Acute infectious diarrhea

Yesterday at VA Morning Report, we discussed about infectious diarrhea with Dr. Bedimo. Below are some key points from the discussion.

  • Diarrhea is considered acute if the duration is less than 14 days.
  • Etiology can be divided into two groups: inflammatory versus non-inflammatory.
  • Inflammatory organisms include Campylobacter, Shigella, Salmonella, C. diff, E. coli. Noninflammatory bugs include Noravirus, Rotavirus, S. aureus, B. cereus, C. perfringens.
  • Majority of acute infectious diarrhea cases are due to viruses.
  • Further diagnostic evaluation is warranted in patients who present with severe illness (fever, bloody diarrhea, hypovolemia, >6 bowel movements per 24 hours, immunocompromised).
  • Obtaining history of food consumption is important as some organisms present at certain hours after ingestion.
    • Symptoms that begin within 6 hours can be caused by release of toxin from S. aureus or B. cereus.
    • Symptoms that begin 8-16 hours after ingestion suggests C. perfringens.
    • At more than 16 hours from ingestion, consider both viral and bacterial infections.
  • Stool cultures and fecal ova and parasite tests are not required for every patient who presents with diarrhea. Consider these tests in patients who are immunocompromised, present with severe inflammatory diarrhea, have underlying inflammatory bowel disease, co-morbidities that put them at risk for complications.
  • Consider empiric antibiotics in patients who are immunocompromised, severely volume depleted, >1 week of symptoms, blood and pus in stools while awaiting culture results.

Check out this review article from The New England Journal of Medicine,  “Acute Infectious Diarrhea in an Immunocompetent Adults”:

http://www.nejm.org/doi/full/10.1056/NEJMra1301069