Gastroenteritis

Descripción General

Epidemiología

• 2da causa de morbilidad y mortalidad a nivel mundial
• 3 millones de muertes anuales (> 8 400 por día)
• Afecta principalmente a niños pequeños en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum países en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum desarrollo.
• Los LOS Neisseria viajeros internacionales son particularmente susceptibles.
• En EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum Estados Unidos:
  • 179 millones de casos por año (17 millones de casos son transmitidos por los LOS Neisseria alimentos)
  • Aproximadamente 2 millones de hospitalizaciones por año

Etiología

• Viral:
  • Norovirus Norovirus Norovirus is a nonenveloped, single-stranded, positive-sense RNA virus belonging to the Caliciviridae family. Norovirus infections are transmitted via the fecal-oral route or by aerosols from vomiting. The virus is one of the most common causes of nonbacterial gastroenteritis epidemic worldwide. Symptoms include watery and nonbloody diarrhea, nausea, vomiting, and low-grade fever. Norovirus (común)
  • Rotavirus Rotavirus A genus of Reoviridae, causing acute gastroenteritis in birds and mammals, including humans. Transmission is horizontal and by environmental contamination. Seven species (rotaviruses A through G) are recognized. Rotavirus (común)
  • Adenovirus Adenovirus Adenovirus (member of the family Adenoviridae) is a nonenveloped, double-stranded DNA virus. Adenovirus is transmitted in a variety of ways, and it can have various presentations based on the site of entry. Presentation can include febrile pharyngitis, conjunctivitis, acute respiratory disease, atypical pneumonia, and gastroenteritis. Adenovirus entérico
  • Astrovirus
  • Pacientes inmunocomprometidos:
    • Citomegalovirus
    • Enterovirus Enterovirus A genus of the family picornaviridae whose members preferentially inhabit the intestinal tract of a variety of hosts. The genus contains many species. Newly described members of human enteroviruses are assigned continuous numbers with the species designated ‘human enterovirus’. Coxsackievirus
• Bacteriana:
  • Salmonella Salmonella Salmonellae are gram-negative bacilli of the family Enterobacteriaceae. Salmonellae are flagellated, non-lactose-fermenting, and hydrogen sulfide-producing microbes. Salmonella enterica, the most common disease-causing species in humans, is further classified based on serotype as typhoidal (S. typhi and paratyphi) and nontyphoidal (S. enteritidis and typhimurium). Salmonella (común)
  • Campylobacter Campylobacter Campylobacter (“curved bacteria”) is a genus of thermophilic, S-shaped, gram-negative bacilli. There are many species of Campylobacter, with C. jejuni and C. coli most commonly implicated in human disease. Campylobacter (común)
  • Shigella Shigella Shigella is a genus of gram-negative, non-lactose-fermenting facultative intracellular bacilli. Infection spreads most commonly via person-to-person contact or through contaminated food and water. Humans are the only known reservoir. Shigella
  • Escherichia coli Escherichia coli The gram-negative bacterium Escherichia coli is a key component of the human gut microbiota. Most strains of E. coli are avirulent, but occasionally they escape the GI tract, infecting the urinary tract and other sites. Less common strains of E. coli are able to cause disease within the GI tract, most commonly presenting as abdominal pain and diarrhea. Escherichia coli (E.coli)
  • Clostridium
  • Yersinia Yersinia Yersinia is a genus of bacteria characterized as gram-negative bacilli that are facultative anaerobic with bipolar staining. There are 2 enteropathogenic species that cause yersiniosis, Y. enterocolitica and Y. pseudotuberculosis. Infections are manifested as pseudoappendicitis or mesenteric lymphadenitis, and enterocolitis. Yersinia spp./Yersiniosis
• Parasitaria:
  • Giardia Giardia A genus of flagellate intestinal eukaryotes parasitic in various vertebrates, including humans. Characteristics include the presence of four pairs of flagella arising from a complicated system of axonemes and cysts that are ellipsoidal to ovoidal in shape. Nitroimidazoles lamblia
  • Entamoeba histolytica Entamoeba Histolytica A species of parasitic protozoa causing entamoebiasis and amebic dysentery (dysentery, amebic). Characteristics include a single nucleus containing a small central karyosome and peripheral chromatin that is finely and regularly beaded. Amebicides
  • Cryptosporidium Cryptosporidium A genus of coccidian parasites of the family cryptosporidiidae, found in the intestinal epithelium of many vertebrates including humans. Hyper-IgM Syndrome
  • Cyclospora Cyclospora Cyclospora is a genus within the Coccidia subclass of protozoans. They are single-celled, obligate intracellular parasites that cause intestinal infections in humans. Humans are the only host for these species, and they are both transmitted through the fecal-oral route. The symptoms of cyclosporiasis are watery diarrhea, abdominal pain, and fever. Cystoisospora/Cystoisosporiasis and Cyclospora/Cyclosporiasis

Patogénesis

• Modos de infección:
  • Transmitido por los LOS Neisseria alimentos (acumulación de toxinas en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum los LOS Neisseria productos alimenticios)
  • Fecal-oral (contaminación bacteriana)
  • Transmisión animal directa o indirecta
• El mecanismo de la diarrea, los LOS Neisseria hallazgos asociados y la etiología se describen en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la siguiente tabla.

