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Infectious Diarrhea

more about Infectious Diarrhea

  • Increased volume of stool, usually with increased frequency of stool
  • Usually watery stool
  • Commonly, the duration of illness is days to weeks, but not prolonged.
  • Diarrhea caused by viruses, bacteria, or parasites

  • Rotavirus, Salmonella, Shigella, Campylobacter, and Yersinia all commonly produce abdominal pain and watery stools.  Salmonella, Shigella, Campylobacter, and Yersinia may show mucus, pus, and blood in the stool.
  • Rotavirus is the commonest cause of infectious Diarrhea in pediatrics, usually affecting the age group between 6 and 24 months.  Nausea and vomiting are common.
  • Salmonella is the most common cause of bacterial Diarrhea in U.S. children.  It is most likely to occur in infants.  Nausea, vomiting, and crampy abdominal pain are followed by Diarrhea. Fever and chills may also occur.  Seizures and Dehydration are complications, and the bacterial infection sometimes spreads to the bloodstream.
  • Shigella-caused Diarrhea often has high fever and crampy abdominal pain, but vomiting is rare.  Tenesmus (straining) is common after each stool.  Headache is common, and 10% of children with this Diarrhea will have convulsions.  Besides Dehydration, Pneumonia may be a complication.
  • Campylobacter Diarrheal symptoms range from mild to severe (bloody Diarrhea, hypotension, Dehydration, fever).  Severe abdominal pain may occur.  A common source of the bacteria is contaminated chicken.
  • Yersinia Diarrhea is usually accompanied by severe abdominal pain, fever, and vomiting.
  • Amebic dysentery has a slow onset, contrasted with the sudden onset of bacterial Diarrhea.  Fever is usually slight, and the mucus in the stool is clear, and not white.  These also are differences from bacterial Diarrhea.
  • Giardia, is a protozoan parasite, commonly causing Diarrhea in the U.S.  It may be hard to diagnose if the stool is not persistently examined, over many specimens.  Besides abdominal pain and Diarrhea, significant weight loss may occur with Giardia, and the symptoms may be slow-onset.  The Diarrhea may persist for months, whereas a bacterial or viral Diarrhea might typically resolve within 2 weeks.

  • Viruses are the usual cause.
  • Bacterial causes: Salmonella, Shigella, Campylobacter, and Yersinia. Cholera is a major cause of bacterial Diarrhea in developing countries, but not in the U.S.
  • Parasitic causes: Amebic dysentery (caused by E. histolytica) is one of the most important causes of parasitic Diarrhea.  Worldwide, E. histolytica is probably the commonest cause of parasitic Diarrhea.  Giardia is another common cause of parasitic Diarrhea, and is the commonest intestinal parasitic cause of Diarrhea in the U.S.

  • This is usually confirmed by stool examination, stool testing, and/or culture.
  • Culture of the stool is a method of detecting bacterial causes, but parasites must be observed directly under the microscope to be detected in the usual clinical setting, and can only be cultured by special techniques.
  • Giardia may be particularly difficult to detect, since many affected patients only shed the parasite into the stool intermittently.  One test for Giardia involves collecting a sample of the parasite from the duodenum, by passing a collecting device orally into the small intestine.

  • Infectious Diarrhea spreads via contaminated food and water, but in children it also spreads very commonly via the oral-anal cycle: (1) infected stool comes in contact with the fingers of a patient (or a close contact of that patient); (2) the now-contaminated fingers are placed in or near the mouth of another person, thus introducing the infection into another person's mouth (another child's mouth), or (3) the contaminated fingers belong to a food-handler, who introduces the infection into the food that other people eat.  (4) The infected material is swallowed, thus entering the digestive tract of another person.
  • Since children commonly touch the face or lips of other children, this is a way for infectious Diarrhea to spread among children.
  • Unsanitary living areas and poor personal hygiene may be risk factors.

  • Treatment depends on the exact cause of the infectious Diarrhea.  Often it is prudent not to treat a mild case of Salmonella Diarrhea, since treatment might prolong the carrier state (making the patient shed the bacteria into the stool for months).  This carrier state increases the risk that other persons will become infected.
  • Uncomplicated Salmonella Diarrhea in healthy children usually is not treated with antibiotics.  Infants under the age of 3 months, children with immune deficiencies, or malnourished children are given antibiotics because they are at risk for sepsis.
  • Treatment of Shigella Diarrhea may be difficult because strains of Shigella are often resistant to commonly-used antibiotics.  One performs sensitivity tests on the strain of Shigella, to find an antibiotic to which the strain is susceptible.  Trimethoprim/sulfa is often used for treatment, now that many strains are resistant to ampicillin.
  • Campylobacter Diarrhea usually resolves before the diagnosis is made, but treatment, usually with erythromycin, shortens the illness.
  • Yersinia Diarrhea usually is not treated, unless there is systemic illness.
  • Amebic dysentery caused by E. histolytica can be treated with amebocides, but for some of the amebocides, safety of the drug in children is an issue.
  • Anti-parasitic medicine is given for Giardia Diarrhea.

  • Dehydration and electrolyte imbalance (abnormal amounts of sodium, potassium, and acid in the blood)
  • Weight loss
  • Seizures

  • Physician evaluation is prudent, especially in young infants.  Infants are especially prone to Dehydration and electrolyte imbalance.

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