Diarrhea: Novel Advances and Future Perspectives in the Etiological Diagnosis and Management

Abstract

Diarrhea is an increase in the incidence and fluidity of feces that is greatest characterized by duration (acute versus chronic), pathophysiologic apparatus, and anatomic location. Different types of diarrhea influence the health of both sexes. Infectious diarrhea is a big issue in many underdeveloped nations, with a high death rate, specifically among children under the age of five. Water diarrhea can be caused by a variety of microorganisms, including viruses, bacteria, and parasites. Acute bloody diarrhea is a health emergency that should be treated quickly. Most instances of acute diarrhea are clear on their own days without remedy. If you have adopted lifestyle adjustments and domestic remedies for diarrhea without achievement, there these are thought to be clinical remedies. By proper sanitation, hygiene protection, hand washing, food hygiene, and vaccination are required to control diarrhea.

1. Introduction

Higher cases of diarrhea are seen in developing countries. In which 14% of children aged fewer than five years had diarrhea, reported in a health survey of Nepal Demographic 2011. During the last three years, diarrhea cases in Nepal were increasing with time. It is estimated that out of 1000 children, 528–629 children are affected by it. During 2013–2014, in Nepal, 36 children per 1000 under less than five years of age die due to this infection [1]. In 2015, 9% of children less than five years of age are affected by diarrhea worldwide 1400 children are died due to it each day and annually 530,000 children are died due to it. Death rates of diarrhea are high in less than two years of children in Asia and Africa [2].

In Ethiopia, it is a very serious health problem for children in the region. In 2011, 13% of Children, less than five years of age were affected by this disease [3] 24–30% of the infant died due to diarrhea in this country [4]. The Ethiopian region is the very poorest region in the world and shows a high mortality rate of diarrhea [5] 15% of children having an age of fewer than five years are died due to it in developing countries. Acute diarrhea is a major cause of health problems worldwide. In 1973, rotavirus was the first time introduced as the cause of diarrhea when it was collected from epithelium cells of the upper villi surface in the gastrointestinal tract. Rotavirus was first seen in electro micrograph in 1973 and the word rotavirus has an origin from the Latin word, which means wheel-like. At the end of 1973, many types of research were conducted by doctors to determine the virus that caused diarrhea in infants and young children [6].

In the same year, the first-time rotavirus was identified in humans, when the first child is admitted to the hospital due to acute diarrhea. It was present in the cytoplasm of duodenal epithelial cells [7]. In Pakistan every year one child dies due to diarrhea. 400,000 infants die in his/her first years of life, published in the annual report in 2011 of Pakistan Medical Association. Acute diarrhea is a major problem in most developing countries. Most children remain under the threat of acute diarrhea infection during the first five years of life. It is estimated that 4.6 million deaths of children occurred annually in which acute diarrhea is the main factor of 25–30% of death of children aged less than five years [8]. 1.7 million children are infected by diarrhea worldwide, according to the world health organization. 760,000 mortalities of children occur each year due to diarrhea, which is why it is considered as the second major cause of death in children aged less than five years [9, 10].

2. Definition

Diarrhea is an increase in the incidence and fluidity of feces that is greatest characterized by duration (acute versus chronic), pathophysiologic apparatus, and anatomic location or the way of three or more loose or liquid couches per day it may also be described as a more common passage than is the normal for the individual.

3. Types of diarrhea

3.1 Acute watery diarrhea

It lasts several hours or days and consists of cholera. You have liquid stools if you have watery diarrhea. This is, for the most part, a sign of a gastrointestinal illness. Water diarrhea can be caused by a variety of microorganisms, including viruses, bacteria, and parasites, some of which are readily treated or do not require treatment.

3.2 Acute bloody diarrhea

It is also called dysentery. Acute bloody diarrhea is a health emergency that should be treated quickly. Its cause is usually significant and actionable usually known. Acute bloody diarrhea as a standalone scientific presentation, on the other hand, has received little scientific attention in recent decades. Despite the wide range of probable causes for acute bloody diarrhea, infectious considerations are crucial and should always be prioritized in such patients’ evaluations. The goal of the history, examination and laboratory tests should be to get a diagnosis as quickly as possible (and, by extension, to implement appropriate therapy). Adroit therapy for children with acute bloody diarrhea requires carefully planned testing and imaging, avoiding unnecessary diagnostic endeavors, and providing supportive care while waiting for a diagnosis.

4. Other classification

4.1 Osmatic

4.2 Secretory

4.3 Functional

Individuals with functional diarrhea may additionally represent a subgroup of human beings with IBS (irritable bowel syndrome). People with IBS regularly document altered bowel conduct, which includes diarrhea and/or constipation, associated with a stomach ache. Bloating, feeling a pressing want to apply a restroom, straining, or a sense of incomplete evacuation may also occur. Many of those signs arise in individuals with functional diarrhea, however, the absence of abdominal pain distinguishes those humans from those with IBS. People with practical bowel problems no longer exhibit physical or laboratory abnormalities to explain their gastrointestinal (GI) signs. One instance of a purposeful bowel disease is irritable bowel syndrome (IBS), which is envisioned to have an effect on about 10–15% of all adults.

