Infectious diarrhea is a major cause of morbidity and mortality world wide. Children in developing countries are disproportionately affected by acute diarrhea, averaging 1-3 episodes per year. In these settings, infectious diarrhea accounts for approximately 20-25% of the mortality in children less than 5 years of age. In addition, morbidity of repeated infections is manifest as malnutrition with cognitive and physical developmental delays. Around the world, there is a substantial difference in incidence of disease among children from different socioeconomic strata. This difference is likely related to variability in sanitation, living quarters, and access to treated food and water. Over the last several decades, mortality from infectious diarrhea has significantly decreased, yet morbidity remains largely unchanged. The decline in mortality is believed to be the result of the widespread implementation of oral rehydration therapy as recommended by the World Health Organization (WHO).The lack of improvement in living conditions.
In developed nations, the mortality rate is lower, seen predominantly at the extremes of age. Morbidity still remains a major problem, with children experiencing 2-3 episodes and all persons experiencing 1-2 episodes of acute diarrhea per year. In the United State alone, there are an estimated 200-300 million episodes of diarrhea illness each year, resulting in 73 million physician consultations, 1.8 million hospitalizations, and an estimated 63 billion dollars spent each year on medical costs and loss of productivity. With globalization of food processing and distribution, the number of food borne diarrheal illnesses has risen.
With the morbidity, mortality, and cost of infectious diarrhea, it is important to promptly determine the appropriate diagnostic evaluation and treatment.
Cause of infectious diarrhea
The major pathogens causing acute infectious diarrhea are viruses, bacteria, and parasites. Most cases are self-limited, resolve within 24 – 48 h and in developed nations, are likely to be viral. A pilot study in the USA indentified a pathogen in approximately 70% of cases, three-quarters of which were norovirus. In health adults, the most likely pathogens causing severe diarrheas are bacteria. In developing nations and in returning travelers, enterotoxigenic Escherichia coli (ETEC) is the most likely pathogen. Parasites are identified less frequently as the cause of acute infectious diarrhea.
Diarrhea is classified as acute (duration less than 2 weeks) persistent (2-4 weeks), and chronic (greater than 4 weeks). Most infectious diarrhea are brief and self-limited, and managed by patients alone. Of those patients who do present to clinicians, their illness can generally be divided into small intestinal or ileocolonic disease.
Pathogens affecting the small intestine are usually noninvasive organisms. These patients present with high-volume watery stools and in some cases Malabsorption, frequently leading to dehydration. Patients often have periumbilical pain and cramping.
The most common pathogens in this category are viruses, such as norovirus and rotavirus, but also include bacteria: enteroxigenic E. coli, Vibrio Cholerae, toxin- producing Staphylococcus aureus, and the parasites Giardia lamblia, Isospora belli, and cryptosporida. These enteropathogens typically cause disease via eterotoxin production, ingestion of performed toxin, and/or bacterial adherence to epithelial cells.
Colonic and distal small intestinal pathogens are more likely to be invasive. They result in a syndrome of lower abdominal pain; small volume, frequent stools which can be bloody and tenismus (when the rectum is involved). The most common pathogens causing this presentation are bacteria including. Campylobacter, Shigella, Salmonella and Shiga toxin producing E. coli, and Clostridium difficile.
Features of small intestinal and ileocolonic disease
|Features of small intestinal disease|
Diffuse periumbilical pain
Large volume stools
|Features of ileocolonic disease|
Lower abdominal pain
Small volume stools
Stools may be bloody
Diagnostic evaluation of infectious diarrhea
When diagnostic evaluation is indicated, it is important to decide what type of testing is appropriate. Diagnostic testing should be selective, based on the patient’s individual clinical picture. When the epidemiologic history suggests a specific pathogen, individual testing for the enteropathogens can be performed.
(Stefano Guandalini, Haleh Vaziri; Diarrhea: Diagnostic and Therapeutic Advances 2009; 34-35, 52)
Homeopathic treatment of infectious diarrhea
Homeopathy is one of the most popular holistic systems of medicine. The selection of remedy is based upon the theory of individualization and symptoms similarity by using holistic approach. This is the only way through which a state of complete health can be regained by removing all the sign and symptoms from which the patient is suffering. The aim of homeopathy is not only to treat infectious diarrhea but to address its underlying cause and individual susceptibility. As far as therapeutic medication is concerned, several medicines are available for infectious diarrhea treatment that can be selected on the basis of cause, sensation, modalities of the complaints. For individualized remedy selection and treatment, the patient should consult a qualified homeopathic doctor in person. There are some specific homeopathic remedies which have remarkable action over infectious diarrhea:
Nux vomica, Aloe, Podophyllum, Arsenic Album, Sulphur, Natrum Sulph, Pulsatilla, Carbo Veg, Calcaria Carb, Calcaria Phos, Natrum Mur, Mag Carb, Croton TIg and many other medicines are work well in case of infectious diarrhea.