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Acute diarrheal disease, which is associated with ~1.4 million deaths per year, is the second most common infectious cause of death worldwide among children <5 years old (after lower respiratory tract infection). The wide range of clinical manifestations is matched by the wide variety of infectious agents involved (Table 82-1). An approach to pts with infectious diarrhea is presented in Fig. 82-1.
|Mechanism||Location||Illness||Stool Findings||Examples of Pathogens Involved|
|Noninflammatory (enterotoxin)||Proximal small bowel||Watery diarrhea||No fecal leukocytes; mild or no increase in fecal lactoferrin||Vibrio cholerae, enterotoxigenic Escherichia coli (LT and/or ST), enteroaggregative E. coli, Clostridium perfringens, Bacillus cereus, Staphylococcus aureus, Aeromonas hydrophila, Plesiomonas shigelloides, rotavirus, norovirus, enteric adenoviruses, Giardia lamblia, Cryptosporidium spp., Cyclospora spp., microsporidia|
|Inflammatory (invasion or cytotoxin)||Colon or distal small bowel||Dysentery or inflammatory diarrhea||Fecal polymorphonuclear leukocytes; substantial increase in fecal lactoferrin||Shigella spp., Salmonella spp., Campylobacter jejuni, enterohemorrhagic E. coli, enteroinvasive E. coli, Yersinia enterocolitica, Listeria monocytogenes, Vibrio parahaemolyticus, Clostridium difficile, A. hydrophila, P. shigelloides, Entamoeba histolytica, Klebsiella oxytoca|
|Penetrating||Distal small bowel||Enteric fever||Fecal mononuclear leukocytes||Salmonella typhi, Y. enterocolitica|