4.4 Acute diarrhea

Acute diarrhea is a syndrome this is regularly now not differentiated clinically by means of a particular etiologic agent. The extensive spectrum of evolution varies from self-confined sickness to demise. Death is particularly because of dehydration and acute diarrhea takes the very best toll among children in low- and middle-earnings nations (LMIC). Acute diarrheal diseases ranked seventh among the reasons of mortality in LMIC in the international disorder burden collection, 2013, with an envisioned 1. Three million deaths (2 Four %).1 Most of those deaths arise in kids under the age of 5 years in LMIC and diarrhea stays among the top 5 causes of all deaths among children more youthful than age 5 years, as tabulated in 2013 [11, 12, 13, 14, 15, 16, 17, 18, 19, 20].

5. Causes

5.1 Infective

5.1.1 Bacteria

Which infected the food or water for instance salmonella (salmonella is a group of microorganisms that typically motive meals borne infection. An infection with the aid of the microorganism is known as salmonellosis and you could get it by way of eating infected meals merchandise, which includes uncooked poultry, eggs, beef, and in a few instances fruit. Salmonella has ended up a prime foodborne pathogen throughout the globe, inflicting approximately three.4 million cases and 681,316 annual deaths, with 63.7% of instances occurring in children under 5 years of age [21, 22]. There was as a minimum a hundred and fifty non-typhoidal Salmonella serotypes that can purpose gastroenteritis, with Salmonella Typhimurium and Salmonella Enteritidis being the maximum common serotypes. In terms of control, the recommended empiric parenteral remedy includes cefotaxime or ceftriaxone, while oral therapy consists of amoxicillin, trimethoprim-sulfamethoxazole, or azithromycin. Salmonella isolates have an excessive resistance in the direction of at least one antimicrobial agent, particularly towards clindamycin, oxacillin, penicillin, and vancomycin, for that reason, antibiotic susceptibilities of Salmonella should be determined for the targeted antibiotic therapy and vegetable) shigella and vibrio cholera [23, 24, 25, 26, 27, 28, 29].

Viruses also are contributing as the causative agent of diarrhea for example norovirus (Norovirus turned at the beginning known as the Norwalk virus, after the metropolis of Norwalk, OH, wherein the first showed outbreak happened in 1972). This concept is to be the most common purpose of acute gastroenteritis (diarrhea and vomiting contamination) around the sector. It spreads effortlessly through food and drinks and can have a large effect on people’s fitness. Norovirus is an emerging cause of acute gastroenteritis, accountable for approximately 17–18% of all acute gastroenteritis cases globally, mainly among advanced international locations [30, 31]. The age organization below one to twelve months vintage has the peak frequency of norovirus infection with extra dangerous factors which consist of intercourse of the [32]. Norovirus is noticed during the year, with the winter and fall (weather seasons) determined to report an improved frequency of illustrations [33, 34]. The finding rate of norovirus cases associates definitely with humidity. Co-contamination with rotavirus [19, 20], astrovirus, and salmonella both may occur in positive cases. Norovirus infections are discovered to reason greater excessive signs of gastroenteritis in children in comparison with rotavirus, especially after the advent of the rotavirus vaccination duration astrovirus.

With an astrovirus-causing acute gastroenteritis’ global common prevalence of 11%, the very best prevalence of human astrovirus infections changed inside the organization of youngsters between thirty-seven and forty-eight months old. Human astrovirus contamination particularly takes place for the duration of the dry season in the African continent; meanwhile, the highest occurrence mentioned inside the tropical areas is regularly during the rainy season and winter season in temperate climate countries. Patients commonly manifested with diarrhea, fever, vomiting, and abdominal pain, and rotavirus (It is an epidemic that causes diarrhea and different intestinal symptoms. It’s very contagious and is the maximum common cause of diarrhea in toddlers and young children globally. If you observe rotavirus through a microscope, it has a spherical form. The Latin phrase for wheel is “Rota,” and is the reason how the virus got its call.

5.2 Non-infective

1. Medicine along with antibiotics, cancer capsules, and antacids that contain magnesium is also taking part in diarrhea problems.

