Infectious Diarrhea

Publication Date: November 29, 2017

Key Points

Key Points

The greatest burden of infectious diarrhea occurs in low and middle income countries, where inadequate sanitation and hygiene are prevalent.
  • 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.
Highly effective measures are available to prevent and treat diarrheal disease and its complications. Avoiding dehydration by ensuring adequate fluid and electrolyte intake for replacement and maintenance is the mainstay of diarrheal illness management. Increasing resistance to antimicrobial agents and risk of worsening illness (such as diarrhea associated with Clostridium difficile) can result from antimicrobial and antimotility drug use and highlight the need for appropriate use of these interventions.

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

...iagnosis

...Demographic, and Epidemiologic Features...

...ical and exposure history should be...

...ople with diarrhea who attend or work in child...

...h fever or bloody diarrhea should...

...ver should be considered when a febrile pe...

...eople of all ages with acute diarrhea should b...

...clinical or epidemic history suggests a p...

If available, diagnostic approaches that...

...igella dysenteriae type 1, and rarely, other p...

...linicians should evaluate people for post...


...stics (Table 3)...

...ool testing should be performed for Salmonella, Sh...

...ols are not an expected manifestation of inf...

...Conkey agar or an appropriate chromogeni...

...res should be obtained from infants...

...esting should be performed under clearly ident...

...der set of bacterial, viral, and p...

A broad differential diagnosis is recommen...

People with acquired immune deficiency...

...stic testing is not recommended in most cases of u...

...difficile should be performed in trav...

...inical consideration should be incl...

...s that test positive for bacterial pathogens by c...

...ulture may be required in situations where ant...

...people involved in an outbreak of en...

...ure-independent, including panel based mu...

...ultures of bone marrow (particularly valua...

...c tests should not be used to diagnose e...

...be considered for C. difficile in people o...

...C. difficile may be considered in...

...al stool specimen is recommended for detecti...

...e optimal specimen for laboratory diag...

Molecular techniques generally are more s...

...ecal leukocyte examination and stool lactoferri...

...ic tests are NOT recommended to establish an eti...

...considered for people with post-diarrheal H...

...heral white blood cell count and differential...

...be useful clinically. ( W , L)705...

...oring of hemoglobin and platelet counts, el...

...peripheral blood smear for the pres...

...proctoscopic examination should be considere...

...enal aspirate may be considered in select pe...

...ultrasonography, computed tomography [CT], or...

...ow-up testing is not recommended in most people fo...

...analysis of serial stool specimens usi...

...tioners should collaborate with local public h...

...laboratory re-evaluation may be indicated in...

...-infectious conditions, including IB...

...f fluid and electrolyte balance, nutritional stat...


...1. Exposure or Condition Associated with Pathog...


...Clinical Presentations Suggestive...


...ratory Diagnostics for Organisms Associated...


...gure 1. Considerations when Evaluatin...


Treatment

Treatme...

...iric Management of Infectious Diarrhea (Table...

...etent children and adults, empiric an...

...pt for the following: Infants 38.5° Ce...

...ntimicrobial therapy in adults should be eith...

...mpiric therapy for children includes...

...ibacterial treatment should be con...

...contacts of people with bloody diarrhea sh...

...inical features of sepsis who are suspected o...

...l therapy should be narrowed when antimicrobial...

...olate is unavailable and there is a clinical susp...

...herapy for people with infections attributed to S...

...imicrobial therapy for people with infecti...

...with acute watery diarrhea and witho...

...ay be made in people who are immunocompromised or...

...mptomatic contacts of people with acute o...


...rected Management of Infectious D...

...robial treatment should be modified or discont...

...smolarity oral rehydration solutio...

...stric administration of ORS may be considered in...

...ehydration, shock, or altered mental sta...

...leus (S, M)705...

...le with ketonemia, an initial course of int...

...vere dehydration, intravenous rehydration s...

The remaining deficit can be repla...

...ants, children, and adults with mild-to-mod...

...the patient is rehydrated, maintena...

...ng should be continued in infants and children t...

...n of an age-appropriate usual diet is recommended...

...ncillary treatment with antimotility, antinausea...

...ty drugs (e.g., loperamide) should not be given...

...peramide may be given to immunocompet...

...ld be avoided at any age in suspected or pr...

Antinausea and antiemetic (e.g., ondansetron) dru...

...rations may be offered to reduce the sympto...

...upplementation reduces the duration of diarrh...

...tic people who practice hand hygiene and...

...matic people who practice hand hygiene and live a...

...t-infectious Manifestations Associated with Enteri...

Table 5. Recommended Antimicrobial Agents by Patho...

...Fluid and Nutritional Management of...

...ygiene should be performed after using th...

...alcohol-based sanitizers should be followe...

The selection of a hand hygiene produc...

...priate food safety practices are recommended t...

...h care providers should direct educational effor...

...diarrhea should avoid swimming, water-relat...

...cine should be administered to all...

...id vaccination is recommended as an adjunct t...

...ter doses are (S,...

...attenuated cholera vaccine, which is a...

...iseases listed in the table of National...


Prevention

...evention...

...ne should be performed after using the...


...n control measures including use o...


...of a hand hygiene product should be based...


...te food safety practices are recomm...


...roviders should direct educational ef...


...eople with diarrhea should avoid swimming, wat...


...ne should be administered to all i...


...ccines (oral and injectable) are licensed in t...


...oster doses are recommended for pe...


...attenuated cholera vaccine, which is available...


...ses listed in the table of National Notifiab...


...fectious Diseases Designated as Notifiable at the...