs in regional epidemics, causes the most severe disease.
Tissue destruction and possibly watery diarrhoea are caused in part by the extremely potent Shiga toxin, produced in relatively large amounts by S. dysenteriae Type 1.
Shigella is spread mostly by person-to-person transmission.
Campylobacter jejuni
In developing countries, C. jejuni causes disease mostly in infants. C. jejuni also infects animals, especially chickens and dogs, and is spread by contact with their faeces or consumption of contaminated
food, milk, or water.
C. jejuni can cause both watery diarrhoea (two-thirds of cases) or dysentery (one-third of cases). Fever may be present. The disease is not usually severe and lasts 2–5 days.
Cryptosporidium
This is a coccidian parasite that causes disease in infants, immunodeficient patients and a variety of domestic animals.
In developing countries infection is frequent and most episodes of illness occur in the first year of life.
Thereafter, infections are usually asymptomatic.
Diarrhoea is usually neither severe nor prolonged, except in immunodeficient patients, such as those with severe malnutrition or AIDS.
In such individuals, Cryptosporidium is an important cause of persistent diarrhoea with wasting.
• Non-typhoid Salmonella in areas where commercially processed foods are widely used;
• Enteropathogenic Escherichia coli (in infants in hospitals).
Mixed infections involving two or more enteropathogens occur in 5–20% of cases seen at health facilities.
Vibrio cholerae 01
V. cholerae 01 has two biotypes (classical and El Tor) and two serotypes (Ogawa and Inaba).
V. cholerae 01 is non-invasive, diarrhoea being mediated by a cholera toxin which causes a profuse secretion of water and electrolytes in the small bowel.
Diarrhoea may be severe, leading to dehydration and collapse within a few hours if the lost fluids and salts are not replaced.
In endemic areas cholera occurs mostly in children, adults have
substantial immunity from previous infections.
In non-endemic areas, epidemics cause disease with equal frequency in adults and children.
Salmonella
Most Salmonella infections can be traced to infected animals or contaminated animal products.
Salmonellae are an unusual cause of diarrhoea in most developing countries but may be important in communities where commercially processed foods are widely used. Diarrhoea is usually watery, but dysentery may occur.
Antibiotics are not effective and may cause delayed clearance of
Salmonellae from the intestinal tract.
Other pathogens
A number of other pathogens can cause diarrhoea in young children although their importance is not well defined. They include:
• Viruses: Norwalk agent, enteric adenoviruses
• Bacteria: Aeromonas hydrophila, enteroadherent Escherichia coli, enteroinvasive Escherichia coli, enterohaemorrhagic Escherichia coli, Plesiomonas shigelloides, Vibrio cholerae non-O group 1, Vibrio parahaemolyticus, Yersinia enterocolitica
• Protozoa: Giardia lamblia, Entamoeba histolytica, Isospora belli.
Enteric pathogens can also be found in about 30% of healthy children under 3 years of age, making it difficult to know whether a pathogen isolated from a child is actually the cause of that child’s
illness.
This is especially true for Giardia lamblia, cysts of which are found nearly as often in healthy children as in those with diarrhoea; it is also true for enteropathogenic E. coli or C. jejuni isolated from children older than 1 year.
On the other hand, Shigella and rotavirus are rarely identified in healthy children; their presence in a child with diarrhoea strongly indicates that they are the cause of the illness.
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