Persistent Diarrhoea

Persistent Diarrhoea

Acute episodes of diarrhoea that last for 14 days or longer and are presumed to be infectious are termed persistent diarrhoea.

General Considerations 

Although only about 5-15% of acute diarrhoeal episodes last longer than 14 days, the case fatality is upto 5-7%, accounting for one third to half the death caused by diarrhoea.

Etiology

Infections 

• Enteroadhesive E. coli.
• Enteropathogenic E. coli.
• Shigella.
• Salmonella (non-typhoid).
• Campylobacter jejuni.
• Giardia lamblia.
• Entamoeba histolytica.
• Cryptosporidium.

Host Factors 

• Malnutrition.
• Lactose intolerance.
• Repeated bouts of diarrhoea.

Laboratory Investigations 

• Stool exam, gross and microscopic.
• Stool culture.
• Stool pH, reducing substances.
• Electrolytes.

Treatment 

• Rehydration with ORS.
• Correct sodium and potassium deficits.
• Continue breast feeding.
• If evidence of lactose intolerance, yogurt may be given.
• Small and frequent high caloric density feedings.
• Micronutrients such as Vit. A, Zinc, Vit. B, folate.
• Drugs as necessary - only for shigella.