This document discusses acute diarrhoeal diseases, their causes, and salmonella infection. It defines different types of diarrhoea and lists common infectious causes. Salmonella is described as a gram-negative bacteria causing two main types of infection: acute gastroenteritis and enteric fever. Enteric fever is then discussed in further detail, covering transmission, clinical features across its stages, investigations, and treatment approaches at both the case and carrier levels. Prevention methods are also outlined, including personal hygiene, vaccination, and environmental sanitation.

1. ACUTE DIARRHOEAL DISEASES
Dr. Indrajeet Kumar
Department of Community Medicine
M.G.M Medical College, Jamshedpur.

2. MAJOR CAUSES OF IMR (Infant Mortality Rate)
Diarrhoea
ARI (acute respiratory infection)
Malaria
Measles
Malnutrition.

3. DEFINITION
DIARRHOEA: Passage of loose, liquid watery stool.
CHRONIC DIARRHOEA: Diarrhoea lasting for 3wks or more.
ACUTE DIARRHOEA: Diarrhoea of sudden onset which usually
lasts for 3-7days.
DYSENTERY: Watery stool with presence of blood.
GASTROENTERITIS: Acute diarrhoea of infective origin.

4. Infections causing diarrhoea
 VIRAL : Rotavirus
Adenovirus
Corona virus
Enterovirus; e.g. Polio, hepatitis-A & E.
 BACTERIAL: Campylobacter jejuni
Escherichia coli**
Shigella
Salmonella
Vibrio cholerae** & parahemolyticus
Bacillus cereus.
 PROTOZOAL:Entamoeba histolytica, Giardia intestinalis,
Cryptosporidium***,
 OTHERS: intestinal worms.

5. SALMONELLA INFECTION
 Gram negative bacilli.
 Species which infect human being
a. S. typhimurium & enteritidis – acute gastroenteritis.
b. S.typhi & paratyphi – Typhoid & para - typhoid fever
(ENTERIC FEVER)

6. ENTERIC FEVER
AGENT FACTOR:
Agent: 95% by S.typhi 5% by S.paratyphi.
:- 3 types of antigen ‘O’ , ‘H’ & ‘Vi’.
Reservoir: Human Cases & Carrier.
Infective material: Faeces & urine.
Period of infectivity: a.case: during I.P & early disease
b. carrier: longer period or life long.

7. HOST FACTOR
 AGE: highest between 5-19yrs.
 SEX: Cases more in male.
Carrier rate more in female.
 IMMUNITY: No strong immunity after infection.
Hence re-infection occurs.

8. INCUBATION PERIOD : 10 – 14days
MODE OF TRANSMISSION: faeco - oral
urino - oral

9. Clinical features
Divided into stages of 4wks
1st Week: Prodromal symptoms similar to URTI.
Remittent or Step ladder fashion temperature.
Relative bradycardia.
2nd Week: Maculo-papular “rose spot rash”,
Pea soup stool or constipation,
soft spleenomegaly.
3rd Week: “Week of complications” : hemolytic anaemia,
meningitis,
acute cholecystitis,
UTI,
intestinal perforation and haemorrhage.
4th Week: “Week of convalescence”

10. INVESTIGATION
 1st Week of fever: Blood culture.
 2nd Week of fever: Widal test & urine culture.
 3rd Week of fever: Stool culture.
 4th Week of fever: Stool culture.

12. At source level
CASE
“EARLY DIAGNOSIS & TREATMENT”
 Diagnosis by lab methods.
 Treatment in isolation.
a. Quinolones drug of choice.
Ciprofloxacin 500mg bid for 7days.
Ofloxacin 200mg bid for 7days.
b. 3rd Generation cephalosporins.
Cefixime: 200mg x 2 x 7days
Cefotaxime 2gm bid im/iv
 Disinfection:
a. Concurrent: of stool/urine by 5% cresol.
b. Terminal : of room/bed etc.
 Follow up : at 3month & 12month by stool/
urine culture.
CARRIER
“EARLY DIAGNOSIS & TREATMENT”
 Diagnosis by lab methods: Vi antibody positive.
:urine/stool culture +ve even months after Tt
 Treatment:
biliary carrier: Cholecystectomy
+
Ciprofloxacin 750mg x bid x 4wks.
urinary carrier: Ciprofloxacin 750mg x bid x 4wks
+ / -
Nephrectomy (of damaged kidney)
 Disinfection:
 Follow up:

13. Transmission level
a. PERSONAL HYGIENE:
b. ENVIRONMENTAL SANITATION:
:- water sanitation
:- food sanitation.
:- excreta disposal.

14. At host level by vaccination
PARENTERAL
 Killed vaccine.
 Types
MONOVALENT ( S.typhi)
BIVALENT (S.typhi & S.paratyphi A)
TRIVALENT /“TAB Vaccine”(S.typhi , paratyphi A &
B)
 Dose: 2doses - s.c – 6wks apart.
 Booster: every 3yrs
 Protection rate: 70 to 85% for 3-4yrs.
ORAL VACCINE
 Live attenuated vaccine.
 Strains of s.typhi used
Ty21a developed by swiss.
541Ty developed by US.
 Dose: one cap. On day 1 – 3 – 5
before meals.
 Booster: every 3yrs (all 3doses).
 Protection: 90% protection for 3yrs.