Diarrheal diseases which are especially prevalent in the developing world,
cause significant morbidity and mortality. Each year, diarrheal diseases kill an approximate 2 million children below 5 years of age. The most important cause of mortality and deaths associated with these diarrheal diseases is primarily dehydration, and the most vital life saving treatment in preventing the high incidence of deaths with complications of sever diarrheal diseases is rehydration therapy.
Most developed countries are constantly researching and improving better ways to comprehend the epidemiology of diarrheal diseases since the microorganisms causing such are constantly changing. New and effective ways of water disinfection, pasteurization, and appropriate food handling and packaging have significantly decreased the incidence of diseases such as cholera and typhoid. However, importation of foreign food related products, environmental and ecological changes in diagnostic test modalities have resulted in the efficient recognition of important new trends and outbreaks of diarrheal diseases.
Transmission of diarrheal diseases
The portal of entry of all diarrheal diseases and its pathogens is primarily oral ingestion. Although the food we basically eat is far from absolutely sterile and free from microbial activities, the high acidity of the stomach and the anti-body producing cells of the small bowel generally serve as the first line of defense in decreasing the potentially infectious dose such pathogens might cause. Decreased gastric acidity with disruption of normal bowel flora (as a normal occurrence following surgery), use of antimicrobial agents, and the immune dysfunction of AIDS all decrease the intestinal defenses of diarrheal causing pathogens.
Causes of diarrheal diseases
There are many bacterial, viral and parasitic causes of diarrheal diseases. Common causes of bacterial infection include Escherichia coli and Salmonella, Shigella, Campylobacter and Yersinia species. The most significant of viral causes of diarrhea are Rotavirus, which commonly results in diarrhea in young children, and Calcivirus (often called Norovirus), a virus associated with outbreaks in long term health care facilities, prison and correctional facilities and cruise ships. Parasitic infections of importance include Giardia and Cryptoporidium species and Entamoeba histolytica.
Plans and goals for diarrheal diseases
The most important goals are maintenance of fluid and electrolyte balance, increased knowledge about the disease and the risk of contamination, transmission and absence of complications. The individual is assessed to determine the degree of dehydration. This assessment will help determine the amount and route of rehydration necessary and appropriate for the individual. Oral rehydration therapy is a strategy is a strategy used to reduce the severe complications brought about by diarrheal diseases regardless of the of the causative pathogen or agent. It is inexpensive and effective for the general class of patients, but this method is often underused because of sustained cultural beliefs discouraging oral intake during episodes of diarrhea.
Patients with mild dehydration will normally exhibit dry mucous membrane of the mouth and experience increase thirst. The rehydration
goal at this level is to deliver at least 50 ml of or oral rehydration solution per 1kg of weight over a 4-hour interval. For moderate dehydration, common findings include sunken eyes, loss of skin turgor, increased thirst and dry oral mucous membranes. The rehydration goal at this level is to deliver about 100 ml/kg of oral rehydration solution over 4 hours. The patient experiencing severe dehydration from diarrheal diseases will show signs of shock and should receive bolus IV fluid replacement until hemodynamic and mental status of the individual returns to normal.