Gastroenteritis

You have devoured your favorite shrimp salad at dinnertime. In a few hours you might be racked by stomach cramps and diarrhea. You will probably experience vomiting and low grade fever too. This is a classic case of gastroenteritis - a condition where the intestines are inflamed due to bacterial or viral infection. Gastroenteritis infection can also be caused due to food poisoning, food allergy, intestinal parasites, viral infection, medication or food consumed while you are traveling. Gastroenteritis can affect anyone but it is usually more severe in infants, the elderly and immunosuppressed people. Gastroenteritis in children can be serious if left unattended. It is the leading cause of death among children worldwide.

Viral and Bacterial Gastroenteritis

Viral gastroenteritis is caused by a viral infection that affects the stomach and intestines. In fact, viral gastroenteritis is one of the most common ailments in the U.S. A person can contract this viral gastroenteritis infection from contaminated food or drinking water. Within a few hours, the first symptoms are noticed. While viral gastroenteritis infections usually clear up without medicines within a few days, bacterial gastroenteritis needs to be treated. Rotavirus is the most common cause for viral gastroenteritis. It affects infants and young children and can surface as an outbreak during some seasons. Rotavirus can also affect other age groups. The Norwalk Virus is another cause of infectious gastroenteritis. It is common in school-going children. Viral gastroenteritis is usually treated with self care measures. Bacterial gastroenteritis infection can be caused by Salmonella, Escherichia coli (E coli), Campylobacter or Shigella. These bacteria can be found in poultry, eggs or meat. Once they enter the body, they multiply and produce toxins. After a few hours of eating, symptoms of bacterial gastroenteritis appear.A stool assay can help in identifying the specific agent for the gastroenteritis and aid treatment.

Treating Gastroenteritis

Usually the reaction to gastroenteritis infections hinges on your immune system’s ability to resist the infection. A person suffering from gastroenteritis will probably feel nauseous and experienced a bloated feeling. Abdominal cramps and mild to severe watery stools may be noticed for a couple of days. Severe cases of gastroenteritis can result in dehydration. Signs of dehydration to look out for are dry skin, excessive thirst and absence of urination for many hours. If a person suffering from gastroenteritis experiences severe abdominal pain or high fever or blood in the stools, consult a health professional at once. With little children, it is essential to give them clear fluids to replace lost fluids due to vomiting and diarrhea. Infants can be breast fed normally. Gastroenteritis can be very serious in infants. If you notice dry mouth, sunken eyes and irritability, consult a doctor immediately.

• Drink plenty of water and fluids to restore fluid and salt requirements of the body
  
• Avoid milk and dairy products
  
• Take adequate rest till symptoms persist
  
• Consume bland foods and avoid spicy foods, fried foods and alcohol
  
• Consume electrolyte solutions
  
• Avoid aspirin and ibuprofen as they irritate the gastrointestinal system
  
• Avoid sharing food and water and utensils with others for fear of spreading the infection
  

Stool Culture

Gastroenteritis and bacterial diarrhea are the most common forms of infections that occur both in children and adults. These infections are predominant in tropical regions. The most common etiology for diarrhea is either through parasitic infections or bacterial infections. Both these forms have distinctive clinical characteristics. The identification of the type of disease caused can provide a comprehensive route to differentiate and treat the disease through appropriate anti-parasitic or anti-microbial drugs.

Clinical symptoms

Gastroenteritis or enteric fever identification is characterized by abdominal discomfort, diarrhea and extreme dehydration. In most cases, these kinds of infections occur because of food or water borne contamination. The differential diagnosis of this condition in order to identify the disease is done through additional clinical symptoms, physiological changes and bio-chemical metabolic pathways. One of the most important factors in the identification of bacterial enteric fever is the presence of associated sepsis and spiking fever. In addition to this, in epidemic and highly infectious diseases like Cholera, caused by Vibrio cholera, the cyclic AMP(adenosine mono phosphate) levels are elevated leading to intense dehydration which can be fatal if left unattended.

Diagnosis

In case of bacterial enteric fever or associated diarrheas, stool specimens help understand and identify the type of organism causing the disease. Stool specimens are collected by patients in sterile container and the areas of stool in which blood and mucous are present are used for processing as they are useful portions of the specimen. The obtained media is usually transported by incorporating a transport media to avoid bacterial count decline because of varied PH of the external environment.

Microbiological media such as Selenite feces broth, Mackonkey agar, Salmonella Shigella agar, TCBS medium and Nagglers medium are used in the culture laboratory to identify disease causing organisms such as Salmonella(Typhoid, enteric fever) Shigella( Diarrhea) E.coli 0167or entero - hemorrhagic (Traveler's Diarrhea), Clostridium Botulinum(Food poisoning), Vibrio cholera( Cholera) and Campylobacter.

Apart from these bacteria, stool cultures are also done to identify the presence of enteric viruses such as Rota virus which causes viral gastroenteritis. All organisms isolated are subjected to respective antimicrobial assay to determine the suitable drugs for the respective organism. Careful precautions are taken and clinical details of the patient are recorded by the microbiologist to administer specific drugs for specific organisms. This helps to prescribe medications to specific persons too, such as pregnant and lactating women and children.

Typhoid

Typhoid is caused by bacterium Salmonella Typhi and is spread by drinking contaminated water. Those suffering from typhoid carry this bacteria in their intestinal tract and blood. Even after recovery from the typhoid fever, the bacteria continue to reside leading to spread of the disease.

Eating food handled by a carrier leads to the spread of typhoid. Typically typhoid fever goes as high as 103° to 104° F. The patient suffers stomach pain, headache, gastroenteritis, weakness and loss of appetite. It can also result in rose-colored rashes, known as 'rose spots' in the abdomen. Some might notice epistaxis (bleeding from the nose) and swelling in the abdomen. As the disease progresses, there might be delirium and agitation. If typhoid fever continues into the third week, there might be life-threatening complications such as intestinal hemorrhage, Cholecystitis (inflammation of the Gallbladder) and intestinal perforation. Intestinal leakage could lead to intense irritation and inflammation of the abdominal cavity - a condition known as Peritonitis which can be fatal.

Other Complications:

• There might be a decrease in WBC count and blood culture tests may show positive for Salmonella typhi or paratyphi.
  
• The spleen and liver might become enlarged.
  
• Anemia owing to intestinal bleeding
  
• Lowered body defenses could not fight against bacterial infections like Streptococcus Pneumoniae
  
• Infection may spread to heart or brain causing Meningitis and even coma.
  

If typhoid is diagnosed early, antibiotics for about 7 - 14 days are prescribed. The patient must be given plenty of fluids and small meals. Plenty of bed rest is needed to recoup from a bout of typhoid.