Gastroenteritis: Difference between revisions

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(Created page with "== Background == * Rapid-onset diarrheal illness usually lasting less than 2 weeks == Clinical Manifestations == {| class="wikitable" !Species !Incubation !Duration !Risk Fa...")
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== Background ==
 +
==Background==
   
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* Rapid-onset diarrheal illness usually lasting less than 2 weeks
 +
*Rapid-onset diarrheal illness usually lasting less than 2 weeks
   
βˆ’
== Clinical Manifestations ==
 +
==Clinical Manifestations==
 
{| class="wikitable"
  
{| class="wikitable"
 
!Species
  
!Species
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|[[Staphylococcus aureus]]
  
|[[Staphylococcus aureus]]
 
|1-6 hours
  
|1-6 hours
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|24-48 hours
 +
|≀24 hours
 
|preformed toxin in unrefrigerated food
  
|preformed toxin in unrefrigerated food
 
|watery diarrhea, with prominent vomiting
  
|watery diarrhea, with prominent vomiting
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|preformed toxin in unrefrigerated food
  
|preformed toxin in unrefrigerated food
 
|watery diarrhea, with prominent vomiting
  
|watery diarrhea, with prominent vomiting
  +
|-
  +
|[[Clostridium perfringens]]
  +
|8-16 hours
  +
|24-48 hours
  +
|preformed toxin in meat, poultry, canned food
  +
|watery diarrhea
  +
|-
  +
|Enteric viruses, including [[rotavirus]], [[adenovirus]], [[astrovirus]], and [[sapovirus]]
  +
|10-16 hours
  +
|2-9 days
  +
|contaminated food or water
  +
|watery diarrhea
 
|-
  
|-
 
|[[Norovirus]]
  
|[[Norovirus]]
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|molluscs, shellfish, leafy vegetables, fruit, sandwiches
  
|molluscs, shellfish, leafy vegetables, fruit, sandwiches
 
|watery diarrhea, with prominent vomiting
  
|watery diarrhea, with prominent vomiting
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|-
  
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|[[Clostridium perfringens]]
  
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|8-16 hours
  
βˆ’
|24-48 hours
  
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|meat, poulty, canned food
  
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|watery diarrhea
  
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|-
  
βˆ’
|Enteric viruses, including [[rotavirus]], [[adenovirus]], [[astrovirus]], and [[sapovirus]]
  
βˆ’
|10-16 hours
  
βˆ’
|2-9 days
  
βˆ’
|contaminated food or water
  
βˆ’
|watery diarrhea
  
 
|-
  
|-
 
|[[Listeria monocytogenes]]
  
|[[Listeria monocytogenes]]
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|watery diarrhea
  
|watery diarrhea
 
|-
  
|-
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|Nontyphoidal [[Salmonella]]
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|[[Non-typhoidal Salmonella]]
 
|1-3 days
  
|1-3 days
 
|1-7 days
  
|1-7 days
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|inflammatory diarrhea, dysentery
  
|inflammatory diarrhea, dysentery
 
|-
  
|-
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|[[Campylobacter species]]
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|[[Campylobacter]]
 
|1-3 days
  
|1-3 days
 
|5-14 days
  
|5-14 days
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|inflammatory diarrhea, dysentery
  
|inflammatory diarrhea, dysentery
 
|-
  
|-
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|[[Shigella species]]
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|[[Shigella]]
 
|1-3 days
  
|1-3 days
 
|2-3 days
  
|2-3 days
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|inflammatory diarrhea, dysentery
  
|inflammatory diarrhea, dysentery
 
|-
  
|-
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|[[Yersinia species]]
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|[[Yersinia]]
 
|4-6 days
  
|4-6 days
 
|1-3 weeks
  
|1-3 weeks
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|}
  
|}
   
  +
===Extraintestinal Complications===
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=== Red Flags ===
  
