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
...iagnosis
...ographic, and Epidemiologic Features...
...ailed clinical and exposure history should be ob...
...th diarrhea who attend or work in child care...
...ever or bloody diarrhea should be evalua...
...teric fever should be considered when a febrile...
...ople of all ages with acute diarrhea shoul...
...l or epidemic history suggests a possible Shiga-t...
...diagnostic approaches that can distinguish betw...
...igella dysenteriae type 1, and rarely,...
...should evaluate people for post-inf...
...gnostics (Table 3)...
...should be performed for Salmonella,...
...stools are not an expected manifesta...
...ol-MacConkey agar or an appropriate chro...
...ltures should be obtained from infants...
...esting should be performed under clearl...
...bacterial, viral, and parasitic agents should be...
...erential diagnosis is recommended...
...with acquired immune deficiency syndrome (AIDS) w...
...sting is not recommended in most cases of u...
...ifficile should be performed in travelers treated...
...inical consideration should be included in the...
...that test positive for bacterial pa...
...e may be required in situations where antimic...
...people involved in an outbreak of enteri...
...dent, including panel based multiplex...
...y, cultures of bone marrow (particularly v...
...gic tests should not be used to diagnose enteric f...
...ay be considered for C. difficile...
...difficile may be considered in people who...
A single diarrheal stool specimen is recommended f...
...al specimen for laboratory diagnosis of infec...
...lar techniques generally are more s...
...al leukocyte examination and stool lactoferrin...
Serologic tests are NOT recommended to e...
...be considered for people with post-diarrhea...
...white blood cell count and differe...
...may be useful clinically. ( W , L)705...
...itoring of hemoglobin and platelet counts, electr...
Examining a peripheral blood smear for the presenc...
...or proctoscopic examination should be con...
...aspirate may be considered in select peop...
...ultrasonography, computed tomography [CT],...
...p testing is not recommended in most p...
...d analysis of serial stool specimens using cultu...
...ioners should collaborate with local public...
...linical and laboratory re-evaluation...
...on-infectious conditions, including IBD and I...
...ssessment of fluid and electrolyte balance,...
...sure or Condition Associated with Pathogens Ca...
...le 2. Clinical Presentations Suggestive...
...oratory Diagnostics for Organisms...
...derations when Evaluating People with I...
Treatment
Treatme...
...nagement of Infectious Diarrhea (Table 5)Â...
...nt children and adults, empiric antimicrobi...
...r the following: Infants 38.5°...
...timicrobial therapy in adults should...
...ric therapy for children includes a third gen...
...piric antibacterial treatment should be conside...
...tacts of people with bloody diarrhea should not...
People with clinical features of se...
...erapy should be narrowed when antimicrobi...
...is unavailable and there is a clin...
...microbial therapy for people with...
...icrobial therapy for people with infections at...
...ople with acute watery diarrhea and without r...
...be made in people who are immunocompromised or y...
...ptomatic contacts of people with acute...
...ement of Infectious Diarrhea...
...microbial treatment should be modified o...
Reduced osmolarity oral rehydration solution (ORS...
...sogastric administration of ORS may be...
...re dehydration, shock, or altered mental...
...leus (S, M)705...
...ith ketonemia, an initial course of i...
In severe dehydration, intravenous rehydra...
...ficit can be replaced by using ORS (W, L)...
...dren, and adults with mild-to-moderate deh...
...ce the patient is rehydrated, maintenance fluids s...
...eding should be continued in infants and ch...
Resumption of an age-appropriate usual diet...
...lary treatment with antimotility, antinausea...
Antimotility drugs (e.g., loperamide) shou...
...operamide may be given to immunocompetent...
...t should be avoided at any age in suspected...
...ea and antiemetic (e.g., ondansetron) d...
...preparations may be offered to reduce the sympto...
...ral zinc supplementation reduces the duration of...
...ple who practice hand hygiene and live an...
...people who practice hand hygiene and live...
...infectious Manifestations Associated wi...
...ended Antimicrobial Agents by PathogenHaving t...
...ble 6. Fluid and Nutritional Management...
...should be performed after using th...
...ol-based sanitizers should be followed in the care...
...of a hand hygiene product should be based upon...
...safety practices are recommended to a...
...providers should direct educational efforts toward...
...diarrhea should avoid swimming, water-rel...
...virus vaccine should be administered to...
...yphoid vaccination is recommended as...
...doses are (S, H)705...
...ted cholera vaccine, which is available as a s...
...listed in the table of National Notifiab...
Prevention
...vention
...should be performed after using the to...
...ection control measures including use of glov...
...a hand hygiene product should be based upon a kno...
...propriate food safety practices are re...
...e providers should direct educational efforts...
...ith diarrhea should avoid swimming, water-rel...
...e should be administered to all infants wi...
...hoid vaccines (oral and injectable) are li...
...oses are recommended for people who remain a...
...ttenuated cholera vaccine, which is...
...diseases listed in the table of National No...
...ctious Diseases Designated as Notifiable at the Na...