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Infectious Diarrhea


Defn diarrhea >3/day; 200 g or ml; loose/liquid consistency
Acute/ persistent/ chronic Acute <14 days; Chronic >1 month
Chronic diarrhea: etiology Malabsorption; motility disorders; inflammation
Assessing severity of illness dehydration; duration of sx; inflammation (fever, blood, tenesmus)
Order stool studies if: Diarrhea is persistent or recurring; h/o fever or tenesmus
E. histolytica necrosis of lg intestine; tropical; abd pain, cramping, colitis; can be bloody/fevers; travelers, MSM
Vibrio watery dia, abd cramping; V para: also wound infxn; heat to >75C to destroy; susceptible: liver dz & Fe overload states
V cholera MOA activates adenylate cyclase (cAMP regulates Na & Cl absorpn/secretion)
V cholera S/S rice-water stools; poss hypotensive shock within 2 hrs; dose fx; tx rehydrate & 1 dose Cipro; untx’d 50% mortality
Pre-formed toxins: organisms S aureus; B Cereus; Clostridium Perfringens
Giardia: most susceptible immunocompromised; immunocompetent w/Ig def
Dx giardiasis with: giardia antigen stool assay
C perfringens sx Abd cramps & watery diarrhea without fever or N/V; lasts <24 hr
Invasive pathogens (most common causes of infxs diarrhea) Salmonella, shigella, campy, hemorrhagic E coli
E coli: most likely from: undercooked beef; unpasteurized juice; spinach; in warm weather
E coli: hemorrhagic colitis: severe abd pain, bloody diarrhea (no fever usually) caused by shiga or shiga-like toxin
HUS may be due to: E coli; shigella
ETEC: tx travelers diarrhea; Abx after sx onset may decrease duration; Cipro or rifaximin
Salmonella Sx fevers, myalgias, abd cramping, HA;
Salmonella complications Septicemia/Bacteremia; poss osteomyelitis, endocarditis, arthritis
Salmonella typhi Sx 10-14d post-ingestion: fever, HA, myalgia, malaise, anorexia; followed by GI sx (GB colonization & intestine reinfxn); typhoid fever: pulse-temperature discordance; 1-5% chronic carriers
Shigella Sx Lower abd cramps, diarrhea, fever, bloody, purulent stools & tenesmus; usu self-ltg (7 days)
Shigella Tx Abx recommended (FQ or Bactrim)
Yersinia Sx: Diarrhea, fever, abdominal pain for 1-2 wks (chronic: poss for mos); fx terminal ileum; lg lymph nodes (mimics appy); systemic dz: high mortality
Campy Sx: dysentery; poss bacteremia; usu self ltg (may last 1 wk/longer); assoc w/GBS & Reiters
Most common cause of nosocomial diarrhea C diff (Abx-induced diarrhea); tx w/Flagyl or oral vanco
Loperamide opiate w/o systemic fx; inhibits peristalsis; can use w/Abx for traveler’s diarrhea
DO NOT use anti-motility agents in: pts w/shigella, C diff, E coli O157 (inflammatory diarrhea)
Antimicrobial tx: used for: shigellosis, traveler’s diarrhea, C.difficile, campylobacter; can prolong salmo/C diff shedding, or worsen shiga toxin course
Tx of choice for more severe infxs diarrhea: FQ; TMP-SMX = 2nd-line tx; Add azithro for Campy
Common antibiotic causes of colitis: Ampicillin, clindamycin, tetracycline, cephalosporins
C diff mgmt: IV/PO Flagyl or PO vanco. 20% relapse in 1-2 wks after DC of therapy; relapses respond well to 2nd course of tx. Multiple relapses: consider taper & pulsed therapy
Created by: Abarnard