Presentación clínica

• Síntomas comunes:
  • Cólicos y dolores abdominales
  • Diarrea (acuosa, mucoide o sanguinolenta)
  • Vómito
  • Fiebre
  • Anorexia Anorexia The lack or loss of appetite accompanied by an aversion to food and the inability to eat. It is the defining characteristic of the disorder anorexia nervosa. Anorexia Nervosa
  • Cefalea
  • Mialgia
• Evidencia de deshidratación severa:
  • Taquicardia
  • Hipotensión

Diagnóstico

• Análisis de heces:
  • La mayoría de los LOS Neisseria pacientes no requieren análisis de heces.
  • Guiados por antecedentes y hallazgos clínicos:
    • Sangre o pus en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum las heces
    • Fiebre persistente
    • Síntomas severos
    • Curso prolongado
    • Pacientes de alto riesgo
  • Leucocitos fecales o lactoferrina → diarrea inflamatoria
  • Coprocultivo y reacción en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum cadena de la polimerasa ( PCR PCR Polymerase chain reaction (PCR) is a technique that amplifies DNA fragments exponentially for analysis. The process is highly specific, allowing for the targeting of specific genomic sequences, even with minuscule sample amounts. The PCR cycles multiple times through 3 phases: denaturation of the template DNA, annealing of a specific primer to the individual DNA strands, and synthesis/elongation of new DNA molecules. Polymerase Chain Reaction (PCR)) en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum heces
  • Huevos y parásitos en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum heces
  • Antígeno viral directo (rara vez indicado)
  • Inmunoensayo enzimático de toxina de C. difficile
• Pruebas generales:
  • Por lo general, solo se realiza en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum caso de enfermedad grave con evidencia de deshidratación.
  • Panel metabólico básico → busca descartar lesión renal aguda y anomalías electrolíticas
  • Hemograma completo → se puede observar leucocitosis; la eosinofilia puede indicar una infección parasitaria

El siguiente algoritmo resume el estudio de la gastroenteritis Gastroenteritis Gastroenteritis is inflammation of the stomach and intestines, commonly caused by infections from bacteria, viruses, or parasites. Transmission may be foodborne, fecal-oral, or through animal contact. Common clinical features include abdominal pain, diarrhea, vomiting, fever, and dehydration. Gastroenteritis:

Tratamiento

• Cuidados de soporte:
  • La mayoría de las infecciones son autolimitadas y solo requieren terapia de rehidratación oral.
  • La hidratación con líquidos por vía intravenosa puede ser necesaria para la enfermedad grave.
  • Las soluciones orales e intravenosas deben contener electrolitos de reemplazo.
• Agentes antidiarreicos (loperamida, salicilato de bismuto):
  • Reducir la duración de la diarrea.
  • Pueden retrasar la excreción de los LOS Neisseria patógenos o toxinas causantes, y están contraindicados en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum:
    • Diarrea con fiebre
    • Heces sanguinolentas o mucoides
    • Diarrea causada por C. difficile y Shigella Shigella Shigella is a genus of gram-negative, non-lactose-fermenting facultative intracellular bacilli. Infection spreads most commonly via person-to-person contact or through contaminated food and water. Humans are the only known reservoir. Shigella
• Terapia con antibióticos:
  • No se usa rutinariamente
  • La decisión de usar antibióticos a menudo es empírica, porque las pruebas de patógenos entéricos no siempre son expeditos.
  • Posibles indicaciones:
    • Disentería (paso de heces sanguinolentas)
    • Fiebre > 38°C (100,4°F)
    • Síntomas severos y hospitalización
    • Grupo de población de alto riesgo (lactantes, ancianos, inmunocomprometidos, pacientes con comorbilidades)
    • Infección por C. difficile
  • Contraindicado si se sospecha E. coli productora de toxina Shiga (riesgo de síndrome hemolítico urémico (SHU))
  • Antibióticos de uso frecuente:
    • Fluoroquinolonas
    • Azitromicina
    • Trimetoprim–sulfametoxazol (TMP-SMX)
    • Cefalosporinas de 3ra generación

Complicaciones

• Durante la infección:
  • Shock Shock Shock is a life-threatening condition associated with impaired circulation that results in tissue hypoxia. The different types of shock are based on the underlying cause: distributive (↑ cardiac output (CO), ↓ systemic vascular resistance (SVR)), cardiogenic (↓ CO, ↑ SVR), hypovolemic (↓ CO, ↑ SVR), obstructive (↓ CO), and mixed. Types of Shock hipovolémico
  • Deshidratación severa
  • Lesión renal aguda
  • Acidosis Acidosis A pathologic condition of acid accumulation or depletion of base in the body. The two main types are respiratory acidosis and metabolic acidosis, due to metabolic acid build up. Respiratory Acidosis metabólica
  • Desequilibrios electrolíticos
  • Muerte
• Las complicaciones posdiarreicas se resumen en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la siguiente tabla:

