There are different causes of diarrhea, that varies form country to country.

I advanced countries it is usually caused by non infectious diseases (Chrohn’s disease or irritable bowel), or Viruses ( Nora virus) or milder form of bacteria like(Giardia or Campylobactor). Occasional Salmonella (different species from the one that causes typhoid) out break happen, usually due to egg. Diarrhea in these countries is usually self limiting and treated with clear liquid diet only. Agents like Imodium and Pepto-Bismol can be used to reduce motility of intestine, but antibiotic is not needed in majority of cases.

Diarrhea in developing countries like India is usually caused by protozoan , parasites or aggressive bacteria. It can be severe, causing bloody stools, also called Dysentery.

Protozoan are microscopic one cell organisms ( much lager than bacteria or virus), that live in human intestine. They go out of patient’s body in the stool, get in food and water and enter another person, through mouth. The so called “ Feco Oral contamination”. Basically one ends up eating minute amount of feces from a patient.

The commonest of these is called Amoeba ( Entamoeba Histolica). This is the most common cause of the diarrhea in India. Nearly all Indians have suffered from it one time or other in their lives. 90% times the infection is asymptomatic (patient harbors the germ without symptoms) . It manifests in 4-5% only. Others may be chronic carriers and shed its eggs in stool. Diarrhea is only second to Malaria in mortality by protozoan. Most common age is young children. It is the leading cause of Malnutrition under the age of 5. These malnourished children are more prone to all diseases. They also have stunted brain development.. This disease must be treated by antibiotics. Just liquid diet and Imodium is not enough.

Parasites are larger agents. Visible by naked eyes. They are the common “Worms”, noted in stool. They are also asymptomatic in most cases. Thread worms causes anal itching. Hook worm causes silent intestinal bleeding and anemia. They are also acquired by feco-oral contamination. All of them cause malnutrition. They are treated by special deworming medicines.

Bacteria cause Cholera (Vibrio Cholerae) and Typhoid ( Salmonella Typhae). Both these are serious diseases with high mortality rate. Both are caused by feco-oral contamination.

Diarrhea can be severe to cause rapid dehydration and death. Cholera stools are called “Rice water “ stool, as it is just fluid. Typhoid infection makes intestinal wall friable, resulting in its breakdown and spread of feces in the whole belly. A very serious condition. Tuberculosis is another cause of diarrhea in India. It happens when the disease attacks intestines. Tuberculosis mostly starts in lung and spreads to the rest of the body. All these conditions need specialized treatment in a hospital setting.

Prevention: Protozoan , bacteria and the eggs of parasites are readily killed by boiling the water. This will make most water safe to drink in India. Iodine tablets also kill these agents. They should be used to soak fruits before eating.

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