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
Diagnosis
...ographic, and Epidemiologic Features...
...linical and exposure history should be obta...
...diarrhea who attend or work in child car...
...with fever or bloody diarrhea shoul...
...ic fever should be considered when a febrile pe...
...ll ages with acute diarrhea should be...
...n the clinical or epidemic history suggests a po...
...diagnostic approaches that can disti...
..., Shigella dysenteriae type 1, and rarely, other...
...ians should evaluate people for post-infe...
...nostics (Table 3)...
Stool testing should be performed for Salmonella...
...y stools are not an expected manifestati...
...onkey agar or an appropriate chromogen...
...should be obtained from infants...
...ool testing should be performed under clearly...
...der set of bacterial, viral, and pa...
...differential diagnosis is recommended in immunoc...
...ith acquired immune deficiency syndr...
...sting is not recommended in most cases of un...
...r C. difficile should be performed in t...
...consideration should be included in the interpre...
...specimens that test positive for bacte...
...culture may be required in situations where...
...from people involved in an outbreak of...
...re-independent, including panel based mu...
...ionally, cultures of bone marrow (...
...tests should not be used to diagnose...
...e considered for C. difficile in people over 2 ye...
...ng for C. difficile may be considere...
...arrheal stool specimen is recommended...
...imen for laboratory diagnosis of inf...
...lecular techniques generally are more...
...examination and stool lactoferrin de...
...sts are NOT recommended to establish an et...
...idered for people with post-diarrh...
...te blood cell count and differential and serolo...
...ut may be useful clinically....
Frequent monitoring of hemoglobin and p...
...a peripheral blood smear for the presence of red...
...y or proctoscopic examination shoul...
...aspirate may be considered in select people for...
...ing (e.g., ultrasonography, computed tomograp...
...ng is not recommended in most people for case man...
...and analysis of serial stool specim...
Practitioners should collaborate w...
...aboratory re-evaluation may be indicated in peop...
...onditions, including IBD and IBS, should be c...
Reassessment of fluid and electrolyte bal...
...ble 1. Exposure or Condition Associat...
...e 2. Clinical Presentations Suggest...
...atory Diagnostics for Organisms Associate...
...gure 1. Considerations when Evaluating Peop...
Treatment
...reatment...
...c Management of Infectious Diarrhe...
...munocompetent children and adults, empir...
...following: Infants 38.5° Celsius and/...
...ric antimicrobial therapy in adults should be e...
...therapy for children includes a third gen...
...ntibacterial treatment should be considered in i...
...ic contacts of people with bloody diarrhea should...
...clinical features of sepsis who are...
...imicrobial therapy should be narrowed when...
...ate is unavailable and there is a cl...
...obial therapy for people with infec...
...icrobial therapy for people with infections...
...with acute watery diarrhea and withou...
...eption may be made in people who are immunocompro...
...ic contacts of people with acute or persistent wa...
...ement of Infectious Diarrhea...
...robial treatment should be modified or d...
...ity oral rehydration solution (ORS) is recommend...
...ric administration of ORS may be cons...
...dehydration, shock, or altered mental stat...
...eus (S, M)705...
...eople with ketonemia, an initial course o...
...n severe dehydration, intravenous reh...
The remaining deficit can be replaced...
...ren, and adults with mild-to-moderat...
Once the patient is rehydrated, maintenance...
...k feeding should be continued in infants and chil...
...n age-appropriate usual diet is recommended dur...
...treatment with antimotility, antinausea, or a...
...y drugs (e.g., loperamide) should not be g...
...operamide may be given to immunocompetent...
...e avoided at any age in suspected or proven...
...and antiemetic (e.g., ondansetron) drugs...
...otic preparations may be offered to reduc...
...plementation reduces the duration of...
...ople who practice hand hygiene and live a...
...ic people who practice hand hygiene and...
...st-infectious Manifestations Associat...
...Recommended Antimicrobial Agents by PathogenH...
...and Nutritional Management of DiarrheaHav...
...hygiene should be performed after using the...
...lcohol-based sanitizers should be followed...
...e selection of a hand hygiene product...
...riate food safety practices are recom...
...ealth care providers should direct educational eff...
...ple with diarrhea should avoid swimming, water-rel...
...virus vaccine should be administere...
...id vaccination is recommended as a...
...oses are (S, H)705...
...tenuated cholera vaccine, which is available as a...
...ses listed in the table of National Notifiable...
Prevention
Prevention
...hould be performed after using the toilet, changin...
...nfection control measures including use of gl...
...ction of a hand hygiene product should...
...propriate food safety practices are recommended to...
...alth care providers should direct educational ef...
Ill people with diarrhea should avoid swimmin...
...ine should be administered to all infants wi...
...oid vaccines (oral and injectable) are licen...
...are recommended for people who remain...
...d cholera vaccine, which is available as a...
...isted in the table of National Notifia...
...e 7. Infectious Diseases Designated a...