Campylobacter

Patógeno

• Campylobacter jejuni Campylobacter jejuni A species of bacteria that resemble small tightly coiled spirals. Its organisms are known to cause abortion in sheep and fever and enteritis in man and may be associated with enteric diseases of calves, lambs, and other animals. Campylobacter son bacilos curvos, gram-negativos, oxidasa-positivos con flagelos polares.
• Características distintivas:
  • Requiere un ambiente rico en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum CO₂
  • Crecer a 42,0°C (107,6°F)
  • Puede aparecer en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum forma de S o como alas ALAS An enzyme of the transferase class that catalyzes condensation of the succinyl group from succinyl coenzyme a with glycine to form delta-aminolevulinate. It is a pyridoxal phosphate protein and the reaction occurs in mitochondria as the first step of the heme biosynthetic pathway. The enzyme is a key regulatory enzyme in heme biosynthesis. In liver feedback is inhibited by heme. Heme Metabolism de gaviota debido a su estructura helicoidal
• El patógeno más común responsable de la gastroenteritis Gastroenteritis Gastroenteritis is inflammation of the stomach and intestines, commonly caused by infections from bacteria, viruses, or parasites. Transmission may be foodborne, fecal-oral, or through animal contact. Common clinical features include abdominal pain, diarrhea, vomiting, fever, and dehydration. Gastroenteritis transmitida por los LOS Neisseria alimentos en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum los LOS Neisseria Estados Unidos
• Altamente contagioso

Transmisión

• Fecal-oral
• Transmitido por alimentos (aves de corral poco cocidas y leche no pasteurizada) y agua contaminada
• Contacto directo con animales infectados (gatos, perros, cerdos) o productos animales

Patogénesis

• Invade la mucosa de los LOS Neisseria intestinos → produce endotoxinas, enterotoxinas y citotoxinas → destruye las superficies mucosas → sangre y pus en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum las heces (diarrea inflamatoria)
• Rara vez penetra para causar septicemia

Presentación clínica

• Diarrea acuosa y sanguinolenta aguda
• Fiebre
• Dolor Dolor Inflammation severo en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el cuadrante inferior derecho del abdomen que se asemeja a la apendicitis (“pseudoapendicitis”)
• Cefalea
• Mialgias

Tratamiento

• La mayoría de los LOS Neisseria casos tendrán una resolución espontánea.
• Macrólidos y fluoroquinolonas
• Se puede administrar una cefalosporina de 3ra generación, imipenem Imipenem Semisynthetic thienamycin that has a wide spectrum of antibacterial activity against gram-negative and gram-positive aerobic and anaerobic bacteria, including many multiresistant strains. It is stable to beta-lactamases. Clinical studies have demonstrated high efficacy in the treatment of infections of various body systems. Its effectiveness is enhanced when it is administered in combination with cilastatin, a renal dipeptidase inhibitor. Carbapenems and Aztreonam, ampicilina o gentamicina para las infecciones extraintestinales.

Complicaciones

• Síndrome de Guillain-Barré (reacción cruzada entre anticuerpos contra C. jejuni y gangliósidos humanos)
• Artritis reactiva ( en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum pacientes HLA-B27 positivos)
• Anemia Anemia Anemia is a condition in which individuals have low Hb levels, which can arise from various causes. Anemia is accompanied by a reduced number of RBCs and may manifest with fatigue, shortness of breath, pallor, and weakness. Subtypes are classified by the size of RBCs, chronicity, and etiology. Anemia: Overview and Types hemolítica
• Endocarditis Endocarditis Endocarditis is an inflammatory disease involving the inner lining (endometrium) of the heart, most commonly affecting the cardiac valves. Both infectious and noninfectious etiologies lead to vegetations on the valve leaflets. Patients may present with nonspecific symptoms such as fever and fatigue. Endocarditis y miopericarditis
• Meningitis Meningitis Meningitis is inflammation of the meninges, the protective membranes of the brain, and spinal cord. The causes of meningitis are varied, with the most common being bacterial or viral infection. The classic presentation of meningitis is a triad of fever, altered mental status, and nuchal rigidity. Meningitis

Salmonella No Tifoidea

Patógeno

• S. enteritidis S. enteritidis A serotype of Salmonella enterica which is an etiologic agent of gastroenteritis in man and other animals. Salmonella y S. typhimurium S. typhimurium A serotype of Salmonella enterica that is a frequent agent of Salmonella gastroenteritis in humans. It also causes paratyphoid fever. Salmonella son bacterias gram-negativas que no fermentan lactosa.
• Producen sulfuro de hidrógeno y son móviles (a diferencia de Shigella Shigella Shigella is a genus of gram-negative, non-lactose-fermenting facultative intracellular bacilli. Infection spreads most commonly via person-to-person contact or through contaminated food and water. Humans are the only known reservoir. Shigella)
• El 2do patógeno más común responsable de la gastroenteritis Gastroenteritis Gastroenteritis is inflammation of the stomach and intestines, commonly caused by infections from bacteria, viruses, or parasites. Transmission may be foodborne, fecal-oral, or through animal contact. Common clinical features include abdominal pain, diarrhea, vomiting, fever, and dehydration. Gastroenteritis bacteriana transmitida por los LOS Neisseria alimentos

