Diarrhea of ​​microbial origin

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What is it about ?

A large number of different germs can trigger diarrhea in humans. It is mainly bacteria, viruses and parasites.

Most of these infections are harmless, short-lived, and go away on their own without treatment. They do not pose a particular problem in healthy people.

However, a number of infections can be serious and lead to dangerous illnesses which, especially in children and the debilitated, can be associated with dehydration and be potentially fatal.

Bacterial infections

Intestinal infections caused by bacteria are almost always due to the consumption of infected foods or drinks. Symptoms appear within hours or days of infection.

Bacteria that can cause diarrhea are:

  • Salmonella;
    • A Salmonella infection produces sudden diarrhea, associated with stomach pain and fever.
    • Antibiotics are only needed in severe cases.
    • Typhoid fever is also caused by a bacteria of the Salmonella type, but which is different from the one that causes a common gastrointestinal infection. This bacterium is found only in tropical regions, where it is very rare. There is a vaccine against typhoid fever.
  • Campylobacter;
    • In our country, Campylobacter infection is the number one cause of bacterial diarrhea.
    • It is characterized by acute diarrhea, often accompanied by severe stomach aches and fever.
    • If you still have symptoms when the bacteria are identified, the doctor will prescribe an antibiotic.
  • The group of bacteria Escherichia coli (E. coli);
    • There are many types of E.coli. Two types, enterohemorrhagic Escherichia coli (ECEH) and entero-invasive E. coli (ECEI), can cause bloody diarrhea.
  • Shigella;
    • This bacteria can cause bloody diarrhea and is always treated with antibiotics.
    • Shigella infections are most often acquired abroad.
  • Yersinia ;
    • This bacterium is known in several forms. One of them (Y. pestis) caused the famous Black Death or the Great Plague, in the Middle Ages. But gastrointestinal infections are triggered by other species.
    • Usually, the Yersinia bacteria is transmitted via contaminated pork.
    • The disease usually goes away on its own.
  • Vibrio cholerae;
    • This bacterium is responsible for cholera, a disease which has fortunately disappeared in Belgium.
    • The disease is spread through the consumption of infected food or water, mainly in areas where hygiene conditions are poor.
    • There is a vaccine against cholera, but it is not recommended for travelers.
  • Clostridium difficile.
    • An infection caused by this bacteria occurs during or after treatment with an antibiotic.

Food poisoning can also be triggered by toxins released by certain bacteria. These are often the bacteria Staphylococcus aureus, Clostridium perfringens or Bacillus cereus.

Viral infections

Viruses are usually transmitted from humans to humans, via the stool or vomit of an infected person. The most common viruses that cause diarrhea are:

  • Rotaviruses;
    • These viruses are more common in children from the age of 6 months.
    • Vaccination against rotaviruses is included in ONE’s standard vaccination program.
    • One to 3 days after infection, the child develops a diarrhea watery, accompanied by fever and vomiting.
    • The disease usually resolves spontaneously within 5 days.
  • Noroviruses;
    • These viruses affect adults and children.
    • There is no vaccine against norovirus.
    • These infections are often rife with epidemics, most often towards the end of winter.
    • From vomiting abundant occur 12 to 36 hours after contamination, associated with diarrhea and a slight fever.
    • A norovirus infection usually doesn’t last more than 2 days.
Parasitic infections

Parasites (protozoa or unicellular) are microorganisms that live at the expense of a host (which they “parasitize”), in this case humans. The intestines can contain parasites that cause disease (pathogenic parasites) and harmless parasites.

Infections occur mostly in (sub) tropical regions, but they can spread quite easily in more temperate areas.

The most common parasites are:

  • Dientamoeba fragilis ;
    • This parasite is the most common and is also found in people who have not traveled.
  • Entamoeba histolytica ;
    • This parasite is the largest in the world, as it can sometimes be the cause of serious infection, which can even lead to death. Amebiasis or amoebic dysentery may thus be accompanied by bloody diarrhea or an abscess in the liver (hepatic amoebic abscess).
  • Giardia.
    • This parasite is present all over the world.
    • The symptoms can be many and varied. Some people have no symptoms (asymptomatic people), others have severe gastrointestinal problems.

Diarrhea that is caused by parasites often persists for weeks. It is important to think about this, especially if you are returning from a trip.

You can become infected by consuming infected water or food. Once mature, the parasites produce intestinal cysts which are passed with the stool. Food or drink that is prepared under unsanitary conditions can be contaminated by the hands of the original host. This creates an endless man-outside-man cycle, with new people being systematically and constantly infected.

How is contamination found?

It is usually not necessary to identify the germ that causes diarrhea.

In the presence of a persistent diarrhea or severe, a stool sample can be analyzed in the laboratory, to check if the diarrhea is due to bacteria. If the diarrhea lasts or has started after a trip, examining the stool sample will also try to check for the presence of parasites.

The virus detection tests are generally only carried out in cases where the diarrhea occurs in the form of an epidemic, for example when a large number of pupils in the same school suddenly suffer from diarrhea.

What can you do ?

Prevention
  • Hygiene is essential, especially travelling. Avoid foods that are undercooked at all costs.
  • If you are in a tropical area, drink only bottled water and always make sure the bottle is securely closed.
  • If you purify your water, remember that adding regular chlorine does not eliminate parasitic cysts. So boil the water or filter it.
  • Wash and disinfect your hands after each contact with someone with diarrhea.
  • You can also get vaccinated against certain infections. Discuss this with your doctor.
What to do if you have diarrhea
  • If you are suffering from diarrhea, drink enough.
  • For vulnerable populations, such as seniors and children, or in the presence of signs of dehydration, it may be helpful to add oral rehydration solution (ORS) to the water. It is a sachet of saline solution, available in pharmacies, which promotes the absorption of liquids. This compound helps maintain the balance of salt and water in the body.
  • You don’t necessarily have to fast. You can take light and small meals, they will not aggravate the diarrhea.
  • When the diarrhea is very bothersome, you can take loperamide. This medicine can be taken for 2 days, not more. Loperamide cannot be taken in case of fever or blood in the stool because if the diarrhea is caused by certain bacteria, loperamide can make the disease worse.

A worker who suffers from diarrhea, whatever the cause, cannot perform high-risk tasks. High-risk occupations relate in particular to the water distribution sector, care units for newborns, activities involving the handling of foodstuffs with bare hands, etc.

What can your doctor do?

  • Most cases of microbial diarrhea heal spontaneously and do not require treatment.
  • In case of high fever and of blood in stool, the doctor will consider an antibiotic. Antibiotics often provide rapid improvement.
  • The parasitic infections are routinely treated with antibiotics.
  • Hospitalization may be required if you show signs of dehydration or serious complications.

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