DIARRHEAL DISEASES

Diarrhea is defined as the passage of 3 or more loose or liquid stools per day (or more frequent
passage than is normal for the individual).Frequent passing of formed stools is not diarrhoea,
nor is the passing of loose, pasty stools by breastfed babies.

Causes

 Infection: Diarrhoea is a symptom of infections caused by a host of bacterial, viral

and parasitic organisms, most of which are spread by faeces-contaminated water.
Infection is more common when there is a shortage of adequate sanitation and
hygiene and safe water for drinking, cooking and cleaning. Among children under 5
years of age, the most common viral pathogens are rotavirus, norovirus, adenovirus
and astrovirus. Bacterial pathogens include Escherichia coli, Salmonella spp., Shigella
spp., and Campylobacter spp., while parasitic pathogens include Cryptosporidium,
Giardia, and Entamoeba spp. Rotavirus and E. coli are the most common pathogens
among children across all age groups, while parasitic pathogens, are prevalent in
children aged 3–5 years. Bacterial pathogens, including E. coli, Salmonella, and
Shigella, were common in the children age 6 to 10-year age group, as were rotavirus,
norovirus, and sapovirus. Location-specific etiologic patterns also need to be
considered.
 Malnutrition: Children who die from diarrhoea often suffer from underlying
malnutrition, which makes them more vulnerable to diarrhoea. Each diarrhoeal
episode, in turn, makes their malnutrition even worse. Diarrhoea is a leading cause
of malnutrition in children under 5 years old.
 Water contaminated with human faeces, for example from sewage, septic tanks and
latrines, is of particular concern. Procedures on your bowels.
 Food is another major cause of diarrhoea when it is prepared or stored in unhygienic
conditions. You can ingest harmful toxins and pathogens from contaminated foods
or drinks. Once they’re in your gut, the toxins or germs can cause diarrhea.
“Traveler’s diarrhea” is when you get diarrhea while traveling in a new environment
with poor hygiene or sanitation
 Procedures on your bowels. Many people have diarrhea after surgery on their
bowels. It may take a while for your digestive tract to absorb nutrients from the
foods you’re eating and create firm stools from the waste.
 Medications. Diarrhea is a common medication side effect. For example, antibiotics
kill harmful bacteria that make you sick, but they can destroy helpful bacteria in the
process. Not having enough good bacteria can lead to diarrhea. Diarrhea is also a
 side effect of antacids with magnesium and some cancer drugs and treatments.
Overusing laxatives can also cause diarrhea.
 Procedures on your bowels. Many people have diarrhea after surgery on their
bowels. It may take a while for your digestive tract to absorb nutrients from the
foods you’re eating and create firm stools from the waste.

Classification of Diarrheal Diseases

Diarrhea can be grouped in three ways: by how long it lasts, what causes it, and how it
affects the body.
1. Based on Duration
●Acute Diarrhea (Less than 14 days)- Short-term and often caused by infections
(bacteria or viruses), food poisoning, or medications.
▪︎Most people recover with rest and fluids.
●Persistent Diarrhea (2 to 4 weeks)- Lasts longer but is not permanent
▪︎Can result from infections, poor diet, or other health issues.
▪︎Needs medical attention if it continues.
●Chronic Diarrhea (More than 4 weeks)- Long-term, often caused by infections or
conditions like irritable bowel syndrome (IBS) and digestive problems.
▪︎May require special medical treatment.
2. Based on Cause
● Infectious Diarrhea- Caused by germs like bacteria (E. coli, Salmonella), viruses
(Rotavirus, Norovirus), or parasites (Giardia lamblia).
▪︎Spread through contaminated food, water, or contact with infected people.
▪︎Symptoms include stomach pain, vomiting, and fever.
● Non-Infectious Diarrhea- Caused by factors other than germs, such as food intolerance
(e.g., lactose intolerance), medications (e.g., antibiotics), or chronic diseases (Crohn’s
disease, IBS).
▪︎Treatment depends on the specific cause.
3. Based on Clinical Presentation
● Osmotic Diarrhea- Too much water is pulled into the intestines, causing loose stools.
▪︎Caused by too much sugar, artificial sweeteners, or lactose intolerance.
▪︎Stops when the person avoids the food or drink causing it.
●Secretory Diarrhea- The intestines release too much fluid, leading to watery diarrhea.
▪︎Can be caused by infections like cholera or certain diseases.
▪︎Continues even if the person stops eating or drinking.
●Motility Diarrhea- Food moves too fast through the intestines, preventing water
absorption.
▪︎Caused by conditions like IBS or stomach surgeries.
▪︎Leads to frequent, loose stools and stomach discomfort.

