Source: Martin S and Jung
R. Gastrointestinal Infections and Enterotoxigenic Poisonings. In:
DiPiro, JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM. Pharmacotherapy:
A Pathophysiologic Approach. 8th ed. http://accesspharmacy.com/content.aspx?aid=8003383.
Accessed June 25, 2012.
- Acute bacterial gastroenteritis
- Decrease in consistency of bowel movements
and increase in frequency of stools/day.
- Bacterial species most commonly associated with gastrointestinal
(GI) infection and infectious diarrhea in the United States: Shigella, SalmonellaCampylobacter, Yersinia, Escherichia, Clostridium, and Staphylococcus.
- Viral etiologies: rotaviruses, noroviruses, astrovirus, and enteric adenovirus
- Enterotoxin production (Vibrio cholerae, E. coli, Clostridium difficile)
- Fluid secretion exceeds absorptive capacity of intestinal tract, resulting in watery diarrhea
- Invasion of colon by gram-negative bacteria (shigellosis, salmonellosis, campylobacteriosis)
- Changes in transepithelial fluid balance and malabsorption (rotavirus, norovirus)
- Cholera: endemic in Ganges delta, West Bengal, Bangladesh,
and southern Asia
- Escherichia coli: common in United
- Clostridium difficile: most common
cause of infectious diarrhea in hospitalized patients in North America
- Associated with use of broad-spectrum
- Shigellosis primarily disease of children.
- Salmonellosis primarily disease of infants, children, and
- Campylobacteriosis incidence peaks in children <1 year
and those ages 15–44 years.
- Rotavirus most common cause of diarrhea in infants and children
ages 3–35 months.
- Norovirus not well understood. Outbreaks documented in families,
healthcare systems, college dormitories, and on cruise ships.
- Incidence of enteric infections decreased through:
- Public health measures such as clean water supply and sanitation
facilities, as well as quality control of commercial products
- Sanitary food handling and preparation practices
- Education concerning personal hygiene (e.g., handwashing with
soap and running water)
- Traveler’s diarrhea
- Avoid fresh foods
and water in developing countries.
- Prophylaxis recommended in patients with:
- Heart disease in elderly
- Immunosuppressive medications
- Clostridium difficile: use of broad-spectrum antimicrobials
- Most commonly seen in elderly, debilitated patients, cancer patients, surgical patients, patients with nasogastric tubes, and those who frequently use laxatives.
- Decreased gastric acidity, use of antibiotics, malnutrition, and immunodeficiency states
- Inflammatory diarrhea presents as fever, tenesmus, or
bloody stool, whereas secretory or watery diarrhea is more common
and associated with more severe dehydration.
- Incubation period 1–3 days.
- Asymptomatic to life-threatening dehydration due to abrupt
onset of watery diarrhea
- Escherichia coli
- Enterotoxigenic E. coli (ETEC)
onset of nausea and watery stools, with or without abdominal cramping
- Resolves in 24–48 hours without complications
- Enteropathogenic E. coli (EPEC)
- Acute onset of profuse watery diarrhea, vomiting, and
- Enteroadhesive E. coli (EAEC)
- Persistent, watery, mucoid, secretory diarrhea with low-grade
fever and little or no vomiting
- Enteroinvasive E. coli (EIEC)
- Watery diarrhea
- May be indistinguishable from ETEC.
- Enterohemorrhagic E. coli (EHEC)
- Initial presentation: Cramping abdominal pain, abdominal
distension, and watery diarrhea
- Nausea (66%), vomiting (<50%), elevated
white blood cell (WBC) count with left shift, afebrile
- Progresses in 1–2 days to bloody diarrhea with increased
abdominal pain (as many as 12 bloody stools/day).
- Illness resolves in 1 week.
- Hemolytic uremic syndrome (HUS) may develop in 2–7% of
patients, particularly children <5 years and elderly.
- Clostridium difficile
- Onset of diarrhea during or after antimicrobial use
- Can be delayed for 2–3 months...