Diarrhoea : An Emerging Post Flood Disaster and a Disease of Hot Humid Climate

When the stool is watery or excessibly loose it is considered to be diarrhoea, whatever the frequency of defecation. Diarrhoea is a self limiting disorder if mild and non-specific.

The disease is a post flood disaster, while the flood water is receding or recedes, when it appears in an epidemic form, especially in the valley of big rivers where it is endemic (Disease occurring more or less in number, sporadically throughout the year).

Sporadic cases occur most often in endemic areas. A hot humid climate favours the growth of organisms causing diarrhoea in foods and milk which acts as a suitable media, and if these foods are held at ambient temperature in a hot humid climate, after preparation, the organisms multiply. Eating of these foods and drinking of milk cause diarrhoea.

Food handling with uncleaned hands, contaminated with either of the organisms causing diarrhoea, drinking water and water for washing purposes if contaminated with faces of diarrhoea patients and used unboiled or without proper disinfecting; lack of proper sanitation facilities, contaminating foods or water with fecal matter of such patients, these foods or water acts as a vehicle for transmission of the disease, and flies, cockroaches and other vectors act as a carrier for spread of the disease, and evidence of involvement of either of the causative organisms, are specific factors for the disease.

Under the above mentioned circumstances diarrhoea can best be termed as food or water borne disease instead of simply water borne.

It can be mentioned that, not all bacteria, virus or parasite cause diarrhoea. Some of each is responsible and either or more may be involved depending on the economic condition i.e. low income in big families, leading to people's suffering from hunger and monotony in appetite, leading to malnutrition, especially affecting the vulnerable group, viz children, pregnant and lactating mother and elderly.

Malnutrition causes decrease in body immunity, invites further infection and further malnutrition and a vicious cycle is established which is more common in children is a favourable condition for gastro intestinal infection and diarrhoea, sharing food with diarrhoea patient in flood camp is also an important factor.

Diarrhoea may also be caused by some antibitics, chemical agents and surreptitious laxative abuse by women.

Poor housing, over crowding amongst slum dweller, food handling with uncleaned hands and defective sewage system causing polluting of safe water are non specific factors for diarrhoea as these can cause enteric fever and hepatitis etc.

Pathogenetic Mechanisms : The causes of diarrhoea are several and hence to be best considered in relation to underlying pathogenetic mechanisms out lined as the following :

Excessive intra-luminal volume, decreased absorption of water and solute (Osmotic diarrhoea); Increased secretion into the lumen of which the classic model is cholera, same mechanism is active with enteropathogenic

E.Coli and other gram negative organisms; exaggarated propulsive motility mediated by neurohumoral factors including acctylcholine, serotorin and prostaglandins may be an independent and important variable. The most common with "Irritable bowel (IBS) syndrome.

Nacked eye examination of the freshly voided stool is important. Clinical diagnosis is usually easy during an epidemic in an endemic area but in other situation it is important to confirm the diagnosis bacteriologically.

V. Cholera has characteristic movement that can be seen under the Microscope Culture of the stool or rectal swab is usual to isolate and identify the organism.

Mild and moderate diarrhoea responds well with oral dehydration therapy with Oral Rehydration Solution.

Equal volume of solution are required to be replaced for the same volume of loss in each defaecation or vomiting. this replacement therapy should be in repeated doses, So long the diarrhoea or vomiting ceases or the defaecation returns to normal formed stool.

In severe cases a good nursing care is important. Replacement of losses of fluid and electrolytes usually with infusion of physologic saline and 5 per cent glucose, guided by measurement of urinary output and plasma volume.

Replacement of potassium and further adjustment of acid-base balance are guided by serial determinations of Serum Sodium, potassium, chloride and bi-carbonates.

If oral administration is possible, water, sodium chloride and glucose should be forced through dilute, sweetened fruit juices or tea in sufficient quantity to maintain a urinary out put of in excess of 1500ml/day.

Antibiotics can be given depending on the culture and sensitively test.

The drug can be give in recommended route and daily doses for a few days will reduce the duration of excretion of concern bacteria and the total volume of fluid needed for replacement.

The drug may be continued so long the stool sample culture report is negative for about 2-3 consecutive days on daily examination.

Personal prophylaxis means strict personal hygiene. Water for drinking, washing purposes should come from a cleared pipe supply or be boiled or purified with water purifying tablet.

Flies, cockroaches must not be allowed access to food. Control of water sources and of population movement, and public education are most important in an epidemic.

Disinfection of infective discharges and soiled clothing and scrupulous hand washing by medical attendants reduces the danger of spread from treatment centres.

Submitted By:
DR. M MAHBUBUL HOQUE

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