2. Allergies and intolerances to sure food, celiac disease, or lactose intolerance.

3. Radiation therapy, some cancers, and surgical treatments.

4. Malabsorption of food.

5. DM and alcohol.

5.3 Signs and symptoms of diarrhea

• Abdominal cramps or pain

• Bloating

• Nausea

• Vomiting

• Fever

• Blood in stool

• Mucus inside the stool

• Urgent need to have a bowel movement

5.4 Signs of extreme diarrhea

5.4.1 Dehydration

The most serious sign of diarrhea is the lack of water in the body of the person who is facing this disease. In this stage electrolytes like sodium, potassium bicarbonates are not balanced. Another factor is the water imbalance in the body. Other symptoms are vomiting, frequent urination, sweating, stool, and breathing.

• Severe dehydration (as a minimum two of the following symptoms):

• In this stage unconsciousness

• Pinched eyes

• Difficulty in drinking water

• Another sign is the skin pinch and porous is going lower back very slowly (≥2 seconds)

5.5 Examination

On exam it may be diagnosed with sunken eyes, loss of pores and skin turgor, and irritable.

5.6 Health impact

Diarrhea disorder may additionally have bad impact on both bodily and intellectual development. Early formative years malnutrition as a consequence of any cause reduces physical health and paintings productiveness in adults and diarrhea is number one purpose of adolescence malnutrition. It can purpose electrolyte imbalance, kidney impairment, dehydration, and defective immune system response.

Eco-oral Route

Investigation

After cautious history and examination. We will move for investigations.

5.6.1 Blood test

Specific blood antibody assessments can be ordered to assist clarify diagnoses. These can encompass antibodies for precise parasites, celiac disease antibodies, and yeast antibodies.

• Complete blood Hb and TLC (Total Leucocytes Count)

• Serum electrolytes (K+, Na+, Cl-)

• RFT (Renal Function) Test (Urea and creatinine)

5.6.2 Stool test

Stool test is also preferred for the identification of the causative agents of the disease.

For parasites test (eggs and ova).

5.7 Treatment

Most instances of acute diarrhea clear on their own days without remedy. If you have attempted lifestyle adjustments and domestic remedies for diarrhea without achievement, there these ought to be clinical remedies.

• Emergency Management

If the affected person is dehydrated and mentally irritable.

• Pass IV

• Input and 0utput tracking

• Start IV/fluids as an example R/L (Ringer lactate) N/S (Normal Saline) or hemacil.

• Cover antibiotic cover both for aerobes and anaerobe) i.e. ciprofloxacin and fungal.

• Give belly cowl (Risk)

• Once the patient is solid i.e. out of threat, treatment ought to be in keeping with the etiology.

• Antibiotics and anti-parasite tablets for oral use.

• Spasmolytics’ i.e. Bascopan, Nospa.

• Give ORS.

• Start ingesting tender meals or liquid weight loss plan e.g., fruit, juice, and so forth.

• If there may be chronic diarrhea, then remedy is according to motive e.g. in IBS we must discover both it is diarrhea dominant, constipation dominant or ache or in celiac ailment e.g., treatment might be according to reason.

5.8 Prevention of diarrhea water

• Through safe water

Most deaths related to diarrhea are due to pathogens received as a result of unsafe consuming water, poor sanitary conditions, and shortage of hygiene. Washing fingers with soap and water get rid of the bacteria, viruses, and parasites that cause ailment. Programmed and activities encouraging humans to clean their hands have been evolved to be used in groups and faculties, consisting of hygiene education, posters, leaflets, comedian books, songs, and drama.

• Adequate sanitation

• Hygiene protection

• Hand washing

• Exclusive breastfeeding for the first six months of existence.

• Food hygiene

• Health schooling about how infections spread.

• Vaccination of Rotavirus

6. Conclusions

Higher cases of diarrhea are seen in developing countries. Diarrheal is the 2nd leading death of children under the age of 5 years old. There are different types of diarrhea that cause number of death every year. Patients of diarrhea are increasing day by day and also increase the causative agents of this disease. First of all, find out the root cause of the diarrhea and a different diagnosis is necessary for the treatment of this disease. Due to the innovation and latest research scientists are able to find out the causes of the disease and at last best management proper sanitation and treatment is the best way of handling this disease.

Acknowledgments

First of all, I am very thankful to The Almighty Allah who is the greatest creator of the universe. He blessed and inspired me to complete my research work satisfactorily. I also pay my gratitude with heart and soul to the Holy Prophet (P.B.UH) and his beloved and Holy Family. I offered my heartiest gratitude to my most respected, gracious, highly learned, and reverend research Supervisor Dr. Muhammad Asrar Choudhary Assistant Professor Department of Zoology for his consolidated and inspiring guidance.

Thanks

I am really thankful to my group fellows Zeeshan Yousif, Usama Saleem, and Muhammad Faisal for their love, care, and sincere fellowship. I am really thankful to my Mother Balqees Anwar, my aunt Khalida akther, and brother Zeeshan Javed whose hands always raised for my wellbeing.

May Allah bless all these bright minds with long, happy, and peaceful lives including me (Ameen).