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...
...cal and exposure history should be obtained from...
...th diarrhea who attend or work in child care...
...e with fever or bloody diarrhea should be eval...
...c fever should be considered when a feb...
...le of all ages with acute diarrhea should be e...
When the clinical or epidemic history suggests a...
...available, diagnostic approaches that can distin...
...gella dysenteriae type 1, and rarely, other pa...
...s should evaluate people for post-infect...
...Diag...
...ng should be performed for Salmone...
...tools are not an expected manifestat...
...Conkey agar or an appropriate chromogenic...
...s should be obtained from infants...
...ould be performed under clearly ide...
...of bacterial, viral, and parasitic agent...
...tial diagnosis is recommended in immunocomprom...
...with acquired immune deficiency syndrome (AID...
...sting is not recommended in most ca...
...ng for C. difficile should be performed in trave...
...sideration should be included in the interpre...
...ecimens that test positive for bacterial...
..., a culture may be required in situat...
...ns from people involved in an outbrea...
...dent, including panel based multiplex molecular...
Additionally, cultures of bone marrow (parti...
...should not be used to diagnose enteric fever. ( S...
...ay be considered for C. difficile in peopl...
.... difficile may be considered in people who h...
...heal stool specimen is recommended for dete...
...l specimen for laboratory diagnosis of infe...
...techniques generally are more sensitive an...
...ocyte examination and stool lactofer...
...ic tests are NOT recommended to establish a...
...be considered for people with post-diarrheal HU...
...al white blood cell count and differenti...
...e useful clinically. ( W , L)705...
...toring of hemoglobin and platelet co...
...pheral blood smear for the presence of red...
...r proctoscopic examination should be considered...
...aspirate may be considered in select people fo...
...e.g., ultrasonography, computed tomogra...
...up testing is not recommended in most people for...
...on and analysis of serial stool specimens...
...hould collaborate with local public health aut...
...l and laboratory re-evaluation may...
...s conditions, including IBD and IBS, shou...
...of fluid and electrolyte balance, nutritional stat...
...able 1. Exposure or Condition Associated w...
...Clinical Presentations Suggestive of Infectio...
...able 3. Laboratory Diagnostics for O...
...onsiderations when Evaluating People with I...
Treatment
...Empiric...
...mmunocompetent children and adults,...
...ollowing: Infants 38.5° Celsius and/or...
...empiric antimicrobial therapy in adu...
...therapy for children includes a third genera...
...iric antibacterial treatment should be c...
...ic contacts of people with bloody di...
...ple with clinical features of sepsis who ar...
...obial therapy should be narrowed when antimicrob...
...late is unavailable and there is a clinica...
...ial therapy for people with infections attribute...
...microbial therapy for people with infections att...
...eople with acute watery diarrhea and wit...
...tion may be made in people who are...
...ymptomatic contacts of people with acut...
...Directed Mana...
...crobial treatment should be modified or discont...
...duced osmolarity oral rehydration s...
...tric administration of ORS may be considered...
...ion, shock, or altered mental status and failure o...
...eus (S, M)705...
...le with ketonemia, an initial course...
...hydration, intravenous rehydration should be...
...deficit can be replaced by using ORS (...
Infants, children, and adults with mild...
...ent is rehydrated, maintenance fluids should...
...uman milk feeding should be continued in inf...
...n age-appropriate usual diet is re...
...cillary treatment with antimotility, antina...
...ity drugs (e.g., loperamide) should not be give...
...ay be given to immunocompetent adults w...
...voided at any age in suspected or proven cases...
...and antiemetic (e.g., ondansetron) drugs may...
...robiotic preparations may be offered to red...
...c supplementation reduces the duration of...
...tomatic people who practice hand hyg...
...atic people who practice hand hygiene an...
...le 4. Post-infectious Manifestations Associate...
.... Recommended Antimicrobial Agents by...
...nd Nutritional Management of Diarr...
...ene should be performed after using the toilet, c...
...l-based sanitizers should be follo...
...f a hand hygiene product should be based upon...
...d safety practices are recommended to a...
...iders should direct educational efforts towa...
...with diarrhea should avoid swimming, wat...
...otavirus vaccine should be administered to all inf...
Typhoid vaccination is recommended as a...
...r doses are (S, H)705...
...ive attenuated cholera vaccine, which i...
...ases listed in the table of National Notifi...
Prevention
...Prevention...
...d hygiene should be performed afte...
...rol measures including use of gloves and gowns,...
...e selection of a hand hygiene product...
...opriate food safety practices are recommended to...
...are providers should direct educational efforts to...
...le with diarrhea should avoid swimming, water-r...
...vaccine should be administered to all infan...
...phoid vaccines (oral and injectabl...
...r doses are recommended for people who remain...
...d cholera vaccine, which is available...
...isted in the table of National Notifiable Diseas...
...7. Infectious Diseases Designated as Notifi...