Infections Transmitted Through the Fecal Oral Route 81 General Considerations

The most consistent feature of diseases transmitted through the fecal-oral route is diarrhea (see Table 7). Infective agents include bacteria, viruses,

Table 7

Common Causes of Infective Diarrhea

Cause Symptoms Incubation Infectivity Notes

Campylobacter

C, F, N,V, BD

1-10 days

Untreated, 7 weeks

Requires antibiotics. Seek advice. Acute phase exclude from custody.

Escherichia coli 0157:H7

BD (or WD) F unusual

3-8 days

Up to 7 days

Person to person spread. Can be serious with TTP, HUS, dehydration. Seek advice.

Norwalk virus

N, V, D, A P, mild F

24^18 hours

Up to 48 hours after diarrhea stops

Mild to moderate. Self-limiting.

Rotavirus

F. V. WD

24-72 hours

Up to 8 days. Up to 30 d in immunocompromised

Symptomatic treatment. Persists in environment.

Salmonella

H, AP. D, N, F ± V

6-72 hours

1 day to 1 week

Persistent carriage can occur. Requires antibiotics. Seek advice.

Shigella

DY/WD, F, N (C,V)

12-96 hours

Up to 4 weeks

Usually mild in United Kingdom. Can be severe in IC. Requires antibiotics in custody. Take advice. Person to person spread.

AP, abdominal pain; BD, bloody diarrhea; C, cramps; D, diarrhea; DY, dysentery (blood and mucus); F, fever; H, headache; HUS, hemolytic-uremic syndrome; IC, immunocompromised; N, nausea; TTP, thrombotic thrombocytopenic purpura; V, vomiting; WD, watery diarrhea.

AP, abdominal pain; BD, bloody diarrhea; C, cramps; D, diarrhea; DY, dysentery (blood and mucus); F, fever; H, headache; HUS, hemolytic-uremic syndrome; IC, immunocompromised; N, nausea; TTP, thrombotic thrombocytopenic purpura; V, vomiting; WD, watery diarrhea.

and protozoa. Because the causes are numerous, it is beyond the remit of this chapter to cover them all. It is safest to treat all diarrhea as infectious, unless the detainee has a proven noninfectious cause (e.g., Crohn's disease or ulcerative colitis).

All staff should wear gloves when in contact with the detainee or when handling clothing and bedding, and contaminated articles should be laundered or incinerated. The cell should be professionally cleaned after use, paying particular attention to the toilet area.

8.3. Hepatitis A

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