  +
{| class="wikitable"
  +
! rowspan="2" |Complication
  +
! colspan="6" |Bacteria
  +
! colspan="3" |Parasites
  +
|-
  +
![[Campylobacter]]
  +
![[Listeria]]
  +
![[Salmonella]]
  +
![[Shigella]]
  +
![[STEC]]
  +
![[Yersinia]]
  +
![[Cyclospora]]
  +
![[Entamoeba]]
  +
![[Giardia]]
  +
|-
  +
|[[Aortitis]]
  +
|
  +
|
  +
| +
  +
|
  +
|
  +
| +
  +
|
  +
|
  +
|
  +
|-
  +
|Deep tissue infection
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|
  +
|
  +
| +
  +
|
  +
|
  +
| +
  +
|
  +
|
  +
|
  +
|-
  +
|[[Erythema nodosum]]
  +
| +
  +
|
  +
| +
  +
| +
  +
|
  +
| +
  +
|
  +
|
  +
|
  +
|-
  +
|[[Glomerulonephritis]]
  +
| +
  +
|
  +
|
  +
| +
  +
|
  +
| +
  +
|
  +
|
  +
|
  +
|-
  +
|[[Guillain-BarrΓ© syndrome]]
  +
| +
  +
|
  +
|
  +
|
  +
|
  +
|
  +
|
  +
|
  +
|
  +
|-
  +
|[[Hemolytic anemia]]
  +
| +
  +
|
  +
|
  +
|
  +
|
  +
| +
  +
|
  +
|
  +
|
  +
|-
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|[[Hemolytic-uremic syndrome]]
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|
  +
|
  +
|
  +
| +† 
  +
| +
  +
|
  +
|
  +
|
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|
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|-
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|[[IgA nephropathy]]
  +
| +
  +
|
  +
|
  +
|
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|
  +
|
  +
|
  +
|
  +
|
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|-
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|[[Intestinal perforation]]
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| +
  +
|
  +
| +
  +
| +
  +
|
  +
| +
  +
|
  +
| +
  +
|
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|-
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|[[Meningitis]]
  +
|
  +
| +
  +
| +‑ 
  +
|
  +
|
  +
|
  +
|
  +
|
  +
|
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|-
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|[[Osteomyetlitis]]
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|
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|
  +
| +
  +
|
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|
  +
| +
  +
|
  +
|
  +
|
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|-
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|[[Post-infectious irritable bowel syndrome|Post-infectious IBS]]
  +
| +
  +
|
  +
| +
  +
| +
  +
| +
  +
|
  +
|
  +
|
  +
| +
  +
|-
  +
|[[Reactive arthritis]]
  +
| +
  +
|
  +
| +
  +
| +
  +
|
  +
| +
  +
|rare
  +
|
  +
|rare
  +
|}
  +
  +
*†  [[Shigella dysenteriae]] serotype 1
  +
*‑  infants ≀3 months
  +
  +
===Red Flags===
   
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* Duration >1 week
 +
*Duration >1 week
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* Fever
 +
*Fever
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* Bloody diarrhea
 +
*Bloody diarrhea
βˆ’
* Severe abdominal pain
 +
*Severe abdominal pain
βˆ’
* Dehydration, [[hypovolemia]], shock
 +
*Dehydration, [[hypovolemia]], shock
βˆ’
* Weight loss
 +
*Weight loss
βˆ’
* Recent antibiotic exposure
 +
*Recent antibiotic exposure
βˆ’
* Pregnancy
 +
*Pregnancy
βˆ’
* Age over 65 years
 +
*Age over 65 years
βˆ’
* Diabetes, HIV, or other immunocompromising condition
 +
*Diabetes, HIV, or other immunocompromising condition
   
βˆ’
== Management ==
 +
==Management==
   
βˆ’
* Usually supportive, with a focus on rehydration
 +
*Usually supportive, with a focus on rehydration
βˆ’
** Oral rehydration if tolerating enough oral intake
 +
**Oral rehydration if tolerating enough oral intake
βˆ’
** Intravenous rehydration if not
 +
**Intravenous rehydration if not
  +
*Antibiotics are indicated for:
  +
**Extraintestinal disease
  +
**Very young and very old
  +
**Immunocompromised
  +
**Severe symptoms including fever
  +
**Prolonged symptoms
  +
*Choice of antibiotics is directed by the pathogen and local resistance patterns
   