Transmisión

• Infecciones bacterianas transmitidas por los LOS Neisseria alimentos (aves de corral, huevos crudos, leche)
• Reservorio: tractos entéricos de humanos y animales domésticos (tortugas, reptiles, pollos)
• La salmonella Salmonella Salmonellae are gram-negative bacilli of the family Enterobacteriaceae. Salmonellae are flagellated, non-lactose-fermenting, and hydrogen sulfide-producing microbes. Salmonella enterica, the most common disease-causing species in humans, is further classified based on serotype as typhoidal (S. typhi and paratyphi) and nontyphoidal (S. enteritidis and typhimurium). Salmonella es sensible al AL Amyloidosis ácido estomacal. La acidez estomacal reducida (antiácidos o gastrectomía) aumenta el riesgo de infección.
• Otros factores de riesgo:
  • Condiciones hemolíticas ( anemia Anemia Anemia is a condition in which individuals have low Hb levels, which can arise from various causes. Anemia is accompanied by a reduced number of RBCs and may manifest with fatigue, shortness of breath, pallor, and weakness. Subtypes are classified by the size of RBCs, chronicity, and etiology. Anemia: Overview and Types de células falciformes, malaria Malaria Malaria is an infectious parasitic disease affecting humans and other animals. Most commonly transmitted via the bite of a female Anopheles mosquito infected with microorganisms of the Plasmodium genus. Patients present with fever, chills, myalgia, headache, and diaphoresis. Plasmodium/Malaria)
  • Esplenectomía
  • Cirrosis
  • Leucemia y linfoma
  • Infección por VIH

Patogénesis

• Las bacterias invaden la mucosa en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la región ileocecal y se liberan en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la lámina propia → entrada de neutrófilos → inflamación → ↑ prostaglandinas y AMPc → diarrea suelta y necrosis Necrosis The death of cells in an organ or tissue due to disease, injury or failure of the blood supply. Ischemic Cell Damage de la mucosa superior
• La septicemia no es común (< 5%) con S. enteritidis S. enteritidis A serotype of Salmonella enterica which is an etiologic agent of gastroenteritis in man and other animals. Salmonella, pero puede ocurrir con otros subtipos.

Presentación clínica

• Período de incubación de 8–72 horas, dura de 3–7 días
• Diarrea acuosa inflamatoria (ocasionalmente sanguinolenta)
• Fiebre, escalofríos
• Cefalea
• Mialgias
• Vómitos severos
• Cólico abdominal

Tratamiento

• Cuidados de soporte
• Antibióticos:
  • No se requiere para la mayoría de los LOS Neisseria casos sin complicaciones
  • Prolongan la excreción fecal del patógeno
  • Solo indicados para manifestaciones sistémicas o diarrea severa:
    • Fluoroquinolonas (ciprofloxacina)
    • TMP-SMX
    • Azitromicina
    • Cefalosporinas de 3ra generación (ceftriaxona)

Complicaciones

• Bacteriemia
• Artritis reactiva
• Osteomielitis (particularmente en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum pacientes de células falciformes)
• Meningitis Meningitis Meningitis is inflammation of the meninges, the protective membranes of the brain, and spinal cord. The causes of meningitis are varied, with the most common being bacterial or viral infection. The classic presentation of meningitis is a triad of fever, altered mental status, and nuchal rigidity. Meningitis
• Miocarditis, endocarditis Endocarditis Endocarditis is an inflammatory disease involving the inner lining (endometrium) of the heart, most commonly affecting the cardiac valves. Both infectious and noninfectious etiologies lead to vegetations on the valve leaflets. Patients may present with nonspecific symptoms such as fever and fatigue. Endocarditis

Shigella

Shigella Shigella Shigella is a genus of gram-negative, non-lactose-fermenting facultative intracellular bacilli. Infection spreads most commonly via person-to-person contact or through contaminated food and water. Humans are the only known reservoir. Shigella causa disentería bacilar, también conocida como shigellosis Shigellosis Shigella.

Patógeno

• S. dysenteriae S. dysenteriae A species of gram-negative, facultatively anaerobic, rod-shaped bacteria that is extremely pathogenic and causes severe dysentery. Infection with this organism often leads to ulceration of the intestinal epithelium. Shigella, S. flexneri S. flexneri A bacterium which is one of the etiologic agents of bacillary dysentery and sometimes of infantile gastroenteritis. Shigella, S. sonnei S. sonnei A lactose-fermenting bacterium causing dysentery. Shigella y S. boydii S. boydii One of the shigella species that produces bacillary dysentery. Shigella son bacilos gram-negativos.
• Resistente al AL Amyloidosis ácido gástrico
• S. dysenteriae S. dysenteriae A species of gram-negative, facultatively anaerobic, rod-shaped bacteria that is extremely pathogenic and causes severe dysentery. Infection with this organism often leads to ulceration of the intestinal epithelium. Shigella tipo 1 produce toxina Shiga (enterotoxina).

