Etiology of acute non-bloody diarrhoea with little or no fever

If the diarrhoea is very watery, the possibility of cholera must be considered. In these cases rehydration is very important. Antibiotics (such as tetracyclines) also help, but to a lesser extent. Cholera must be notified in view of the possibility of epidemics.

Food poisoning by bacterial toxins (including staphylococci) results in explosive diarrhoea shortly after a meal. The bacteria reproduce in food. These bacteria produce a thermostable toxin. The bacteria are usually killed when food is cooked or left over food is reheated. The toxin is not destroyed by the heat and enters the intestine, where it causes massive diarrhoea, probably by neurotoxic action on the autonomous nervous system. Antibiotics are therefore of no value here. Symptomatic treatment is indicated. Toxins produced by Bacillus cereus (often present in contaminated rice) can produce a similar picture or the “emetic syndrome”. Some milder infections, such as traveller’s diarrhoea, produce hardly any fever. In these cases bowel motion inhibitors (loperamide) can be given. Racecadotril (acetorphan) is an enkephalinase inhibitor with an antisecretory and antidiarrhoeic activity. The product reduces intestinal hypersecretion but not intestinal motility. It prevents the breakdown of endogenous enkephalins in the gastro-intestinal tract. These enkephalins are neurotransmitters in the intestinal wall. They are active on the δ-opiate receptors and reduce the intracellular c-AMP concentration. Loperamide apparently acts only on the μ-opiate receptors.

Category: Medical Subject Notes , Medicine Notes