|
Kosek, Bern, and Guerrent (2003) estimates a global median
incidence of Diarrhoea to be 3.2 episodes Merson (1982) and by
Bern et al. (1992) as well as to those reported in the first
edition of Disease Control Priorities in Developing Countries
(Jamison et al. 1993). Yet every child in Bangladesh suffers an
average of three to five diarrhoeal attacks in each year, which
is a major contributor to malnutrition. According to the
statistical survey, around 125,000 children under five die each
year from diarrhoeal disease; that is, 342 children per day
(IPRSP 2002). Bangladesh, has been experiencing a rapid increase
in population over the past two decades. People migrate to Dhaka
and the most migrants work in marginal employment at very low
wages and live in squatter and slum settlements with few basic
services that are porne to develope Diarrhoea.
CAUSES OF DIARRHOEA
A hundred or more different diseases can be associated with
Diarrhoea. Fortunately, the most of the severe causes are rare
and the most common form is the one that affects the most of us
for a few days each year. It is due to a simple infection,
usually caused by a virus, called Rota virus.

Bacterial infections can cause more serious cases of Diarrhoea
as a result of having contaminated food or drinks (food
poisoning). Common bacteria are campylobacter, salmonellae and
shigella organisms; less common are Escherichia coli (E coli),
yersinial, listerial and cryptosporidial bacteria. These can
cause fairly severe Diarrhoea with vomiting, abdominal cramping
and fever.
|
Non Inflammatory Diarrhoea
Inflammatory Diarrhoea
|
Viral
Rotavirus
Norwalk virus
Norwalk-like virus
Astrovirus
Adenovirus
Protozoal
Giardia lamblia
Cryptosporidium
Bacterial
1. Preformed enterotoxin production
Enterotoxigenic E coli (ETEC)
Vibrio cholerae
2. Enterotoxin production
Staphylococcus aureus
Bacillus cereus
Clostridium perfringens |
Protozoal
Entamoaeba histolytica
Bacterial
1. Cytotoxin production
Enterohemorrhagic
E coli 01S7: HS (EHEC)
Vibrio parahaemolyticus
Clostridium difficile
2. Mucosal invasion
Shigella
Campylobacter jejuni
Salmonella
Enteroinvasive E coli (EIEC)
Aeromonas, Plesiomonas
Yersinia enterocolitica, Chlamydia
Neisseria gonorrhoeae
Listeria monocytogenes |
|
Table - 1 : Organisms responsible for Acute infectious
Diarrhoea |
|
CAUSES OF CHRONIC DIARRHOEA
Osmotic Diarrhoea
| |
1. Medications:
antacids, lactulose, sorbitol
2. Disaccharidase deficiency: lactose intolerance
3. Factitious Diarrhoea: magnesium (antacids,
laxatives)
|
Secretory
Diarrhoea
|
|
1. Hormonally
mediated : Carcinoid, medullary
carcinoma of thyroid (calcitonin),
Zollinger-Ellison syndrome
2. Factitious Diarrhoea (laxative abuse);
phenolphthalein, cascara, Senna
3. Villous adenoma
4. Bile salt malabsorption (ileal resection; Crohn's
ileitis; post cholecystectomy)
5. Medications
|
Inflammatory conditions
|
|
1. Ulcerative
colitis
2. Crohn's disease
3. Microscopic colitis
4. Malignancy: lymphoma, adenocarcinoma (with
obstruction and pseudo Diarrhoea)
5. Radiation enteritis
|
Malabsorption syndromes
|
|
1. Small bowel
mucosal disorders: Cellae sprue, tropical sprue,
Whipple's disease, eosinophilic gastroenteritis,
small bowel resection (short bowel syndrome).
Crohn's disease
2. Lymphatic obstruction: Lymphoma, carcinoid,
infectious (tuberculosis), Kaposi's sarcoma,
sarcoidosis, retroperitoneal fibrosis
3.Pancreatic disease: Chronic pancreatitis,
pancreatic carcinoma
4.Bacterial overgrowth: Motility disorders
(diabetes, vagotomy), scleroderma, fistulas,
small intestinal diverticula |
Motility
disorders
|
|
1. Post-surgical:
Vagotomy, partial gastrectomy, blind loop with
bacterial overgrowth
2. Systemic disorders: Scleroderma, diabetes
mellitus,
hyperthyroidism
3.Irritable bowel syndrome (IBS) |
Chronic
Infections
|
|
1. Parasites:
Giardia lamblia, Entamoeba histolytica
2. AIDS-related:
Viral: Cytomegalo virus, HIV Infection
Bacterial: Clostridium difficile, Mycobacterium avium
Protozoal: Microsporida (Enteroeyloloan bieneusl),
cryptosporidium, Isospora belli
|
1816-1826 :
First Cholera pandemic: The
pandemic began in Bengal, and
then spread across India by
1820.
1829-1851 : Second Cholera
pandemic reached
Europe, London and
Paris in 1832
1961-1970s : Seventh Cholera
pandemic began in
Indonesia, called El Tor
after the strain, and
reached Bangladesh in
1963
1816-1826 :
First Cholera pandemic: The
pandemic began in Bengal, and
then spread across India by
1820.
1829-1851 : Second Cholera
pandemic reached
Europe, London and
Paris in 1832
1961-1970s : Seventh Cholera
pandemic began in
Indonesia, called El Tor
after the strain, and
reached Bangladesh in
1963
1816-1826 :
First Cholera pandemic: The
pandemic began in Bengal, and
then spread across India by
1820.
1829-1851 : Second Cholera
pandemic reached
Europe, London and
Paris in 1832
1961-1970s : Seventh Cholera
pandemic began in
Indonesia, called El Tor
after the strain, and
reached Bangladesh in
1963
1816-1826 :
First Cholera pandemic: The
pandemic began in Bengal, and
then spread across India by
1820.
1829-1851 : Second Cholera
pandemic reached
Europe, London and
Paris in 1832
1961-1970s : Seventh Cholera
pandemic began in
Indonesia, called El Tor
after the strain, and
reached Bangladesh in
1963
|