HWN Suggests

Infectious Diarrhea

Diarrhea is no joking matter (although it can be the butt of many jokes – see what I did there?). It causes a large burden to patients (ex, dehydration), care providers, and the healthcare system. Fortunately, more often than not, it is a self-limited process that requires focusing on maintaining hydration status. There are occasions, however, that may spur one on toward considering antibiotic administration for that “infectious diarrhea.” Recently, the Infectious Disease Society of America (IDSA) published guidelines related specifically to this.

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 Infectious Diarrhea Recommendations

Most patients with diarrhea do not need to be tested for an infectious cause. Stop ordering those cultures.

 Infectious diarrhea: when to test and when to treat

Because most instances of acute diarrhea are self-limiting and because the diagnostic yield of stool cultures is relatively low, testing everyone who presents with infectious diarrhea is not necessary.4 However, guidelines from the Infectious Disease Society of America suggest that stool cultures are important in certain settings because the identification of a pathogen can reduce unnecessary tests or treatments, allow for appropriate treatment where there is documented benefit and prevent inappropriate treatment that could be harmful.

 Pearl of the Day: Acute Infectious and Traveler's Diarrhea

Acute Infectious and Traveler's Diarrhea Background - causes: norovirus > non-Shiga toxin producing E. coli > C. difficile > invasive bacteria, Shiga toxin-producing E. coli, protozoa - increased probability of bacterial diarrhea with foreign travel to Asia, Africa, Latin America, Middle East - other risk factors: food contamination, rainy season while traveling, use of proton pump inhibitor, previous history of traveler's diarrhea, type of travel (e.g., adventure travel, living with native inhabitants).

Articles of Interest

Acute Diarrhea in Adults

The most common etiology is viral gastroenteritis, a self-limited disease. Increases in travel, comorbidities, and foodborne illness lead to more bacteria-related cases of acute diarrhea.

Diarrheal Diseases – Acute and Chronic

Acute diarrhea is one of the most commonly reported illnesses in the United States, second only to respiratory infections. Worldwide, it is a leading cause of mortality in children younger than four years old, especially in the developing world. Diarrhea that lasts less than 2 weeks is termed acute diarrhea. Persistent diarrhea lasts between 2 and 4 weeks. Chronic diarrhea lasts longer than 4 weeks.

Norovirus gives 699 million people diarrhea every year. No one talks about it

We may worry about salmonella in our chicken and the chemical additives in our bread. But how often do we fret about the most common cause of food poisoning and serious stomach flu in the US? No, we don't really talk much about norovirus, an extremely contagious bug spread by — prepare yourself — ingesting the stool or vomit of an infected person often through food or touching a contaminated surface.

What to Blame for Your Stomach Bug? Not Always the Last Thing You Ate

It happens like a bolt out of the blue. One minute you’re fine, and the next you begin to sweat as crippling cramps move wavelike through your belly. You vomit or have diarrhea, or both, fearing you won’t live to see another day. And then it goes away. You’re back to your old self, maybe after a day or two of binge-watching Netflix and chasing dry crackers with ginger ale.

Resources

Anesthesia Key

Infections of the colon (lower intestinal diarrhea) are more likely to cause frequent, large-volume, inflammatory diarrhea, which is recognized by fever and mucus and blood in the stool, often referred to as dysentery. When dysentery is present, Shigella, Salmonella, Campylobacter, Clostridium difficile, enteroinvasive E. coli (EIEC), and Entamoeba histolytica are likely pathogens.