Transmisión

• Fecal-oral
• El ser humano es el único reservorio natural.
• Las moscas son vectores.
• Transmitida por los LOS Neisseria alimentos (productos lácteos no pasteurizados y verduras crudas sin lavar)
• Agua contaminada
• Altamente contagiosa

Patogénesis

• Shigella Shigella Shigella is a genus of gram-negative, non-lactose-fermenting facultative intracellular bacilli. Infection spreads most commonly via person-to-person contact or through contaminated food and water. Humans are the only known reservoir. Shigella invade las células M a través de la macropinocitosis → captada por macrófagos → escapa de su fagosoma → alcanza el citoplasma epitelial y se replica → induce una respuesta inflamatoria → muerte de células epiteliales e inmunológicas
• Los LOS Neisseria filamentos de actina polimerizados se utilizan para propagarse de célula a célula sin necesidad de volver a entrar en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el medio extracelular.
• Liberación de toxina Shiga por S. dysenteriae S. dysenteriae A species of gram-negative, facultatively anaerobic, rod-shaped bacteria that is extremely pathogenic and causes severe dysentery. Infection with this organism often leads to ulceration of the intestinal epithelium. Shigella:
  • Tiene 3 propiedades: neurotóxica, citotóxica, enterotóxica
  • Provoca la secreción intestinal de solutos y agua.
  • Puede inducir SHU
• Efectos resultantes:
  • Diarrea acuosa
  • Secreción de moco
  • Infiltración de leucocitos
  • Úlceras superficiales
  • Rara vez provoca la invasión de los LOS Neisseria vasos sanguíneos.

Presentación clínica

• Período de incubación de 0–48 horas, dura de 2–7 días
• Fiebre
• Cólico abdominal
• Tenesmo (urgencia para defecar)
• Diarrea inflamatoria con moco, pus y sangre

Antibióticos

• Suele resolverse espontáneamente
• Puede ser necesaria la rehidratación y el reemplazo de electrolitos.
• Los LOS Neisseria antibióticos acortan la duración de los LOS Neisseria síntomas y la eliminación de patógenos en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum las heces:
  • Fluoroquinolonas
  • Azitromicina
  • Cefalosporinas de 3era generación
• Evitar los LOS Neisseria medicamentos contra la motilidad, ya que pueden empeorar los LOS Neisseria síntomas y provocar un megacolon Megacolon Megacolon is a severe, abnormal dilatation of the colon, and is classified as acute or chronic. There are many etiologies of megacolon, including neuropathic and dysmotility conditions, severe infections, ischemia, and inflammatory bowel disease. Megacolon tóxico.

Complicaciones

• SHU → debido a la toxina Shiga, a menudo visto en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum niños
• Pérdida aguda de sangre → ulceraciones de la mucosa
• Complicaciones intestinales:
  • Megacolon Megacolon Megacolon is a severe, abnormal dilatation of the colon, and is classified as acute or chronic. There are many etiologies of megacolon, including neuropathic and dysmotility conditions, severe infections, ischemia, and inflammatory bowel disease. Megacolon tóxico
  • Perforación colónica
  • Obstrucción intestinal
  • Proctitis Proctitis Inflammation of the mucous membrane of the rectum, the distal end of the large intestine. Chronic Granulomatous Disease
  • Prolapso rectal → por tenesmo
• Artritis reactiva
• Aunque invasiva, Shigella Shigella Shigella is a genus of gram-negative, non-lactose-fermenting facultative intracellular bacilli. Infection spreads most commonly via person-to-person contact or through contaminated food and water. Humans are the only known reservoir. Shigella rara vez causa septicemia.

Vibrio

El cólera es una forma grave de gastroenteritis Gastroenteritis Gastroenteritis is inflammation of the stomach and intestines, commonly caused by infections from bacteria, viruses, or parasites. Transmission may be foodborne, fecal-oral, or through animal contact. Common clinical features include abdominal pain, diarrhea, vomiting, fever, and dehydration. Gastroenteritis causada por Vibrio cholerae Vibrio cholerae The etiologic agent of cholera. Vibrio (V. cholerae).

Patógeno

• V. cholerae es un bacilo curvo, gram-negativo, oxidasa-positivo, con flagelos polares.
• Crece en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum medios alcalinos
• Característica distintiva: motilidad de “estrella fugaz” inactivada por suero específico
• Produce la toxina del cólera

Transmisión

• Habitante de aguas estuarinas costeras
• Propagación fecal-oral
• Mariscos poco cocidos o agua contaminada
• Sensible al AL Amyloidosis ácido del estómago; requiere una dosis alta para la infección
• Los LOS Neisseria brotes tienden a ocurrir durante los LOS Neisseria meses cálidos.
• Endémica en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum áreas de Asia ASIA Spinal Cord Injuries, África, Medio oriente, América central y del sur y la costa del golfo de EE. UU.
• La susceptibilidad aumenta en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum:
  • Pacientes con sangre tipo O
  • Uso de antiácidos, antihistamínicos o inhibidores de la bomba de protones

