Infectious Diarrhea
Key Points
Key Points
- Nonetheless, economic development also creates opportunities for introduction and transmission of enteric pathogens, including global travel, food importations, mass production and distribution of food, municipal water systems serving large segments of the population, and widespread use of childcare, long-term care, and recreational water facilities.
- Other risk factors include hospitalization, animal exposures, especially in public venues, as well as certain sexual practices (Figure 1).
Acute gastroenteritis is a frequent cause of outpatient visits and hospitalizations in the United States, with an estimated annual burden of 179 million outpatient visits, nearly 500,000 hospitalizations, and over 5,000 deaths.
- Norovirus and Salmonella enterica subspecies were the leading pathogens among the 24 gastroenteritis pathogens transmissible by food that were assessed. Whereas norovirus (58%) exceeded S. enterica subspecies (11%) as a cause of illness, S. enterica subspecies exceeded norovirus as a cause of hospitalization (35% versus 28%) and death (28% versus 11%).
- Rotavirus was the most common pathogen among children younger than 5 years before rotavirus vaccine introduction.
Most acute diarrhea episodes in previously healthy, immunocompetent people are of short duration and self-resolving, and are of viral or unknown etiology. Therefore, laboratory investigation generally is not warranted. However, many factors may justify the expense and complexity of laboratory testing including epidemiologic (Table 1) and clinical features (Table 2) which encompass diarrhea in immunocompromised people, noninfectious and extraintestinal manifestations associated with enteric pathogens (Table 4) the potential for results of laboratory investigation to impact management, and suspicion of an outbreak situation.
Diagnosis
Diagno...
...l, Demographic, and Epidemiologic Features...
...iled clinical and exposure history shoul...
...diarrhea who attend or work in child care centers...
...er or bloody diarrhea should be evaluated for...
...fever should be considered when a feb...
...of all ages with acute diarrhea should be eval...
When the clinical or epidemic history suggests a...
...iagnostic approaches that can distinguish bet...
...Shigella dysenteriae type 1, and rarely, other p...
...ould evaluate people for post-infectiou...
Diagnostics (Table...
...ting should be performed for Salmonella, Shi...
...re not an expected manifestation of infection wit...
...cConkey agar or an appropriate chromogenic...
...ures should be obtained from inf...
...g should be performed under clearl...
...oader set of bacterial, viral, and p...
...tial diagnosis is recommended in immunocomp...
...le with acquired immune deficiency syndrome (A...
...testing is not recommended in most...
...ifficile should be performed in travel...
...deration should be included in the i...
...imens that test positive for bacterial pathog...
...may be required in situations where antimicr...
...imens from people involved in an outbreak of enter...
...ent, including panel based multiplex m...
...ditionally, cultures of bone marrow (particu...
...ic tests should not be used to diagnose enter...
...considered for C. difficile in people over...
...esting for C. difficile may be considered in peo...
...e diarrheal stool specimen is recomme...
...mal specimen for laboratory diagnosis of infectio...
...iques generally are more sensitive and less...
...ecal leukocyte examination and stool lactofe...
...ogic tests are NOT recommended to estab...
...nsidered for people with post-diarrheal HUS i...
...hite blood cell count and differential and serolo...
...may be useful clinically. ( W , L)705...
...itoring of hemoglobin and platelet counts,...
...a peripheral blood smear for the presenc...
...copy or proctoscopic examination should...
...l aspirate may be considered in se...
..., ultrasonography, computed tomography [CT], o...
...llow-up testing is not recommended in most peopl...
...tion and analysis of serial stool specimens usi...
...itioners should collaborate with local pub...
...nical and laboratory re-evaluation may be i...
...ious conditions, including IBD and IBS,...
...of fluid and electrolyte balance, nut...
...1. Exposure or Condition Associated w...
...l Presentations Suggestive of Infectious Diar...
...ble 3. Laboratory Diagnostics for Or...
...1. Considerations when Evaluating...
Treatment
...eatment...
...ment of Infectious Diarrhea (Table 5...
...nt children and adults, empiric antimicrobial the...
...e following: Infants 38.5° Celsius...
...mpiric antimicrobial therapy in adults...
...for children includes a third generation cephalos...
...erial treatment should be considered...
...ntacts of people with bloody diarrhea should n...
...inical features of sepsis who are suspected of...
...therapy should be narrowed when antimicrobial s...
...solate is unavailable and there is a clinical...
...erapy for people with infections attributed to STE...
...therapy for people with infections attrib...
...e with acute watery diarrhea and without r...
...exception may be made in people who are immunoco...
...atic contacts of people with acute o...
...d Management of Infectious Diarrh...
...treatment should be modified or discont...
...smolarity oral rehydration solution (ORS)...
...nistration of ORS may be considered in infants, ch...
...e dehydration, shock, or altered mental status an...
...ileus (S, M)70...
...etonemia, an initial course of intravenous hydrat...
...severe dehydration, intravenous rehydration...
...emaining deficit can be replaced by us...
Infants, children, and adults with mild-t...
Once the patient is rehydrated, maintenanc...
...ilk feeding should be continued in infants and c...
...of an age-appropriate usual diet is recommend...
...llary treatment with antimotility, antinause...
...ugs (e.g., loperamide) should not...
...may be given to immunocompetent adults with a...
...should be avoided at any age in suspected or pr...
...and antiemetic (e.g., ondansetron) drugs...
...preparations may be offered to reduce the sympt...
...nc supplementation reduces the duration...
...atic people who practice hand hygiene and live and...
Asymptomatic people who practice han...
...able 4. Post-infectious Manifestations Associated...
...Recommended Antimicrobial Agents by Pathogen...
...ble 6. Fluid and Nutritional Management of D...
...e should be performed after using the to...
...lcohol-based sanitizers should be followe...
...tion of a hand hygiene product should be based u...
...od safety practices are recommende...
...care providers should direct educational efforts t...
Ill people with diarrhea should avoid swimming, wa...
...ne should be administered to all infant...
...ation is recommended as an adjunct to hand hygi...
...ooster doses are (S, H)705
...ve attenuated cholera vaccine, which is availa...
...diseases listed in the table of National...
Prevention
...reventio...
...hygiene should be performed after using the toil...
...control measures including use of gloves and gow...
...tion of a hand hygiene product should be base...
...opriate food safety practices are recomm...
...th care providers should direct education...
...diarrhea should avoid swimming, wat...
...us vaccine should be administered to all infants...
...id vaccines (oral and injectable)...
...r doses are recommended for people who rem...
...ated cholera vaccine, which is avai...
...eases listed in the table of National Noti...
...ctious Diseases Designated as Notifia...