Lecture By Dr.Satti Moh'd Saleh Medical Director

1. ACUTE INFECTIOUS DIARRHEA
:BY
DR.SATTI MOH’D SALEH
INFECTIOUS DISEASE 
PHYSICIAN
MEDICAL DIRECTOR 
MEEQAT GENERAL HOSPITAL 
CBAHI INFECTION CONTROL 

2. MECHANISM OF DISEASE
OSMOTIC LOAD. 1
INTESTINAL SECRETION. 2
MECHANISM OF DISEASE1.
DISEASE
INTESTINAL MALABSORPTION. 3
OSMOTIC LOAD
2. INTESTINAL SECRETION MOTILITY.4
ALTERED INTESTINAL
3. INTESTINAL MALABSORPTION
4.ALTERED INTESTINAL MOTILITY

3. OSMOTIC DIARRHEA
NON ABSOBABLE SUBSTANCE 
(.(PURGATIVE
(MAL ABSORTION (GLUCOSE 
SPECIFIC MALABSORTION DEFECT 
(.(DISACHARIDASE

4. SECRETORY DIARRHEA
ENTEROTOXIN 
(HORMONES (VIP 
(BILE SALTS (ILEAL VESECTION 
(FATTY ACIDS (ILEAL VESECTION 
(LAXATIVES (DSS 

5. INFLAMATORY DIARRHEA

6. ABNORMAL MOTILITY
DM,VAGOTOMY,HYPERTHYROIDISM 
MOTILITY
ALTERED
DM,VAGOTOMY,HYPER
THYROIDISM

7. ACUTE INFECTIOUS
DIARRHEA
:DEFINITION
Alteration of normal physiological function GIT
.by ingested microorganisms or their products
.Toxigenics organisms - - secretion + absorption-
Rota Norwalk, otherinal illness - - infection of-
.Entrocytes and loss of brush border enzymes
Invasive pathogens - - infalm, Int. secretion altered-
.motility

8. HOST DEFENSE
Host defenses
1- Gastric Acidity
Gastric Acidity- 1 
2- Bowel Motility
Bowel Motility- 2 
3- Colonic Flora Colonic Flora- 3 
4- Local anti-body Local anti-body- 4 

9. CAUSES
CAUSES OF ACUTE INFECTIOUS
DIARRHEA
WATERY DIARRHEA WATERY DIARRHEA
-B. CEREUS B. CEREUS -
- STAPHYLOCOCCUS STAPHYLOCOCCUS -
- VIBRIO VIBRIO -
- ETEC ETEC -
- EPEC -
- SALMONELLA SPP. EPEC
- CAMPYLOBACTER .SALMONELLA SPP -
CAMPYLOBACTER
- CLOSTRIDIUM PERFRINGENS -
CLOSTRIDIUM PERFRINGENS
- CLOSTRIDIUM DEFFICILE -
CLOSTRIDIUM DEFFICILE -

10. DYSENTERY
SHIGELLA -
SALMONELLA -
CAMPYLOBACTER -
EIEC -
EHEC -
.YERSENIA ENT -
VIBRIO PARAHAEMOLYTICUS -
CLOSTRIDIUM DEFICILE -

11. Selected notifiable diseases by region Jul - Sept 2011
Madina KSA

12. SYMTOMS & SIGNS
TOXIGENIC INFLAMMATORY VIRAL
No systemic upset Systemic upsetAbdminal Systemic upset
Small number pain, tenesmus, fever . URTI
Large volume Stool Fever nausea
Stool no RBCs no Large number Frequent Myalgia
leukocytes. Small volume blood -stain Stool
mucus, pus cells Voluminous, watery
Mechanism Mechanism
Invasion of enterocytes Osmatic or secretory
leading to mucosal cell
death and inflammatory
response

13. APROACH TOwith diarrhea
Approach to pt PATIENTS
( entrotoxin ( a febrile- 1 
potentially invading( Fever + blood or – 2 
( dysentery
completely invading ( fever + bactreamia- 3 
Diarrhea with GI bleeding- 4 
Investigation
Rectal swab, stool general , Stool c/s , toxin-
assay ,elisa, PCR

14. entrotoxin ( a febrile ) - 1
2 – potentially
invading( Fever + blood or
dysentery )
3- completely invading ( fever
+ bactreamia
4- Diarrhea with GI bleeding
Investigation
- Rectal swab, stool general ,
Stool c/s , toxin assay
,elisa, PCR