Patogénesis

• La motilidad, la mucinasa y los LOS Neisseria pili Pili Filamentous or elongated proteinaceous structures which extend from the cell surface in gram-negative bacteria that contain certain types of conjugative plasmid. These pili are the organs associated with genetic transfer and have essential roles in conjugation. Normally, only one or a few pili occur on a given donor cell. This preferred use of ‘pili’ refers to the sexual appendage, to be distinguished from bacterial fimbriae, also known as common pili, which are usually concerned with adhesion. Salmonella corregulados por toxinas ayudan a adherirse a la mucosa intestinal.
• Conduce a la colonización del revestimiento intestinal sin invasión de la pared intestinal
• La enterotoxina del cólera se libera: activa la adenilato ciclasa → ↑ AMPc → salida de electrolitos y agua por la mucosa del intestino delgado en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el duodeno y el yeyuno

Presentación clínica

• El período de incubación es de 1–3 días.
• Algunos pacientes pueden ser asintomáticos o tener solo síntomas leves.
• Heces profusas de “agua de arroz”
• El dolor Dolor Inflammation abdominal y las náuseas son menos prominentes que otras formas de gastroenteritis Gastroenteritis Gastroenteritis is inflammation of the stomach and intestines, commonly caused by infections from bacteria, viruses, or parasites. Transmission may be foodborne, fecal-oral, or through animal contact. Common clinical features include abdominal pain, diarrhea, vomiting, fever, and dehydration. Gastroenteritis.
• Puede conducir rápidamente a una deshidratación severa y agotamiento de electrolitos en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum cuestión de horas:
  • Sed
  • Oliguria Oliguria Decreased urine output that is below the normal range. Oliguria can be defined as urine output of less than or equal to 0. 5 or 1 ml/kg/hr depending on the age. Renal Potassium Regulation
  • Calambres musculares
  • ↓ turgencia cutánea
• Los LOS Neisseria casos graves pueden provocar alteración del estado mental, necrosis Necrosis The death of cells in an organ or tissue due to disease, injury or failure of the blood supply. Ischemic Cell Damage tubular renal y colapso circulatorio.

Tratamiento

• El reemplazo urgente de líquidos y electrolitos es la 1ra prioridad.
• Los LOS Neisseria antibióticos se usan para enfermedades graves y pueden disminuir la diarrea y el desprendimiento:
  • Doxiciclina
  • Azitromicina (eritromicina en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum niños)
  • Ciprofloxacino

Complicaciones

• Deshidratación severa
• Insuficiencia renal
• Shock Shock Shock is a life-threatening condition associated with impaired circulation that results in tissue hypoxia. The different types of shock are based on the underlying cause: distributive (↑ cardiac output (CO), ↓ systemic vascular resistance (SVR)), cardiogenic (↓ CO, ↑ SVR), hypovolemic (↓ CO, ↑ SVR), obstructive (↓ CO), and mixed. Types of Shock hipovolémico

Infecciones por otras especies de Vibrio Vibrio Vibrio is a genus of comma-shaped, gram-negative bacilli. It is halophilic, acid labile, and commonly isolated on thiosulfate-citrate-bile-sucrose (TCBS) agar. There are 3 clinically relevant species: Vibrio cholerae (V. cholerae), Vibrio vulnificus (V. vulnificus), and Vibrio parahaemolyticus (V. parahaemolyticus). Vibrio

La siguiente tabla resume brevemente la forma más leve de gastroenteritis Gastroenteritis Gastroenteritis is inflammation of the stomach and intestines, commonly caused by infections from bacteria, viruses, or parasites. Transmission may be foodborne, fecal-oral, or through animal contact. Common clinical features include abdominal pain, diarrhea, vomiting, fever, and dehydration. Gastroenteritis causada por especies de Vibrio Vibrio Vibrio is a genus of comma-shaped, gram-negative bacilli. It is halophilic, acid labile, and commonly isolated on thiosulfate-citrate-bile-sucrose (TCBS) agar. There are 3 clinically relevant species: Vibrio cholerae (V. cholerae), Vibrio vulnificus (V. vulnificus), and Vibrio parahaemolyticus (V. parahaemolyticus). Vibrio no colérico:

Yersinia

Patógeno

• Yersinia enterocolitica Yersinia enterocolitica A species of the genus yersinia, isolated from both man and animal. It is a frequent cause of bacterial gastroenteritis in children. Yersinia spp./Yersiniosis son cocobacilos gram-negativos, oxidasa-negativos.
• Anaerobios facultativos
• Bacteria Bacteria Bacteria are prokaryotic single-celled microorganisms that are metabolically active and divide by binary fission. Some of these organisms play a significant role in the pathogenesis of diseases. Bacteriology pleomórfica que pertenece a Enterobacteriaceae Enterobacteriaceae A family of gram-negative, facultatively anaerobic, rod-shaped bacteria that do not form endospores. Its organisms are distributed worldwide with some being saprophytes and others being plant and animal parasites. Many species are of considerable economic importance due to their pathogenic effects on agriculture and livestock. Cephalosporins
• Patógeno obligado
• Características distintivas:
  • Móvil a 25,0°C (77°F), inmóvil a 37,0°C (98,6°F)
  • Crecimiento en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum frío

