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
...iagnosi...
..., Demographic, and Epidemiologic Featur...
A detailed clinical and exposure histor...
...th diarrhea who attend or work in...
...th fever or bloody diarrhea should be ev...
...should be considered when a febrile person...
...ages with acute diarrhea should be evaluated for...
...clinical or epidemic history suggests a possible S...
...diagnostic approaches that can distinguish between...
...n, Shigella dysenteriae type 1, and rarely,...
...ould evaluate people for post-infectious an...
...stics (Table 3)
...should be performed for Salmonella, Sh...
...dy stools are not an expected manifesta...
...bitol-MacConkey agar or an appropriate chromogen...
...od cultures should be obtained from infa...
...ol testing should be performed under clearly iden...
...roader set of bacterial, viral, and parasitic...
...oad differential diagnosis is recommended in imm...
People with acquired immune deficien...
...ting is not recommended in most cases of...
...difficile should be performed in travelers treate...
...ideration should be included in the...
...ll specimens that test positive for bacte...
...so, a culture may be required in situati...
...pecimens from people involved in an outbreak...
...dent, including panel based multiplex mo...
...cultures of bone marrow (particularl...
...ts should not be used to diagnose enteric f...
...onsidered for C. difficile in people ov...
...or C. difficile may be considered in people who...
...heal stool specimen is recommended for detection...
...specimen for laboratory diagnosis of infect...
...cular techniques generally are more sensitive an...
...yte examination and stool lactoferrin detec...
...rologic tests are NOT recommended to establish...
...sidered for people with post-diarrheal HUS in...
...eripheral white blood cell count and d...
...useful clinically. ( W , L)705...
...monitoring of hemoglobin and platelet counts,...
...peripheral blood smear for the pr...
Endoscopy or proctoscopic examinat...
Duodenal aspirate may be considered in select...
Imaging (e.g., ultrasonography, computed to...
...w-up testing is not recommended in most pe...
...tion and analysis of serial stool s...
...oners should collaborate with local public health...
...ical and laboratory re-evaluation may be in...
Non-infectious conditions, including IBD and...
...assessment of fluid and electrolyte balance, nu...
.... Exposure or Condition Associated...
...Clinical Presentations Suggestive o...
...tory Diagnostics for Organisms Associated wit...
...onsiderations when Evaluating People with In...
Treatment
...eatment...
...iric Management of Infectious Diarrhea (Table...
...n immunocompetent children and adults, empiri...
...t for the following: Infants 3...
...ric antimicrobial therapy in adults should b...
...apy for children includes a third ge...
...erial treatment should be considered in...
...matic contacts of people with bloody diarrh...
...ople with clinical features of sepsis who are s...
...al therapy should be narrowed when an...
...unavailable and there is a clinica...
...imicrobial therapy for people with inf...
...herapy for people with infections attr...
...ith acute watery diarrhea and without recent i...
...exception may be made in people who...
Asymptomatic contacts of people with acute or p...
...d Management of Infectious Diarrhea...
...reatment should be modified or disco...
...larity oral rehydration solution (ORS) is recomme...
...ogastric administration of ORS may be considered...
...ehydration, shock, or altered mental s...
...ileus (S, M)705...
In people with ketonemia, an initial co...
...ation, intravenous rehydration should...
...ining deficit can be replaced by using ORS (W...
...children, and adults with mild-to-mod...
...he patient is rehydrated, maintenan...
...ing should be continued in infants and...
...tion of an age-appropriate usual diet is r...
...y treatment with antimotility, antinausea, or...
...tility drugs (e.g., loperamide) should...
...be given to immunocompetent adults with a...
...voided at any age in suspected or p...
...and antiemetic (e.g., ondansetron) drugs...
...robiotic preparations may be offered to reduce...
...lementation reduces the duration of diarrhe...
Asymptomatic people who practice hand h...
...symptomatic people who practice hand hygiene and l...
...Post-infectious Manifestations Assoc...
...commended Antimicrobial Agents by PathogenHaving...
...Fluid and Nutritional Management of DiarrheaHavin...
...should be performed after using the toile...
...alcohol-based sanitizers should be followe...
...election of a hand hygiene product should b...
...priate food safety practices are recommended...
...providers should direct educational efforts towar...
...ople with diarrhea should avoid swimming, wate...
...tavirus vaccine should be administered to all infa...
...ation is recommended as an adjunct to hand hygiene...
...ooster doses are (...
...ated cholera vaccine, which is available...
...ases listed in the table of National Notifiabl...
Prevention
...vention
...should be performed after using the t...
Infection control measures including use o...
...he selection of a hand hygiene product shoul...
...riate food safety practices are rec...
...alth care providers should direct educat...
...diarrhea should avoid swimming, water-related...
...vaccine should be administered to a...
...yphoid vaccines (oral and injectable)...
...are recommended for people who rem...
...d cholera vaccine, which is availabl...
...ases listed in the table of National Notifi...
...7. Infectious Diseases Designated a...