Chapter 85: Infectious Diarrheas and Bacterial Food Poisoning
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Acute diarrheal disease, which is associated with ∼1.7 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 85-1). An approach to pts with infectious diarrhea is presented in Fig. 85-1.
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 |
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Acute diarrheal disease, which is associated with ∼1.7 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 85-1). An approach to pts with infectious diarrhea is presented in Fig. 85-1.
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 |
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