Acute gastroenteritis
What kind of infection is it?It is a transient illness accompanied by sudden vomiting and diarrhea. Generally, vomiting is a symptom of gastritis, and diarrhea is a symptom of enteritis. They are mainly caused by microorganisms and their toxins, and are divided into infectious disease type and toxin type. Microorganisms include viruses, bacteria, and protozoa. In rare cases, they may be caused by two or more microorganisms. Other factors that may be involved include chemicals and allergies. Under the Infectious Diseases Control Law, cholera, bacterial dysentery, typhoid fever, and paratyphoid fever are classified as Class 2 infectious diseases and require treatment such as hospitalization or disinfection depending on the situation. Enterohemorrhagic E. coli infection is a Class 3 infectious disease, and requires measures such as work restrictions for certain occupations and disinfection. Amebic dysentery, Croptosporidiosis, Vancomycin In acute gastroenteritis, the causative agent (food, etc.) and the route of infection may be clear, but in many cases they are unknown. When traveling abroad, people can become infected by food or drinking water in the local area (place of stay). In some cases, people can become infected by pets. How symptoms manifest In the case of bacterial infection, symptoms include vomiting and diarrhea, and in severe cases, blood may be mixed in. Viral infections are characterised by watery diarrhea. Testing and diagnosisIf bacterial infection is suspected, bacterial culture and drug susceptibility tests are performed because there may be drug-resistant bacteria (specific drugs are ineffective). For hemorrhagic E. coli, there is an immunochromatography method that can be used to test directly from stool. In the case of viruses, antigens are detected using immunological techniques such as immunochromatography and enzyme antibody techniques. In recent years, rapid diagnostic methods have become more common, and genetic diagnostic methods are also used for bacterial and viral infections. In the case of an outbreak, it is also necessary to test food ingredients and the environment. For epidemiology and vaccine development, we may investigate the serotype and genotype of microorganisms, and ultimately perform genome analysis. Simple pathogen testing includes microbial staining of stool under a microscope and estimation of the number of white blood cells in the stool. Treatment methodsFor treatment methods, please refer to the sections on viruses, bacteria, and protozoa. In the case of bacterial infection, antibiotics such as quinolones are used. In cases of severe dehydration such as cholera, intravenous fluid administration is important. In the case of viral infection, intravenous fluid administration may be used to maintain electrolytes in the body. Normal bacteria in the intestinal tract What to do if you notice an illnessGenerally, diarrhea in the summer is more likely to be bacterial (including toxins) and diarrhea in the winter is more likely to be viral. However, with the recent globalization of food and the use of frozen food, this is no longer necessarily the case. If the stool is bloody or purulent, bacterial infection is suspected. If it is a temporary condition that resolves after one or two bouts of diarrhea, you can wait and see with a live bacterial preparation, but if it gradually worsens or if the frequency of bloody or purulent stools continues to increase, you should see a doctor. Related TopicsViral diarrhea, cryptosporidiosis, hepatitis A, hepatitis E, influenza Hiroji Ushijima Source: Houken “Sixth Edition Family Medicine Encyclopedia” Information about the Sixth Edition Family Medicine Encyclopedia |
どんな感染症か突然の嘔吐や下痢を伴う病気で、一過性のものをいいます。一般に、嘔吐は胃炎、下痢は腸炎の症状です。 主として、微生物やその毒素などで生じ、感染症型と毒素型に分けられます。微生物には、ウイルス、細菌、原虫などがあります。まれに、2つ以上の微生物によって起こることもあります。そのほか、化学物質やアレルギーなども関係します。 感染症法では、コレラ、細菌性赤痢(せきり)、腸チフス、パラチフスは2類感染症で、状況に応じて入院や消毒などの処置が必要です。 腸管出血性大腸菌感染症は3類感染症で、特定職種への就業制限・消毒などの処置が必要です。 アメーバ赤痢、クロプトスポリジウム症、バンコマイシン 急性胃腸炎は、食品などの原因物質や感染経路が明らかな場合がありますが、不明な場合も少なくありません。海外旅行などで、現地（滞在地）の食材や飲み水で感染することもあります。ペットなどから感染する場合もあります。 症状の現れ方 細菌性の場合は、嘔吐や下痢のほか、重症化すると血液が混入した、あるいは ウイルス性の場合は、水様性の下痢便が特徴です。 検査と診断細菌性が疑われた場合は、薬剤耐性菌（特定の薬が効かない）のことがあるので、細菌培養と薬剤感受性テストを行います。出血性大腸菌では、便から直接検査できるイムノクロマト法があります。 ウイルスの場合は、イムノクロマト法、酵素抗体法などの免疫学的手法での抗原検出が行われます。 近年、迅速診断法が普及するようになってきました。また、遺伝子診断法も細菌・ウイルス性で用いられます。 集団発生などの場合は、食材や環境などの検査も必要です。疫学やワクチンの開発には、微生物の血清型や遺伝子型を調べたり、究極的にはゲノム解析を行うこともあります。 簡易な病原体の検査としては、顕微鏡下での便中微生物染色、便中の白血球の数による推定があります。 治療の方法治療法は、ウイルス・細菌・原虫の各項目を参考にしてください。 細菌性の場合は、ニューキノロンなどの抗生物質が用いられます。コレラのように脱水が強い場合は、輸液が重要です。ウイルス性の場合は、体内の電解質の保持のため、輸液を行う場合があります。 腸管内の正常細菌 病気に気づいたらどうする通常、夏の下痢症は細菌性（毒素を含む）が多く、冬の下痢症はウイルス性が多くみられます。しかし、近年の食材のグローバル化および冷凍保存などで、このことは必ずしもあてはまりません。 血便・膿性の便の場合は細菌性を疑います。一過性で1～2回の下痢で治まるなら、生菌製剤で様子をみることができますが、次第に悪化する場合や、血便・膿性の便の回数が多く続くようなら受診しましょう。 関連項目ウイルス性下痢症、クリプトスポリジウム症、A型肝炎、E型肝炎、インフルエンザ 牛島 廣治 出典 法研「六訂版 家庭医学大全科」六訂版 家庭医学大全科について 情報 |
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