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
Diagnos...
...cal, Demographic, and Epidemiologic Features...
...linical and exposure history should be obta...
...th diarrhea who attend or work in child car...
...ever or bloody diarrhea should be evaluated for en...
...fever should be considered when a febrile person (...
...all ages with acute diarrhea should be evaluated...
...ical or epidemic history suggests a possible Shiga...
...diagnostic approaches that can disti...
...gella dysenteriae type 1, and rarely,...
...hould evaluate people for post-infectious a...
...tics (Table 3)...
...ng should be performed for Salmonella, Shig...
...e not an expected manifestation of infecti...
Sorbitol-MacConkey agar or an appropriate chromo...
...cultures should be obtained from infants...
...ool testing should be performed under clearly i...
...ader set of bacterial, viral, and parasitic age...
...oad differential diagnosis is recomm...
...acquired immune deficiency syndrome (AI...
...ic testing is not recommended in most cas...
...ifficile should be performed in travelers tre...
...onsideration should be included in t...
...that test positive for bacterial pathogens by...
...lso, a culture may be required in situ...
...eople involved in an outbreak of enteric disease...
...lture-independent, including panel base...
...ditionally, cultures of bone marrow (p...
...should not be used to diagnose enteric...
...considered for C. difficile in peopl...
...for C. difficile may be considere...
A single diarrheal stool specimen is recom...
...mal specimen for laboratory diagnosis of in...
...cular techniques generally are more sensiti...
...cal leukocyte examination and stool lactoferrin...
...ests are NOT recommended to establish an etio...
...onsidered for people with post-diarrheal HUS i...
...peripheral white blood cell count and d...
...useful clinically. ( W , L)705...
...toring of hemoglobin and platelet c...
...mining a peripheral blood smear for the pre...
...py or proctoscopic examination should be conside...
...denal aspirate may be considered in selec...
...ing (e.g., ultrasonography, computed...
...ng is not recommended in most people for case ma...
...ection and analysis of serial stool specimens usi...
...oners should collaborate with local public health...
...al and laboratory re-evaluation may be...
...ctious conditions, including IBD and IBS, shou...
...eassessment of fluid and electrolyte balance, n...
...le 1. Exposure or Condition Associated with P...
...2. Clinical Presentations Suggestive of Infect...
...Laboratory Diagnostics for Organisms Ass...
...derations when Evaluating People with Infectiou...
Treatment
Treatment
Empiric Management of Infectious Di...
...immunocompetent children and adults, empiric...
...e following: Infants 38.5° Celsius and/o...
...imicrobial therapy in adults should be either...
...for children includes a third generat...
...erial treatment should be considere...
...tic contacts of people with bloody d...
...clinical features of sepsis who are suspect...
...timicrobial therapy should be narrowed when antim...
...f an isolate is unavailable and there is a clinic...
...bial therapy for people with infections attri...
...ntimicrobial therapy for people wi...
...with acute watery diarrhea and without recent in...
...y be made in people who are immunocomprom...
...atic contacts of people with acute or persistent w...
...rected Management of Infectious Diarrhea...
...obial treatment should be modified or disc...
...osmolarity oral rehydration solution (O...
...c administration of ORS may be considered in infan...
...ehydration, shock, or altered mental status a...
or ileus (S, M)7...
...e with ketonemia, an initial course of intra...
...dehydration, intravenous rehydration...
...he remaining deficit can be replaced...
...ildren, and adults with mild-to-moderate...
...e the patient is rehydrated, maintenance flui...
...milk feeding should be continued i...
...umption of an age-appropriate usual...
...reatment with antimotility, antinausea,...
Antimotility drugs (e.g., loperamide) should no...
...be given to immunocompetent adults wit...
...ut should be avoided at any age in...
...antiemetic (e.g., ondansetron) drugs may be given...
...rations may be offered to reduce the symptom seve...
...lementation reduces the duration of...
...ple who practice hand hygiene and live and work...
...matic people who practice hand hygiene and li...
...ble 4. Post-infectious Manifestatio...
...able 5. Recommended Antimicrobial Agents by Pathog...
...and Nutritional Management of DiarrheaHaving tr...
...ne should be performed after using t...
...r alcohol-based sanitizers should be follow...
...e selection of a hand hygiene product sho...
...safety practices are recommended to...
...are providers should direct educat...
...with diarrhea should avoid swimming, water-relat...
...vaccine should be administered to all infants wit...
...id vaccination is recommended as an adjunct to ha...
...oses are (S, H)705
...d cholera vaccine, which is available...
...s listed in the table of National Notif...
Prevention
...evention
...e should be performed after using the to...
...nfection control measures including use...
...e selection of a hand hygiene product should be...
...e food safety practices are recommended to a...
...iders should direct educational efforts to...
...ll people with diarrhea should avoid swimming,...
...ne should be administered to all infant...
...typhoid vaccines (oral and injectable) are l...
...ter doses are recommended for people who remai...
...attenuated cholera vaccine, which is avail...
...s listed in the table of National Notifiable Dise...
...tious Diseases Designated as Notifiab...