Signs and symptoms of diarrheal diseases

Common Symptoms:
 Frequent, Loose, Watery Stools: The primary symptom of diarrhea is the frequent
passage of loose or watery stools.
 Abdominal Cramps and Pain: Many individuals experience cramping and pain in the
abdomen.
 Urgency to Have a Bowel Movement: There is often a sudden, urgent need to have a
bowel movement.
 Nausea and Vomiting: Some people may feel nauseous or vomit.
 Bloating: A feeling of fullness or swelling in the abdomen.
 Fever: A mild to moderate fever may accompany diarrhea, especially if it is caused
by an infection.
 Dehydration: Symptoms of dehydration can include dry mouth, increased thirst,
reduced urine output, dark-colored urine, fatigue, dizziness, and confusion.
Severe Symptoms:
 Blood or Mucus in Stools: The presence of blood or mucus in the stool can indicate a
more serious condition.
 Severe Abdominal Pain: Intense pain in the abdomen may be a sign of a more
serious underlying issue.
 High Fever: A high fever (above 102°F or 39°C) can be a sign of a severe infection.
 Persistent Vomiting: Continuous vomiting can lead to severe dehydration and
requires medical attention.
 Weight Loss: Unintended weight loss can occur with chronic diarrhea.
Signs of Dehydration:
 Dry Mouth and Skin: Lack of moisture in the mouth and skin.
 Extreme Thirst: An intense need to drink fluids.
 Little or No Urine: Reduced frequency of urination or very dark urine.
 Weakness and Fatigue: Feeling unusually tired or weak.
 Dizziness or Lightheadedness: Feeling faint or dizzy, especially when standing up.
 Sunken Eyes: Eyes that appear sunken or hollow.
 Rapid Heartbeat: An unusually fast heart rate.
When to Seek Medical Attention:
 Diarrhea lasting more than two days for adults or 24 hours for children.
 Severe abdominal or rectal pain.
 Blood or pus in the stool.
 Signs of severe dehydration.
 High fever.
 Persistent vomiting.

Complications of diarrheal diseases

Diarrheal diseases can lead to several complications, particularly if they are severe or
prolonged. These complications can affect individuals of all ages but are especially
dangerous for young children, the elderly, and those with weakened immune systems
Dehydration
The most immediate and serious complication, resulting from the loss of fluids and
electrolytes. Severe dehydration can lead to shock and organ failure.
Electrolyte Imbalance
Loss of electrolytes such as sodium, potassium, and bicarbonate can result in serious
health issues, including cardiac complications.
Acute Kidney Injury
Severe dehydration can reduce blood flow to the kidneys, leading to acute kidney injury
or worse kidney failure which may require medical intervention or dialysis.
Shock
Significant fluid loss can cause hypovolemic shock, a critical condition where the body
lacks enough blood volume to maintain proper circulation and organ function, leading to
potential organ failure.
Malnutrition
Chronic or severe diarrhea can impair the absorption of nutrients, leading to
malnutrition, especially in children. This may result in growth delays, weight loss, and
deficiencies in essential vitamins and minerals.
Post-Infectious Irritable Bowel Syndrome (IBS)
Some individuals may experience ongoing gastrointestinal symptoms, such as
abdominal pain, bloating, and altered bowel habits, even after the initial infection has
resolved (post-infectious IBS).
Acid-Base Imbalance
Diarrhea can cause metabolic acidosis due to loss of bicarbonate and can affect overall
pH balance in the body
Intestinal Damage
Some pathogens, like certain strains of E. coli and Shigella, can cause damage to the
intestinal lining, leading to complications such as colitis or hemorrhagic colitis.
Sepsis
In severe cases, bacteria may enter the bloodstream, leading to sepsis, a life-threatening
systemic inflammatory response triggered by infection.
Hemolytic Uremic Syndrome (HUS)
Infection with enteropathogenic E. coli (especially O157:H7) can lead to HUS,
characterized by kidney failure, low platelet count, and hemolytic anemia. This serious
complication is mainly seen in children.
Mortality
In severe cases, particularly among vulnerable populations (young children, the elderly,
and immunocompromised individuals), complications from diarrheal diseases can lead
to death if not managed promptly and effectively.

Predisposing Factors of Diarrheal Diseases

Diarrheal diseases are caused by infections, toxins, or other underlying health conditions
that lead to frequent and loose stools. Various factors contribute to an individual’s
susceptibility to diarrhea, which can be categorized into host factors (related to the
individual) and environmental factors (external conditions that increase risk).

