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‫‪Gastro- intestinal diseases‬‬
‫المرحلة الرابعة‬
‫اعداد‬
‫د‪ .‬وفاء محمود جاسم‬
Main Subjects
1- Main lines of infectious agent ,
diagnosis and prevention
2- Gastrointestinal infections
3-Food born infection
4- Outbreaks
5- Epidemiological investigation
Infectious Agents: There are many enteric
pathogens implicated in outbreaks of
gastrointestinal disease, including
1- Bacteria such as E. coli, Salmonella and
Shigella
2- Parasites such as Cryptosporidium,
Cyclospora, and Giardia;
3-VIruses such as noroovirus.
Organism
Usual incubation
(range)
Organism
Usual incubation
(range)
Campylobacter
2-5 days (1-10
days)
Giardia
7-10 days (3-25
days)
Salmonella
12-36 hours (6-72
hours)
Cryptosporidi
um
7 days (1-12 days)
Shigella
1-3 days (12-96
hours)
Cyclospora
7 days (1-2 weeks)
E. coli
3-4 days (1-10
days)
Norovirus
1-2 days (10-72
hours)
Diagnosis and treatment
• Diagnosis: Stool specimens can be
tested for the presence of any of the
enteric pathogens. In outbreak situations
arrangements can be made on a case-bycase basis to test stool specimens
• Treatment: Treatment of gastrointestinal
illness, including the use of antibiotics.
PREVENTION AND CONTROL
1-Cohorting of symptomatic patients is essential.
Individual staff should be restricted to caring
for only one cohort of patients.
2-Staff floating should be minimized.
3- If norovirus is suspected or confirmed as the
cause of an outbreak, symptomatic staff should
be excluded from all food handling duties for
72 hours past symptom resolution or 72 hours
past the date a specimen positive for norovirus
was provided,
4- If a bacterial or parasitic agent is suspected or
confirmed, symptomatic staff should be tested
and allowed to return to food handling duties
when diarrhea is resolved
PREVENTION AND CONTROL
5-Patients with gastrointestinal symptoms
should be placed on standard plus contact
precautions for the duration of their illness.
Patients who test positive for a bacterial or
parasitic agent should remain on
precautions until a negative stool
specimen is produced.
6- For patients treated with antibiotics the
stool specimens should not be collected
until 48 hours after cessation of antibiotic
therapy.
PREVENTION AND CONTROL
7- Proper hand hygiene should be
emphasized to all staff and residents
Noroviruses are highly infectious,. They are
easily spread from one person to another
and are found in large quantities in the
stool or vomitus of an infected person.
Staff should wash their hands with soap
and water after patient care. Hands
should be dried with a dry, disposable
paper towel.
PREVENTION AND CONTROL
8-Articles contaminated with infective
material, such as soiled linens and
clothing, should be discarded or bagged
and labeled before being sent for
washing.
9-Special attention should be paid to
environmental cleaning and disinfection.
Gastrointestinal infections
Gastrointestinal infections
The term of the Gastrointestinal infections
extends to the following areas:
1- zoonotic disease
2- general gastro-intestinal illness
3- water related issues both microbiological
and chemical
4- food related issues related to human
infective diseases
Foodborne illness
»Foodborne illness (also foodborne
disease and also referred to asfood
poisoning) is any illness resulting
from
thecontaminatedfood, pathogenic
»bacteria, viruses, or parasites that
contaminate food as well as
chemical or natural toxins such
as poisonous mushrooms.
Foodborne illness
Terms applied to illness acquired by consumption
of contaminated food
(food born intoxication, food born infection )
1- Illness caused by toxicants elaborated by
bacterial growth before consumption
(Staphylococcus aureus )
2- Toxines elaborated in intestine (Clostridium )
3- Illness caused by bacterial infection with short
incubation period (Salmonelosis
Symptoms of food born illness
1- Common symptoms of food born illness are
diarrhea and/or vomiting, typically lasting 1 to 7
days. Other symptoms might include abdominal
cramps, nausea, fever, joint/back aches, and
fatigue.
2- What some people call the “stomach flu” may
actually be a food born illness caused by a
pathogen (i.e., virus, bacteria, or parasite) in
contaminated food or drink.
3-The incubation period (the time between
exposure to the pathogen and onset of
symptoms) can range from several hours to 1
week.
Causes of food born disease
1-Cryptosporidiosis (Cryptosporidium)
2- Escherichia coli
3- Giardiasis (Giardia)
4-Listeriosis (Listeria monocytogenes)
5-Norovirus Infection
6-Salmonellosis (Salmonella)
7-Shigellosis (Shigella)
8-Toxoplasmosis (Toxoplasma gondii)
9-Vibrio Infection (Vibrio parahaemolyticus)
10 Yersiniosis (Yersinia species)
foods Associated with Food born Illness
• Raw foods of animal origin, that is, raw meat and
poultry, raw eggs, unpasteurized milk
• Fruits and vegetables can also be contaminated
with animal waste
• Unpasteurized fruit juices can also be.
contaminated if there are pathogens on the fruit
that is used to make it
• Any food item that is touched by a person who is
ill with vomiting or diarrhea, or who has recently
had such an illness, can become contaminated.
When these food items are not subsequently
cooked (e.g., salads, cut fruit)
Prevention of good born infection
(1) identify and remove contaminated products
from sale
(2) identify and correct faulty food-handling and
food-production practices
(3) understand how food born diseases are caused
and spread
(4) detect new food born disease-causing agents
(5) develop food safety programs and policies.
Out breaks
The occurrence in a community or region of
cases of an illness with a frequency
clearly in excess of normal expectancy
Types of out break
1- Common source – All victims acquire the
infection from the same source (e.g. a
contaminated water supply
2-Continuous source – Common source
outbreak where the exposure occurs over
multiple incubation periods
3- Point source – Common source
outbreak where the exposure occurs in
less than one incubation period
4-Propagated – Transmission occurs from
person to person
Epidemiological Investigation
1-. Establish the existence of an outbreak
2. Confirm the diagnosis
3. Establish the case definition and count
cases
4. Relate the outbreak to time, place and
person
5. Determine who is at risk of becoming ill
6. Formulate a tentative hypothesis
7. Compare the hypothesis with the
established facts
8. Plan a detailed epidemiologic
investigation
9. Prepare a written report
10. Implement control and prevention
measures