Transmisión

• Transmitida por los LOS Neisseria alimentos (cerdo crudo o poco cocido, leche sin pasteurizar)
• Hemoderivados
• Agua contaminada
• Contacto directo o indirecto con un animal infectado (ganado, conejos, roedores)

Patogénesis

• Se adhiere a las células epiteliales en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el íleon → invade la pared intestinal, probablemente a través de las células M → coloniza el tejido linfoide (placas de Peyer)
• Puede invadir los LOS Neisseria ganglios linfáticos mesentéricos y diseminarse
• Producción de enterotoxinas similar a E. coli enterotoxigénica
• Conduce a la ulceración de la mucosa en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el íleon terminal
• Los LOS Neisseria estados de sobrecarga de hierro aumentan la patogenicidad.

Presentación clínica

• El período de incubación es de alrededor de 4–6 días; la duración es de 1–2 semanas.
• Diarrea sanguinolenta inflamatoria
• Fiebre
• Náusea y vómito
• Dolor Dolor Inflammation abdominal
• Faringitis (aproximadamente 20%)

Tratamiento

• Generalmente, solo requiere cuidados de soporte
• Se pueden usar antibióticos en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum función de la gravedad, pero existe un beneficio clínico cuestionable:
  • Fluoroquinolonas
  • TMP-SMX
  • Cefalosporinas de 3ra generación

Complicaciones

• Artritis reactiva
• Eritema nodoso
• Infección sistémica
• Abdominales (raras):
  • Linfadenitis mesentérica (“pseudoapendicitis” con dolor Dolor Inflammation en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el cuadrante inferior derecho)
  • Trombosis de la vena mesentérica (puede provocar necrosis Necrosis The death of cells in an organ or tissue due to disease, injury or failure of the blood supply. Ischemic Cell Damage intestinal)
  • Perforación intestinal
  • Megacolon Megacolon Megacolon is a severe, abnormal dilatation of the colon, and is classified as acute or chronic. There are many etiologies of megacolon, including neuropathic and dysmotility conditions, severe infections, ischemia, and inflammatory bowel disease. Megacolon tóxico
  • Colangitis
  • Peritonitis Peritonitis Inflammation of the peritoneum lining the abdominal cavity as the result of infectious, autoimmune, or chemical processes. Primary peritonitis is due to infection of the peritoneal cavity via hematogenous or lymphatic spread and without intra-abdominal source. Secondary peritonitis arises from the abdominal cavity itself through rupture or abscess of intra-abdominal organs. Penetrating Abdominal Injury

Clostridium

La enterocolitis Enterocolitis Inflammation of the mucosa of both the small intestine and the large intestine. Etiology includes ischemia, infections, allergic, and immune responses. Yersinia spp./Yersiniosis por Clostridium perfringens Clostridium perfringens The most common etiologic agent of gas gangrene. It is differentiable into several distinct types based on the distribution of twelve different toxins. Gas Gangrene se discutirá aquí.

Patógeno

• Clostridium perfringens Clostridium perfringens The most common etiologic agent of gas gangrene. It is differentiable into several distinct types based on the distribution of twelve different toxins. Gas Gangrene tipo A son bacilos gram-positivos, anaeróbicos, formadores de esporas.
• Características distintivas:
  • Inmóviles
  • Anaeróbicos: “fermentación tormentosa” en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum medios lácteos
  • Doble zona de hemólisis en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum agar sangre

Transmisión

• De origen alimentario (carne poco cocida o mal refrigerada, platos de carne recalentados, legumbres)
• Las esporas pueden sobrevivir a las temperaturas de cocción.
• Prolifera en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum alimentos que no se almacenan correctamente

Patogénesis

• Las esporas germinan en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum condiciones anaeróbicas.
• La enterotoxina se produce en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum los LOS Neisseria intestinos → interrumpe el transporte de iones → diarrea acuosa, cólicos

Presentación clínica

• Período de incubación de 6–24 horas, se resuelve en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum 24–48 horas (generalmente < 24 horas)
• Cólicos abdominales severos
• Diarrea acuosa no inflamatoria
• Los LOS Neisseria vómitos y la fiebre son poco comunes.

Tratamiento

• Cuidados de soporte
• Generalmente, una enfermedad autolimitada

Otras manifestaciones patológicas

• Gangrena gaseosa
• Celulitis y fascitis
• Enterocolitis Enterocolitis Inflammation of the mucosa of both the small intestine and the large intestine. Etiology includes ischemia, infections, allergic, and immune responses. Yersinia spp./Yersiniosis necrosante (de cepas tipo C):
  • La beta-toxina produce necrosis Necrosis The death of cells in an organ or tissue due to disease, injury or failure of the blood supply. Ischemic Cell Damage segmentaria del intestino.
  • Se presenta con diarrea sanguinolenta, dolor Dolor Inflammation abdominal y vómitos.
  • Tratamiento:
    • Antibióticos (penicilina G, metronidazol)
    • Posible cirugía por falla al AL Amyloidosis tratamiento, perforación u obstrucción

Rotavirus

Patógeno

• El rotavirus Rotavirus A genus of Reoviridae, causing acute gastroenteritis in birds and mammals, including humans. Transmission is horizontal and by environmental contamination. Seven species (rotaviruses A through G) are recognized. Rotavirus es un reovirus de ARN de doble cadena, segmentado y sin envoltura.
• La causa más común de diarrea severa entre lactantes y niños a nivel mundial.