1. Host Factors (Individual Susceptibility)

These are factors within an individual that make them more vulnerable to diarrheal
diseases.
a) Age
 Infants and young children have immature immune systems, making them more
prone to infections.
 The elderly may have weakened immunity and other chronic conditions, increasing
their susceptibility.
b) Immune Status
 Immunocompromised individuals (e.g., those with HIV/AIDS, undergoing
chemotherapy, or with malnutrition) are more susceptible to infections that cause
diarrhea.
 Lack of previous exposure to certain pathogens may result in severe infections.
c) Nutritional Status
 Malnutrition weakens the immune system, making the body less able to fight
infections.
 Deficiencies in micronutrients like zinc, vitamin A, and iron impair gut integrity and
immune response.
d) Underlying Medical Conditions
 Conditions such as irritable bowel syndrome (IBS), Crohn’s disease, and celiac
disease can predispose individuals to chronic diarrhea.
 Diabetes, liver diseases, and certain cancers can also contribute to increased risk.
e) Poor Personal Hygiene
 Not washing hands properly after using the toilet or before handling food increases
exposure to infectious agents.
 Poor sanitation habits facilitate the transmission of diarrheal pathogens.

2. Environmental Factors
These are external conditions that contribute to the spread of diarrheal diseases.
a) Contaminated Water Supply
 Drinking or using water that is contaminated with bacteria (e.g., E. coli), viruses (e.g.,
rotavirus), or parasites (e.g., Giardia lamblia) increases the risk of infection.
 Poor sanitation and open defecation contribute to waterborne transmission.
b) Poor Sanitation and Waste Disposal
 Lack of proper toilets and sewer systems results in fecal contamination of water and
food.
 Improper waste disposal attracts flies, which can spread pathogens.
c) Food Contamination
 Eating food contaminated with bacteria (e.g., Salmonella, Shigella), viruses (e.g.,
norovirus), or toxins can cause diarrhea.
 Poor food handling, lack of refrigeration, and improper cooking contribute to
contamination.
d) Overcrowded Living Conditions
 High population density increases the risk of person-to-person transmission of
diarrheal pathogens.
 Refugee camps, urban slums, and institutions like prisons and orphanages are high-
risk areas.
e) Climate and Weather Conditions
 Flooding can spread contaminated water, leading to outbreaks.
 Hot and humid climates favor bacterial growth in food and water, increasing the risk
of infections.
 Droughts reduce access to clean water, forcing people to rely on unsafe sources.

3. Behavioral and Socioeconomic Factors

a) Lack of Health Education
 People unaware of the importance of hygiene, safe drinking water, and proper food
handling are at a higher risk of diarrheal diseases.
 Myths and misconceptions about diarrheal diseases can hinder prevention efforts.
b) Poverty and Low Socioeconomic Status
 Limited access to clean water, healthcare, and proper nutrition increases the risk of
infections.
 Poor communities often lack proper sanitation facilities.
c) Unsafe Infant Feeding Practices
 Bottle-feeding with contaminated water can introduce pathogens to infants.
 Early cessation of breastfeeding reduces the protective effects of maternal
antibodies.
d) Travel to High-Risk Areas
 Visiting areas with poor sanitation, especially in developing countries, increases
exposure to new pathogens that the immune system may not recognize.
 Lack of access to clean water and proper food storage during travel increases risk.

4. Medication and Antibiotic Use

a) Overuse of Antibiotics
 Disrupts the normal gut microbiota, making the intestines more susceptible to
opportunistic infections like Clostridioides difficile (C. diff).
b) Certain Medications
 Laxatives, chemotherapy drugs, and some diabetes medications (e.g., metformin)
can cause diarrhea.

Prevention and Control of Diarrheal Diseases

Prevention Measures
 Safe Drinking Water– Boiling, chlorinating, or filtering water can help eliminate
pathogens and prevent infection.
 Proper Sanitation – Use of clean latrines and proper disposal of human waste
reduces contamination.
 Hand Hygiene – Regular handwashing with soap, especially after using the toilet and
before eating, prevents disease transmission.
 Food Hygiene– Properly washing, cooking, and storing food helps prevent
contamination.
 Exclusive Breastfeeding – For infants under six months, breast milk provides
essential nutrients and antibodies that protect against infections.
 Vaccination – Immunization against rotavirus and cholera reduces the risk of
diarrheal diseases.
 Personal Hygiene – Maintaining overall cleanliness, including bathing and wearing
clean clothes, minimizes the spread of germs.
 Vector Control – Controlling flies and other insects that spread diarrheal pathogens
helps prevent infections.
 Proper Waste Disposal – Managing household and community waste properly
prevents environmental contamination.
 Public Health Education – Raising awareness about hygiene, sanitation, and safe
food practices helps communities adopt preventive measures.

Control Measures
 Oral Rehydration Therapy (ORT) – Drinking oral rehydration salts (ORS) or
homemade solutions helps replace lost fluids and electrolytes.
 Zinc Supplementation – Giving zinc to children with diarrhea can reduce the severity
and duration of the illness.
 Antimicrobial Treatment – In cases of bacterial infections, antibiotics may be used
under medical supervision.
 Nutritional Support – Providing a balanced diet, including continued breastfeeding
and nutrient-rich foods, helps recovery.
 Isolation of Infected Individuals – Keeping infected individuals away from food
handling and close contact with others can help limit disease spread.