Harrison's Internal Medicine Chapter 122. Acute Infectious Diarrheal Diseases and Bacterial Food Poisoning
Acute Infectious Diarrheal Diseases and Bacterial Food Poisoning: Introduction Ranging from mild annoyances during vacations to devastating dehydrating illnesses that can kill within hours, acute gastrointestinal illnesses rank second only to acute upper respiratory illnesses as the most common diseases worldwide.
Enteric pathogens have developed a variety of tactics to overcome host defenses. Understanding the virulence factors employed by these organisms is important in the diagnosis and treatment of clinical disease.
The number of microorganisms that must be ingested to cause disease varies considerably from species to species. For Shigella, enterohemorrhagic Escherichia coli, Giardia lamblia, or Entamoeba, as few as 10–100 bacteria or cysts can produce infection, while 105–108Vibrio cholerae organisms must be ingested orally to cause disease.
B. cereus can produce either a syndrome with a short incubation period— the emetic form, mediated by a staphylococcal type of enterotoxin—or one with a longer incubation period (8–16 h)—the diarrheal form, caused by an enterotoxin resembling E. coli LT, in which diarrhea and abdominal cramps are characteristic but vomiting is uncommon. The emetic form of B. cereus food poisoning is associated with contaminated fried rice; the organism is common in uncooked rice, and its heat-resistant spores survive boiling.
The answers to questions with high discriminating value can quickly narrow the range of potential causes of diarrhea and help determine whether treatment is needed. Important elements of the narrative history are detailed in Fig. 122-1.
Physical Examination The examination of patients for signs of dehydration provides essential information about the severity of the diarrheal illness and the need for rapid therapy. Mild dehydration is indicated by thirst, dry mouth, decreased axillary sweat, decreased urine output, and slight weight loss.
Given the enormous number of microorganisms ingested with every meal, the normal host must combat a constant influx of potential enteric pathogens. Studies of infections in patients with alterations in defense mechanisms have led to a greater understanding of the variety of ways in which the normal host can protect itself against disease.
The large numbers of bacteria that normally inhabit the intestine act as an important host defense by preventing colonization by potential enteric pathogens.
Food safety and foodborne diseases are topics of global concern. Food safety
encompasses many areas, including pesticide and antibiotic residues, the presence
of mycotoxins and foodborne pathogens, and all aspects of food production
and preparation. Many issues associated with these topics are common to all
countries. Decisions must be made by each nation to determine priority areas
that should be addressed to ensure the health of its citizens.
Loperamide should not be used by patients with fever or dysentery; its use
may prolong diarrhea in patients with infection due to Shigella or other invasive organisms.
The recommended antibacterial drugs are as follows: Travel to high-risk
country other than Thailand: Adults: (1) A fluoroquinolone such as ciprofloxacin, 750 mg as a single dose or 500 mg bid for 3 days; levofloxacin, 500 mg as a single dose or 500 mg qd for 3 days; or norfloxacin, 800 mg as a single dose or 400 mg bid for 3 days. (2) Azithromycin, 1000 mg as a single dose or 500 mg qd...
I am delighted to have the opportunity to edit this important issue of Obstetrics and
Gynecology Clinics of North America on the topic of Medical Complications in Pregnancy.
The broad field of medicine changes rapidly, with constantly occurring new
breakthroughs, approaches, and recommendations. The area of medical disorders in
pregnancy encompasses a broad range of diseases; a woman may have a long-term
chronic disorder that can have major implications for undertaking a pregnancy. Yet,
other medical conditions are unique to pregnancy but also influence gestational
Our long-term vision is that children in developing
countries are protected from or effectively treated
for enteric and diarrheal diseases at the same rate as
children in developed countries. a number of low-cost
interventions exist and are effective for reducing child
deaths due to these diseases, but today they are not
available for many people in developing countries.
Ranging from mild annoyances during vacations to devastating dehydrating illnesses that can kill within hours, acute gastrointestinal illnesses rank second only to acute upper respiratory illnesses as the most common diseases worldwide. In children 50% of childhood deaths are directly attributable to acute diarrheal illnesses.
That idea gets a firm nod from therapist Lisa
Lieberman. “It’s important not to parentify kids,”
she says. They may learn more responsibility, but
they need permission to be kids, have friends and
be normal in that respect. “They are not there to be
in charge of everything. They need to have some of
the carefree spirit of being a kid.” There is a fine
line between developing an appropriate sense of
responsibility — not pretending that things aren’t
any different — and putting too much onto their
Since 1897 instruction has been given at the University of Minnesota, College of Agriculture, on human foods
and their nutritive value. With the development of the work, need has been felt for a text-book presenting in
concise form the composition and physical properties of foods, and discussing some of the main factors which
affect their nutritive value. To meet the need, this book has been prepared, primarily for the author's
classroom. It aims to present some of the principles of human nutrition along with a study of the more
common articles of food.
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This issue describes cosmetic procedures that can be incorporated into gynecologic
practice successfully by additional education and training that is readily available
through credible post residency educational programs.
For over 40 years, PSI has applied private sector marketing principles to public health
challenges in developing nations and has had significant impact on the lives of millions.
PSI’s initial objective in the 1970s was to improve reproductive health using commercial
marketing strategies. For its first 15 years, PSI worked primarily in family planning but
gradually moved into other health areas. For instance, in 1985, it began promoting oral
rehydration therapy to combat diarrheal disease in children.
launched its first HIV prevention project in 1988.
Members of the genus Vibrio cause a number of important infectious syndromes. Classic among them is cholera, a devastating diarrheal disease caused by V. cholerae that has been responsible for seven global pandemics and much suffering over the past two centuries. Epidemic cholera remains a significant public health concern in the developing world today. Other vibrioses caused by other Vibrio species include syndromes of diarrhea, soft tissue infection, or primary sepsis. All Vibrio species are highly motile, facultatively anaerobic, curved gram-negative rods with one or more flagella.
The negative health impact of many large-scale public health emergencies,
such as an intentional anthrax release, severe acute respiratory
syndrome (SARS), or the recent 2009 H1N1 influenza pandemic, can be
mitigated significantly by medical countermeasures such as antimicrobials,
antivirals, and vaccines. To be effective, these countermeasures generally
must be delivered in very large quantities in a short period of time.
Post-natal infections not only occur more frequently in children stunted in utero but also
promote stunting post-natally in young children, particularly in low- and middle-income settings
where a high prevalence of infectious illnesses combines with poor sanitation to facilitate fecal-
oral transmission of diarrheal and parasitic illnesses (Grantham-McGregor et al 1999b).