 
[[Category:Gastrointestinal infections]]
  
[[Category:Gastrointestinal infections]]

Latest revision as of 16:56, 28 August 2023

Background

  • Rapid-onset diarrheal illness usually lasting less than 2 weeks

Clinical Manifestations

Species Incubation Duration Risk Factors Symptoms
Staphylococcus aureus 1-6 hours ≀24 hours preformed toxin in unrefrigerated food watery diarrhea, with prominent vomiting
Bacillus cereus 1-6 hours 24-48 hours preformed toxin in unrefrigerated food watery diarrhea, with prominent vomiting
Clostridium perfringens 8-16 hours 24-48 hours preformed toxin in meat, poultry, canned food watery diarrhea
Enteric viruses, including rotavirus, adenovirus, astrovirus, and sapovirus 10-16 hours 2-9 days contaminated food or water watery diarrhea
Norovirus 24-48 hours 48-72 hours molluscs, shellfish, leafy vegetables, fruit, sandwiches watery diarrhea, with prominent vomiting
Rotavirus 24-48 hours 48-72 hours molluscs, shellfish, leafy vegetables, fruit, sandwiches watery diarrhea, with prominent vomiting
Listeria monocytogenes 24 hours variable processed meats, hot dogs, soft cheese, pΓ’tΓ©s, and fruit watery diarrhea
Enterotoxigenic Escherichia coli 1-3 days 2-3 days contaminated food or water watery diarrhea
Non-typhoidal Salmonella 1-3 days 1-7 days poultry, eggs, fresh produce, meat, fish, unpasteurized juice or milk inflammatory diarrhea, dysentery
Campylobacter 1-3 days 5-14 days poultry, meat, unpasteurized milk inflammatory diarrhea, dysentery
Shigella 1-3 days 2-3 days raw vegetables, MSM inflammatory diarrhea, dysentery
Enterohemorrhagic Escherichia coli 1-8 days 1 week ground beef or other meat, fresh produce, unpasteurized milk and juice inflammatory diarrhea, dysentery
Yersinia 4-6 days 1-3 weeks pork, untreated water inflammatory diarrhea, dysentery
Giardia lamblia 7-14 days days to weeks contaminated food or water watery diarrhea
Cyclospora cayetanensis 1-11 days weeks herbs and berries watery diarrhea
Cryptosporidium parvum 2-28 days weeks vegetables, fruit, unpasteurized milk watery diarrhea
Clostridioides difficile β€” variable antibiotics, PPI use watery or inflammatory diarrhea

Extraintestinal Complications

Complication Bacteria Parasites
Campylobacter Listeria Salmonella Shigella STEC Yersinia Cyclospora Entamoeba Giardia
Aortitis + +
Deep tissue infection + +
Erythema nodosum + + + +
Glomerulonephritis + + +
Guillain-BarrΓ© syndrome +
Hemolytic anemia + +
Hemolytic-uremic syndrome +†  +
IgA nephropathy +
Intestinal perforation + + + + +
Meningitis + +‑ 
Osteomyetlitis + +
Post-infectious IBS + + + + +
Reactive arthritis + + + + rare rare

Red Flags

  • Duration >1 week
  • Fever
  • Bloody diarrhea
  • Severe abdominal pain
  • Dehydration, hypovolemia, shock
  • Weight loss
  • Recent antibiotic exposure
  • Pregnancy
  • Age over 65 years
  • Diabetes, HIV, or other immunocompromising condition

Management

  • Usually supportive, with a focus on rehydration
    • Oral rehydration if tolerating enough oral intake
    • Intravenous rehydration if not
  • Antibiotics are indicated for:
    • Extraintestinal disease
    • Very young and very old
    • Immunocompromised
    • Severe symptoms including fever
    • Prolonged symptoms
  • Choice of antibiotics is directed by the pathogen and local resistance patterns
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