Good Handwashing and appropriate food handling is key to preventing the spread of further disease.
About
- Inflammation of the stomach and intestinal epithelium and submucosa
- Typically acute and infective coming on soon after exposure to agent
- Most cases never come near the hospital
- Close monitoring e.g. admission for IV fluids for diabetics, pregnancy, paediatrics, immunocompromised, elderly, coexisting diseases
Causes
Causes | Examples |
Viruses | rotavirus, adenovirus, astrovirus, small round viruses, Norwalk virus
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Bacteria | Campylobacter jejuni, Escherichia coli (O157), Salmonella, Shigella, Vibrio cholerae, Staph aureus, Clostridium botulinum, Clostridium perfringens, Bacillus cereus, Clostridioides difficile
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Protozoa | Entamoeba histolytica, Cryptosporidium parvum, Giardia lamblia |
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Toxins | seafood, mushrooms, Scombrotoxin , Ciguatera fish poisoning
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Mechanism
Mechanism | Example |
Non inflammatory | Vibrio cholerae, Enterotoxigenic E.coli produce toxins which cause the cells lining the gut to secrete water and electrolytes
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Inflammatory | Enteroinvasive E.coli and Shigella and salmonella typhi release cytokines and generally damage the epithelium
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Organisms | Code: D=Diarrhoea, V = Vomiting AP=Abdominal pain F=fever S=Sepsis |
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Staph aureus | D&V&AP within 6 hrs of ingestion of infected meat |
Bacillus cereus
| D/V Within 6 hours of ingestion of infected rice
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Scombrotoxin
| D/V and Flushing and hot mouth within 1 hour of eating fish. Scombroid fish poisoning is due to ingestion of food high in Histamine. Antihistamines are given and fluid resuscitation. Proper storage after the fish is caught would prevent this
|
Ciguatera fish poisoning
| D/V/AP tingling all over. Within minutes of ingestion. Ciguatera fish poisoning is due to fish that contain a dinoflagellate that releases ciguatoxin. Management is supportive with fluid replacement. Patients feel hot when cold and vice versa. Diarrhoea and cramps persist. Unusual sensations may persist for many months
|
Salmonella
| D/V/AP/F/S Between 12 and 48 hours after infected meat, eggs, chicken
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Norovirus
| D/V(projectile)/AP within 12-48 hrs. Faeco-oral and from vomitus. Infectious even after symptoms resolve up to 48 hrs
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Rotavirus
| D/V/F within 1-7 days
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Clostridium botulinum
| V/Paralysis/Botulism from canned and processed foods. Diplopia, facial weakness and weakness in his arms and hyporeflexia
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Clostridioides difficile
| V/D/AP. Seen In those on broad-spectrum antibiotics. Faeco-oral spread. Spores. Toxin producing. Pseudomembranous colitis. Toxic megacolon
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Clostridium perfringens
| D/AP from meat within 24 hours
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Vibrio cholerae
| See section. From contaminated water.
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Campylobacter
| D(bloody)/V/F/Acute AP within 5 days of milk, chicken, water. May develop Guillain-Barré syndrome.
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E.Coli O157
| D(bloody), D/V/F/P within 12-72 h,Haemolytic uraemic syndrome
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Yersinia enterocolitica
| D, AP, F from infected milk
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Cryptosporidium parvum
| D/Cramps. Associated with HIV and life-threatening if low CD4. From infected unboiled water. Incubation period 4-12 days
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Giardia lamblia
| D/Malabsorption from cats,dogs within 1 wk-1 month
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Entamoeba histolytica
| D/Malabsorption within 1 wk-1 month
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Shigella
| D(bloody)/Fever,AP within2-3 day of infection from food
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Vibrio parahaemolyticus
| D/AP/V within 48 hours of infected seafood
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Clinical
- Acute onset of nausea, vomiting, anorexia, fever in some cases
- Waves of Intestinal colic and diarrhoea which may be watery faeces initially or mucus or even blood-stained
- Abdominal discomfort, ↑ Bowel sounds
- Dehydration and hypotension in severe cases
Investigations
- Done only in a select few with severe symptoms
- FBC ↑ WCC ↑ CRP
- U&E ↑ Urea, ↑ Creatinine if dehydrated or ↑↑ may suggest renal failure associated with E Coli O157
- Stool samples for microscopy and culture and toxin analysis
- Blood cultures if pyrexial
- AXR - may show gas-filled bowel loops, no faeces
Prevention when abroad
- Avoid unbottled or unboiled water
- Avoid ice cubes and salads and peel your own fruit
- Recently prepared hot food only
Management
- Fluid management using IV fluids if needed
- Oral rehydration sachets
- Loperamide and Codeine phosphate can be used
- Ciprofloxacin if salmonella, shigella or campylobacter suspected with systemic infection or if elderly or immunocompromised
- Notifiable disease in the United Kingdom
Important complications
- Guillain-Barré syndrome with campylobacter
- Haemolytic uraemic syndrome with E.coli O157
- Precipitate Diabetic ketoacidosis in Type 1 DM not following sick day rules
- Hypovolaemic shock
- Muscle weakness - Botulinum toxin