Diarrhoea (acute) – Quick Reference
Məlumat kitabçası
04.10.2012 • Sonuncu dəyişiklik 04.10.2012
Editors
This is a Quick Reference article, and it refers to adult patients. See also the main article Diarrhoeal diseases caused by microbes .
Essentials
- Definition: diarrhoea ≥ 3 times/24 hours, duration ≤ 14 days
- Usually self-limiting
Aetiology
- Most commonly viral (rotavirus, norovirus)
- Severe clinical picture is suggestive of a bacterial cause.
- Salmonella
- Campylobacter
- Shigella
- E. coli
- Clostridium difficile
- Protozoa (giardia, amoeba)
- The aetiology of acute diarrhoea may also be other than intestinal infection (abdominal condition requiring surgical intervention, severe systemic infection).
Diagnostic investigations
- Diagnostic investigations and stool culture are indicated if
- diarrhoea has resulted in hypovolaemia
- stools contain blood or mucus
- fever > 38.5°C
- severe abdominal pain
- history of recent antibiotic use
- immunosuppression
- pregnancy (listeriosis).
Stool tests
- Routine stool culture (salmonella, shigella, campylobacter and yersinia)
- In suspected clostridium infection stool culture or toxin
- If an epidemic is suspected, a stool sample for viral pathogens, including norovirus.
- Protozoa: parasites, worm ova (eggs)
Diagnostic clues
| Pathogen | Clues |
| Rotavirus, norovirus | Epidemics in schools, day care centres, other institutions |
| Adenovirus | Small children, immunosuppressed patients |
| Hepatitis A virus | Travel in endemic regions, inadequate hygiene, intravenous drug users |
| Salmonella, S. aureus, E. coli, campylobacter, yersinia | Food history (meat, eggs, milk, unwashed vegetables) |
| Listeria | Food (vacuum packed fish products), pregnancy |
| Clostridium difficile | History of recent antibiotic use, immunosuppression |
| Protozoa | Travel (giardia), contaminated water, vegetables |
Food poisoning
| Main symptom | Incubation period | Most likely cause | Possible food source |
| Vomiting | 1–6 hrs | S. aureus toxin | Eggs, salads, meat, milk products |
| 24–48 hrs | Viruses (Norwalk) | Seafood, salads, fruit |
| 8–16 hrs | Clostridium perfringens | Meat, poultry |
| Vesiripuli | 1–3 days | Enterotoxic E. coli | Contaminated water or food |
| 10–72 hrs | Enteroviruses | Contaminated water or food |
| Inflammatorinen ripuli | 1–3 days | Salmonella | Eggs, poultry, meat, unpasteurised milk products |
| 2–5 days | Campylobacter | Poultry, water, unpasteurised milk products |
| 1–3 days | Shigella | Contaminated water or food |
Treatment
- Fluids by mouth and other symptomatic treatment is usually all that is needed.
- Loperamide can be used as symptomatic medication (contraindicated in acute bacterial infection).
- Probiotics can be tried.
- Empirical antibiotic treatment (e.g. ciprofloxacin 500 mg twice daily, norfloxacin 400 mg twice daily, treatment period 3–5 days) can be justified in the following cases:
- traveller’s diarrhoea with fever, mucous stools ≥ 4 times/24 hours
- prolonged duration (> 5 days), diarrhoea ≥ 8 times/24 hours, signs of dehydration or immunosuppression.
- Antimicrobial medication according to aetiology:
- salmonella, shigella, E. coli: a fluoroquinolone (ciprofloxacin, levofloxacin) p.o. 5–7 days
- Clostridium difficile: metronidazole 400 mg three times daily, p.o. in mild cases, vancomycin i.v. in severe cases
- campylobacter: a macrolide for 3–5 days.