Diarrhea and vomiting (D&V): some common causative agents and their management (Part 1)
Salmonellosis (typhoid fever)
CAUSAL AGENT(S):
Salmonella typhi and paratyphi A, B, C.
The disease is prevalent in the Far East, Middle East, South and Central America, Africa, South and Eastern Europe.
SOURCE OF INFECTION:
Both types have a purely human reservoir and infection occurs through the feces or urine of a patient or carrier.
Water and food are important vehicles for the spread of infection, particularly poultry, egg products, and related fast foods.
Direct person-to-person spread or handling of exotic pets such as salamanders, lizards or turtles they are also a common mode of contact with the disease.
Any age group can be affected, but the highest incidence of the disease is in young adults. Babies rarely have the disease; when they do, it is often mild and atypical.
These two stereotypes produce septicemic diseases’enteric fever (Typhoid or paratyphoid fever)
*All the others Salmonella The serotypes, of which there are more than 2,000, are subdivided into five distinct subgroups that cause gastroenteritis (diarrhea and vomiting).
They are widely distributed throughout the animal kingdom. Some strains have a clear relationship to particular animal species, e.g.S. arizonae and pet reptiles.
CLINICAL PICTURE:
The incubation period for Salmonella gastroenteritis is 12 to 72 hours with an upper limit of approximately 7 days.
The onset of the disease is usually insidious.
SIGNS AND SYMPTOMS:
Headache, malaise and abdominal discomfort. – A slight abdominal distention may occur. – Persistent cough and epistaxis (nosebleed) may occur in the second week.
The temperature remains high, and diarrhea and vomiting develop. The patient is weak and listless.
The spleen is often enlarged and palpable, and characteristic rashes may appear on the abdomen, face, and chest. (called pink spots)
These may not be visible on pigmented skin. The patient may become delirious, confused, and comatose as the disease progresses.
CARRIER STATUS:
Carriers are people who are infected with the Salmonella organism but do not show symptoms of illness.
TWO TYPES:
Fecal carriers, – Urine carriers – rare
TREATMENT;
Ciprofloxacillin is the drug of choice.
Dose: 500 mg every twelve hours in adults and the treatment is from 10 to 14 days.
Children: 25 mg/kg of body weight.
Other medications that can be used are:
–SEPTRIN –AMOXICILLIN –CHLORAMPHENICOL –PERFLOXIN
TREATMENT OF THE CARRIER STATE:
Ampicillin 3g/day in divided doses x 3 months.
Septrin ii twice daily x 1 month.
PREVENTION:
1. (a) Provision of pure water supplies.
(b) Sanitary safe disposal of excreta.
(c) High standard in food handling, processing and storage. Food handlers must be regularly monitored.
2. Typhoid vaccine: 2 injections s/c (0.5 ml) given 4 weeks apart. Boosters every 3 years – (0.1 ml)
3. Patients should be placed under surveillance and regular stool and urine tests should be performed to detect carrier status.
4. The identified carrier must be prevented from engaging in food handling. Advice on proper personal hygiene is important.
Staphylococcal food poisoning:
CAUSAL AGENT:
staphylococcus aureus it is a common commensal of the anterior nasal passages of humans and, with poor hygiene, transmission takes place through the hands of food handlers to food products such as dairy products (milk, cheese, eggs) and cooked meats.
Improper storage of these foods allows rapid multiplication of the organism and subsequent production of one or more heat-stable foods. enterotoxins which are the real culprits in the manifestation of the signs and symptoms of food poisoning.
SIGNS AND SYMPTOMS:
After ingestion, symptoms of profuse nausea and vomiting develop within a couple of hours (1 to 5 hours). Sometimes the diarrhea may not be as serious as the vomiting. The main pathological agent is toxin(s) that acts on gastrointestinal cells drawing water and electrolytes into the intestinal lumen, causing severe diarrhea and vomiting. Most cases resolve quickly, but severe dehydration and rare deaths due to acute fluid loss and shock are known to occur.
DIAGNOSIS:
The mainstay of diagnosis is to demonstrate the toxins in the stool and to culture the organism from it. When any suspect food is available, it should be cultured for staphylococci and demonstrate toxin production.
TREATMENT:
Antiemetic drugs with adequate fluid replacement are the basis of treatment with some antibiotic to prevent opportunistic infections.
PREVENTION:
Public health authorities should be notified if it involves food sales.
Food handlers must be taught how to practice good hygiene and so must the population.
NB
I have tried to discuss here in a simple way the type of emergencies that arise from the ingestion of contaminated food or drink. Although the individual is not expected to institute any treatment per se, recognition of the signs and symptoms should prompt the individual to seek medical attention as quickly as possible. Part 2 will follow soon.
Author: Ola Suyee