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Chapter 122. Acute Infectious Diarrheal Diseases and Bacterial Food Poisoning

Ranging from mild annoyances during vacations to devastating dehydrating illnesses that can kill within hours, acute gastrointestinal illnesses rank second only to acute upper respiratory illnesses as the most common diseases worldwide. In children 50% of childhood deaths are directly attributable to acute diarrheal illnesses. | Chapter 122. Acute Infectious Diarrheal Diseases and Bacterial Food Poisoning Ranging from mild annoyances during vacations to devastating dehydrating illnesses that can kill within hours acute gastrointestinal illnesses rank second only to acute upper respiratory illnesses as the most common diseases worldwide. In children 5 years old attack rates range from 2-3 illnesses per child per year in developed countries to as high as 10-18 illnesses per child per year in developing countries. In Asia Africa and Latin America acute diarrheal illnesses are not only a leading cause of morbidity in children with an estimated 1 billion cases per year but also a major cause of death. These illnesses are responsible for 4-6 million deaths per year or a sobering total of 12 600 deaths per day. In some areas 50 of childhood deaths are directly attributable to acute diarrheal illnesses. In addition by contributing to malnutrition and thereby reducing resistance to other infectious agents gastrointestinal illnesses may be indirect factors in a far greater burden of disease. The wide range of clinical manifestations of acute gastrointestinal illnesses is matched by the wide variety of infectious agents involved including viruses bacteria and parasitic pathogens Table 122-1 . This chapter discusses factors that enable gastrointestinal pathogens to cause disease reviews host defense mechanisms and delineates an approach to the evaluation and treatment of patients presenting with acute diarrhea. Individual organisms causing acute gastrointestinal illnesses are discussed in detail in subsequent chapters. Table 122-1 Gastrointestinal Pathogens Causing Acute Diarrhea Mechanism Locatio Illness Stool Findings Noninflammato ry enterotoxin Proxima Watery l small diarrhea bowel No fecal leukocytes mild or no increase in fecal lactoferrin Examples of Pathogens Involved Vibrio cholerae enterotoxigenic Escherichia coli LT and or ST enteroaggregativ e E. coli Clostridium perfringens Bacillus .