Diarrhea invasive

Patients with acute infectious diarrhea from invasive organisms also have bloody stools and severe abdominal pain. 

Stool may also be analyzed for mucus, fat, osmolality, fecal leukocytes, and pH. The presence of mucus suggests colonic involvement. Fat in the stool may be due to a malabsorption disorder. Fecal leukocytes can be found in inflammatory diarrheas including infections caused by invasive bacteria (e.g., E. coli, Shigella, and Campylobacter species). Stool pH (normally greater than 6) is decreased by bacterial fermentation processes. 

What is the likelihood that her diarrhea is due to an invasive microorganism ... 

Fecal leukocytes can be found in inflammatory diarrhea, especially when due to invasive microorganisms. 

R. C., et al., Quantitative, non-invasive assessment of antidiarrheal actions of codeine using an experi-mental model of diarrhea in man, Dig. Dis. Sci. 1993, 38, 996-1003. 

EIEC all ages/primarily in the developing regions occasional outbreaks in industrialized countries as short as 10-18 h acute watery diarrhea followed by dysentery cell invasion spread inflammation... 

Shigella incidence highest in children 1-5 years of age 24-72h watery at the onset and may evolve to bloody diarrhea or dysentery invasion and destruction of the distal ileal and colonic mucosa - release of cytokines - PMN mucosal infiltration... 

EPEC causes a degeneration of the microvillus brush border, with cupping and pedestal formation of the plasma membrane at the sites of bacterial attachment and reorganization of cytoskeletal proteins [43, 44], Invasion has been observed in some clinical specimens, but the mechanism of how this bacteria produces diarrhea is not fully understood. Some possibilities include an increase in permeability and loss in microvilli leading to malabsorption. 

While in patients with traveler s diarrhea due to E. coli the efficacy of the antibiotic was uniformity high, the cure rate was significantly lower when invasive pathogens (e.g. Campylobacter jejuni) causing fever and/or dysentery were present (DuPont, unpublished observations). 

Once Salmonella invade the intestinal barrier, the bacteria encounter host immune cells such as neutrophils, lymphocytes and macrophages, which engulf the bacteria (Fields et al., 1986 McCormick et al., 1993) (Fig. 5.1). Salmonella serotypes capable of causing gastroenteritis are killed by host macrophages, and effectively cleared by the immune system. Invasion of M cells and intestinal epithelial cells induces a pro-inflammatory response in the intestinal mucosa (Fig. 5.1a). A combination of inflammatory cytokine production, neutrophil infiltration and fluid and electrolyte secretion by the epithelium results in the diarrhea associated with gastrointestinal enteritis (Fig. 5.1a). 

Oosiridium difUdie Metronidazole 250 mg four limes daily to 500 mg three times daily x 10 days Invasive (dysentery-like) diarrhea... 

Oral ciprofloxacin (10 mg/kg bd) was as safe and effective as intramuscular ceftriaxone (50 mg/kg/day) in the treatment of acute invasive diarrhea in 201 children (aged 6 months to 10 years) (64). Possible drug-related adverse events occurred in 8% and were mild and transient. Joints were normal during and after the completion of therapy in all patients. 

Leibovitz E, Janco J, Piglansky L, Press J, Yagupsky P, Reinhart H, Yaniv I, Dagan R. Oral ciprofloxacin vs. intramuscular ceftriaxone as empiric treatment of acute invasive diarrhea in children. Pediatr Infect Dis J 2000 19(ll) 1060-7. 

Mycophenolate mofetil has been compared with azathioprine in combination with ciclosporin and glucocorticoids in 65 children after kidney transplantation (32). The main adverse effects of this treatment were infections of the urinary tract and the upper respiratory tract, abdominal pain, and diarrhea. Opportunistic infections with cytomegalovirus or cytomegalovirus syndrome occurred in 20% within the first 6 months and tissue-invasive cytomegalovirus disease in 3.1%. These results were similar to those in adults. 

Indications Travelers diarrhea (caused by non-invasive strains of E. coli)... 

Since the 1980s, there has been an alarming increase in GAS-mediated invasive disease, not only in frequency, but also in severity. The severest form of invasive infection results in clinical symptoms similar to staphylococcal toxic shock syndrome and was therefore described as streptococcal toxic shock syndrome (STSS). Characteristic symptoms of STSS include hypotension, fever, rash, vomiting, diarrhea, multiple organ failure, and shock [7]. 

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