00:00
Our topic now, we'll move
to pediatric diarrhea.
00:06
Obviously the definition will
be increased stool output,
and you're definitely worried about in a child
of losing electrolytes.
00:16
Maybe acute or chronic.
00:17
Etiology maybe infection
or perhaps malabsorption.
00:20
We'll talk about differentials
in a little bit.
00:23
Mechanism may be osmotic.
00:26
Stool volume depends on the diet
and decreases with fasting.
00:30
By osmotic, we
mean that there is
not enough absorption,
therefore, creating an osmotic
environment in the intestine,
therefore, pulling in water
resulting in diarrhea.
00:42
Or perhaps it might the secretory type.
00:44
So two different
types of diarrhea
that may be seen in the
pediatric population.
00:50
In secretory, the stool volume is increased
and does not vary with diet.
00:55
That, you want to
pay attention to.
00:57
In osmotic, the less
that the child eats,
there's less of a chance of
stool output being increased.
01:04
If it's secretory, then
there is increased –
let's say, it's something like
a Vibrio cholera infection,
a secretory type of diarrhea,
regardless as to how much
consumption by the child of food,
it's not going to change the
amount of stool volume.
01:21
That will continue to be persistent.
01:23
You pay attention
to that, please.
01:28
Let us now go into
differentials and etiologies.
01:31
Viral, extremely common.
01:33
Of all the viral, rotavirus
is the most common
if you remember from microbiology,
especially during winter
months up in the north.
01:42
This is when the children are playing and
they really don’t play outside too much
and maybe perhaps the parents
are dropping their children off
in day care centers,
and because of lack of
exposure to the outside world,
they're kind of closed in
these closed environments.
01:58
It's easy, really easy for
infections to be taking place
over and over and over again.
02:04
You'll see this during the
winter months quite a bit.
02:08
Also, take a child onto a cruise
in general, meaning to say,
Norwalk virus and I've kind
of made light of this earlier,
and I talked to you about going
on a Norwegian cruise line.
02:21
And the reason I say that is
because Norwalk viruses are viruses
that are found on cruise ships.
02:31
And you can have a child or an
adult
who consumes from the buffet
that has now been infected
by the virus called Norwalk.
02:40
The most common viral cause
of gastroenteritis is Rota.
02:45
Cruise ships, Norwalk.
02:48
Bacterial causes of pediatric diarrhea.
02:51
And I'll walk you through this
in greater detail coming up
In which I will show you
signs and symptoms.
02:56
E. coli, quite common,
especially pathogenic.
03:00
Salmonella, look for
a child having pets,
and by pets, maybe
perhaps even reptiles.
03:06
Shigella. Campylobacter,
extremely common.
03:09
Yersinia.
03:10
Yersinia will be
interesting to you.
03:13
And for that -- And the
reason I say that is because
It shares -- the infection
shares similarities
with certain systemic pathologies
such as inflammatory bowel
disease or perhaps even,
what do we call – What we call
pseudoappendicitis
and Clostridium.
03:31
Parasitic.
03:32
Entamoeba histolytica, giardia.
03:34
If you take the child,
maybe perhaps, he's accompanying
you on a hiking trip
And during that hike,
there's every possibility
that there might be
consumption of water.
03:44
that has been
contaminated by giardia
and cryptosporidium.
03:49
Remember that cryptosporidium
is usually a parasite
that is going to affect a patient
whose immune system is
not fully developed.
03:59
Remember in HIV patients,
the
most common cause of diarrhea,
is Cryptosporidium parvum.
04:05
This is not a child with HIV,
that is not what I'm saying.
04:08
This is a child whose immune
status is not fully mature yet.
04:12
Therefore, maybe susceptible to
cryptosporidium type of infections.
04:18
Pediatric diarrhea, important
gastroenteritis differentials.
04:24
Pediatric diarrhea, important
gastroenteritis differentials.
04:28
The rotavirus, watery diarrhea
for 7-10 days, approximate week.
04:33
Also, in addition to diarrhea,
it may also present
with vomiting
and because this is a virus,
it's supportive therapy.
04:41
And by supportive therapy,
it would mean that you have
to make sure that the child--
First and foremost,
if there's diarrhea and
there's vomiting in a child,
my goodness, you want to make
sure that the hydration status
of your child is
properly taken care of.
04:56
E. coli.
04:58
Here, we have enteropathogenic E.
coli.
05:00
Nurseries and daycares.
05:01
Once again, think of
winter months in which
the children are playing
close together,
And so therefore may
then spread infections.
05:09
Salmonella.
05:10
Egg, poultry, milk, reptiles, pets.
05:15
Salmonella, quite common.
05:18
Shigella.
05:20
Contaminated food and
look for the child
who actually maybe experiencing seizures.
05:26
S – Shigella.
05:27
S- Seizures.
05:29
Specific pathological
clinical manifestations
of some of your infections.
05:36
Continuing.
05:37
Campylobacter, extremely common
Contaminated food,
extremely common.
05:41
Campylobacter jejuni.
05:43
Yersinia
I explained earlier that
what you're paying
attention to would be
how it behaves like systemic
pathologies such as,
be careful not to confuse it
with inflammatory bowel disease
or pseudo-appendicitis.
05:59
And by that, we mean that there
might right lower quadrant pain,
kind of like appendicitis.
06:04
Yersinia,
also transmitted by pets,
contaminated food,
and associated with
arthritis and rash,
look for extra-intestinal
manifestations with Yersinia big time.
06:17
Clostridium, what happens here?
Usually significant.
06:21
Maybe perhaps prior antibiotic use.
06:25
Clostridium.
06:26
Staph aureus, extremely quick.
06:28
twelve hours after
ingestion of let's say
those food items that may
then contain egg products
such as mayo, all right?
So for example, potato
salad and such.
06:41
Diagnosis.
06:43
You're going to recover
the organism in the stool
and enzyme immunoassays.
06:48
Pretty straight forward.
06:48
Examine the stool when
there's pediatric diarrhea.
06:53
Supportive therapy, only for viral.
Only for viral.
06:56
Remember, there are no viral antibiotics.
07:00
No such thing.
07:01
And because of all of the
vomiting and loss of fluid,
you're worried about
the hydration status.
07:08
For salmonella, antibiotics are indicated only for ages less than 12 months.
07:14
If the patient is in a toxic state, if there is disseminated disease, or they are immunocompromised
There is also important to note, that for salmonella typhi
Trimethoprim/sulfamethoxazole actually prolongs to the carriage state.
07:27
For shigella, Azithromycin is the prefered agient, if the antibiotics sensitivity is not known.
07:32
This is due to hyresistance patterns.
07:34
For Campylobacter, antibiotics are reserved for severe disease or patients that are immunocompromised.
07:40
The remmended agient is erythormycin.
07:44
Yersinia.
07:44
Less than 3 months once
again, antibiotics
So you're worried about children
and you want to bolster
their immune system.
07:51
Also with Yersinia,
worried about septicemia.
07:55
Aminoglycosides or third generations cephalosphorins
are a possibilities for Yersinia.
08:01
The difficile,
oral metronidazole
is your drug of choice. if
you find your patient to be
and at some point in time, if
you find your patient to be
resistant to metronidazole,
you should be thinking
about oral vanco.
08:14
Entamoeba, metronidazole.
Giardia, metronidazole.
08:17
In general, if we think
about parasites,
you should be thinking
about metronidazole.