Acute Gastroenteritis Year 4 Paediatrics Notes OmpathStudy

Acute Gastroenteritis Year 4 · Paediatrics Collection: 4TH YEAR ALL NOTES / PAEDS / PAEDS 4.2 / MUNGE / GIT -- Slide 1 Acute Gastroenteritis Dr Rose Munge Slide 2 Introduction The term gastroenteritis denotes inflammation of the gastrointestinal tract, most commonly the result of infections with bacterial, viral, or parasitic pathogens. Many of these infections are foodborne illnesses. Acute gastroenteritis (AGE) captures the bulk of infectious cases of diarrhea.\nThe most common manifestations are diarrhea and vomiting, which can also be associated with systemic features such as abdominal pain and fever. Slide 3 Dysentery refers to a syndrome characterized by frequent small stools containing visible blood, often accompanied by fever, tenesmus, and abdominal pain.\nThis should be distinguished from bloody diarrhea (larger volume bloody stools with less systemic illness) because the etiologies may differ.\nProlonged (lasting 7-13 days) and persistent diarrhea (lasting 14 days or longer) are important because of their impact on growth and nutrition. Slide 4 Burden of Childhood Diarrhea Although global mortality due to diarrheal diseases has declined substantially (39%) during the past 2 decades, it remains unacceptably high.\nIn 2015, diarrheal disease caused an estimated 499,000, or 8.6% of all childhood deaths, making it the 4th most common cause of child mortality worldwide.\nAlmost 1.0 billion episodes occurred in 2015 worldwide, resulting in an estimated 45 million childhood disability adjusted life years.\nApproximately 86% of the episodes occurred in Africa and South Asia (63% and 23%, respectively. Slide 5 The decline in diarrheal mortality, despite the lack of significant changes in incidence, is the result of preventive rotavirus vaccination and improved case management of diarrhea, as well as improved nutrition of infants and children.\nThese interventions have included widespread home- and hospital-based oral rehydration solution (ORS) therapy and improved nutritional management of children with diarrhea. In addition to the risk of mortality, high rates of diarrhea can be associated with long-term adverse outcomes.\nDiarrheal illnesses, especially episodes among young children that are recurrent, prolonged, or persistent, can be associated with malnutrition, stunting, micronutrient deficiencies, and significant deficits in psychomotor and cognitive development. Slide 6 Pathogens- Viral Rotavirus is the most common cause of AGE among children throughout the world.\nSeveral other viruses occur less frequently.\nNorovirus and sapovirus are the 2 genera of Caliciviruses that cause AGE.\nAmong the more than 50 serotypes of adenovirus, 40 and 41 are most often associated with diarrhea.\nAstroviruses are identified less often. Slide 7 Pathogens- Bacterial The major bacterial pathogens that cause AGE are nontyphoidal Salmonella (NTS), Shigella, Campylobacter, and Yersinia.\nFive pathotypes of Escherichia coli infect humans: Shiga toxin–producing (STEC), also known as enterohemorrhagic (EHEC), enterotoxigenic (ETEC), enteropathogenic (EPEC), enteroaggregative (EAEC), and enteroinvasive (EIEC). Two serogroups of Vibrio cholerae (O1 and O139) produce epidemic cholera and cause nearly all sporadic cases.\nClostridium difficile disease can be both nosocomial and community acquired in children.\nBacterial pathogens that cause foodborne illness due to their ability to produce emetic and/or enterotoxins include Bacillus cereus, Clostridium perfringens, and Staphylococcus aureus. Slide 8 Pathogens- parasites Giardia intestinalis, Cryptosporidium spp., Cyclospora cayetanensis, and Entamoeba histolytica are the most common parasites that cause diarrhea. At least 13 species of Cryptosporidium are associated with human disease, but C. hominis and to a less extent C. parvum are most common.\nThe genus Entamoeba comprises 6 species that colonize humans, but only E. histolytica is considered a human pathogen.\nG. intestinalis (formerly G. lamblia and G. duodenalis ) is a flagellate protozoan that infects the small intestine and biliary tract.\nOther protozoa that uncommonly cause AGE are Isospora belli (now designated Cystoisospora belli ) and Blastocystic hominis. Slide 9 Risk Factors for Acute GE Insufficient access to adequate hygiene, sanitation, and clean drinking water are the main factors leading to the heavy burden of AGE in developing countries. The increasing frequency of antimicrobial resistance among bacteria that causes AGE has been linked to the use of antibiotics as growth-promotors for animals bred for food.\nRecreational swimming facilities and water treatment systems have provided a vehicle for massive outbreaks of Cryptosporidium, a chlorine-resistant organism.\nVenues serving catered food to large groups of people, such as hotels and cruise ships, are conducive to outbreaks, as are institutions where hygiene is compromised, such as daycare centers, prisons, and nursing homes.\nHospitalization and mode