15. DIARRHEA CLINICS
PRIMARY CARE CENTER-
SEASONAL CENTER-
HOSPITALS-
EACH CLINIC-
Doctor
Nurse
Health supervisor
Necessary requirements
Supervision -
Regional Infection control Committee + Preventive -
.Medicine Dept

16. OUT PATIENT MANAGEMENT
FOR MILD DIARRHEA
SAUDI -
RESIDENTS -
HAJI WITH PROPER EASILY TRACED -
ADDRESS

17. HOSPITAL
MANAGEMENT
Severe Cases 1.
Positive Cases 2.
Vibrio -
Others -
Suspected Cases. 3
with no proper address

18. HAJ NON HAJ
:Name
SURVEY SHEET OF HOSPITALIZED INFECTIOUS DIARRHEA CASES IN
.MEDINA MUNAWARAH DURING HAJ
:Age Years Sex: M/F Nationality
:History of
Fever Nausea Vomiting
Tenesmus Headache Colic
( Mayalgia Other (specify
:Stools
Frequent >6/day Volume Large Actual amount >1/2 liter
day small >1/2 liter/6 <
Blood Mucus Consistency Formed
Semi formed
Watery
(Other( specify
Contacts: One person involved
Group with common food source
:Examination
.Temp. Pulse BP Resp
Dehydration Mild Level of consciousness Drowsy
Moderate Semiconscious
Severe Comatosed

19. :Laboratory Tests
Blood CBC Hb PCV
RBS
UREA
CREATININE
ELECTROLYTES
STOOL GENERAL BLOOD
MUCUS
WBC
OVA / CYST AMOEBA / GIARDIA
(OTHER( SPECIFY
CULTURE RECTAL SWAB STOOL CULTURE BLOOD CULTURE
ROTA VIRUS Norwalk AGENT
: MANAGEMENT & COMMENTS

20. ANNUAL REPORT OF 2011 Jul
sept
TYPHOID AND PARATHYROID = 57
.K.S.A 2011
SALMONELLA = 390CASE
SHIGELLA =7
.‫ة‬ )CHOLERA = 0

21. TREATMENT OF MOST COMMON
.GASTROINTESTINAL PATHOGENS
S. aureus Hydration Self limited
B. cereus Hydration Self limited
C. perfringeus Hydration Self limited
V.cholrae Tetrcycline’s Ampicilin & TMP-SMX
So effective
Salmonella TMP-SMX Ampicilin
Shigella TMP-SMX Quinolon
,Yersinia TMP-SMX Tetracyclines
.minoglycosides in severe cases
Campylobacter Erythromycin Quinolones
E. coli Hydration Self limiting
v. parahaemolyticus Tetracyclines TMP-SMX
Rotavirus Hydration No specific treatment
Norwalk virus Hydration No specific treatment
TNIDAZOLE Me tronidazole G. lambia
E. histolytica Me tronidazole

22. ‫حال ت الهسهال منطقة المدينة المنورة‬
‫1341 --- 2341 حتى شعبان‬

23. ‫حال ت الهسهال منطقة المدينة‬
‫المنورة‬
‫2341 حتى شعبان‬
‫6747‬
‫312‬

24. MANAGEMENT
MANAGEMENT OF INFECTIOUS
DIARRHEA
1. REHYDRATION REHYDRATION 1.
ORS ORS
IV IV FLUIDS
FLUIDS SHOCK SHOCK
SEVERE VOMITING SEVERE VOMITING
DEPRESSED MENTAL STATE
DEPRESSED MENTAL
2. INDICATIONS FOR ANTIMICROBIALS STATE
a( Parasitic infections E. histililytica
INDICATIONS FOR ANTIMICROBIALS. 2
a) Parasitic infections G. lambia
E. histililytica
Other parasitic infection
G. lambia
b(. V.cholerae Cases
Other parasitic infection
Carriers
b). V.cholerae Cases
discharge after 3 consecutive negative post treatment samples
c(. Carriers
Salmonella Infants
discharge after 3 consecutive negative post treatment samples
c). Salmonella Infants

25. PREVENTION
.PROVISION OF SAFE WATER. 1 1.
.PERSONAL HYGIENE. 2 2.
.AVOID UNDERCOOKED FOOD. 3 3.
.HEALTH INSPECTION. 4 4.
.HEALTH EDUCATION. 5 5.
.ISOLATION & TREATMENT OF CARRIERS. 6 6.
.SCREENING OF FOOD HANDLERS. 7 7.

26. Thank you 