Transmisión

• Vía fecal-oral
• Solo se requiere un pequeño inóculo para la transmisión.
• Común durante los LOS Neisseria meses de invierno.

Fisiopatología

• Penetra en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum las células de las vellosidades del intestino delgado → producción de proteínas similares a la toxina del cólera → destrucción y embotamiento de las microvellosidades → interrumpe la absorción de electrolitos y agua
• ↓ actividad disacaridasa → malabsorción de lactosa y D-xilosa → entrada osmótica en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el intestino
• Las heces acuosas se desarrollan debido a la secreción activa de agua y al AL Amyloidosis deterioro de la absorción.

Presentación clínica

• El período de incubación es < 48 horas y la duración es de 4–5 días.
• Fiebre
• Malestar
• Dolor Dolor Inflammation abdominal
• Vómitos
• Diarrea acuosa no inflamatoria, no sanguinolenta: puede ser grave y provocar una deshidratación grave

Tratamiento y prevención

• La enfermedad es autolimitada.
• Rehidratación oral
• Líquidos intravenosos en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum pacientes con deshidratación severa
• Vacuna viva atenuada:
  • Administrada a todos los LOS Neisseria niños antes de los LOS Neisseria 8 meses de edad
  • Contraindicaciones:
    • Enfermedad de inmunodeficiencia combinada severa
    • Antecedente de intususcepción

Complicaciones

• Convulsiones
• Encefalopatía
• Encefalitis

Norovirus

Patógeno y epidemiología

• El norovirus Norovirus Norovirus is a nonenveloped, single-stranded, positive-sense RNA virus belonging to the Caliciviridae family. Norovirus infections are transmitted via the fecal-oral route or by aerosols from vomiting. The virus is one of the most common causes of nonbacterial gastroenteritis epidemic worldwide. Symptoms include watery and nonbloody diarrhea, nausea, vomiting, and low-grade fever. Norovirus (también conocido como virus Virus Viruses are infectious, obligate intracellular parasites composed of a nucleic acid core surrounded by a protein capsid. Viruses can be either naked (non-enveloped) or enveloped. The classification of viruses is complex and based on many factors, including type and structure of the nucleoid and capsid, the presence of an envelope, the replication cycle, and the host range. Virology de Norwalk) es un calicivirus de ARN sin envoltura.
• Los LOS Neisseria brotes comunitarios (residencias de ancianos, hospitales, cruceros, etc ETC The electron transport chain (ETC) sends electrons through a series of proteins, which generate an electrochemical proton gradient that produces energy in the form of adenosine triphosphate (ATP). Electron Transport Chain (ETC).) son comunes.
• Causa el tipo más común de gastroenteritis Gastroenteritis Gastroenteritis is inflammation of the stomach and intestines, commonly caused by infections from bacteria, viruses, or parasites. Transmission may be foodborne, fecal-oral, or through animal contact. Common clinical features include abdominal pain, diarrhea, vomiting, fever, and dehydration. Gastroenteritis del adulto.

Transmisión

• El virus Virus Viruses are infectious, obligate intracellular parasites composed of a nucleic acid core surrounded by a protein capsid. Viruses can be either naked (non-enveloped) or enveloped. The classification of viruses is complex and based on many factors, including type and structure of the nucleoid and capsid, the presence of an envelope, the replication cycle, and the host range. Virology es altamente virulento.
• Vía fecal-oral a través de alimentos, agua o superficies contaminadas
• Contacto de persona a persona
• Aerosolizada

Patogénesis

• El mecanismo no se entiende del todo.
• El retraso en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el vaciado gástrico provoca náuseas y vómitos.
• La biopsia yeyunal muestra borramiento de las microvellosidades, pero, aparte de ello, la mucosa está intacta.
• Se observa vacuolización citoplasmática junto con infiltrados mononucleares de tejido.
• El virus Virus Viruses are infectious, obligate intracellular parasites composed of a nucleic acid core surrounded by a protein capsid. Viruses can be either naked (non-enveloped) or enveloped. The classification of viruses is complex and based on many factors, including type and structure of the nucleoid and capsid, the presence of an envelope, the replication cycle, and the host range. Virology parece disminuir las enzimas del borde en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum cepillo, causando malabsorción.

Presentación clínica

• El período de incubación es de 24–60 horas.
• Inicio brusco de náuseas y vómitos.
• Diarrea acuosa, no sanguinolenta
• Cólicos abdominales
• Cefalea
• Mialgias
• Malestar

Diagnóstico y tratamiento

• El diagnóstico suele basarse en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la sospecha clínica.
• El tratamiento incluye la rehidratación con líquidos orales o intravenosos.