Gastroenteritis

Gastroenteritis is acute diarrhea. Most acute diarrheal illnesses are caused by intestinal infections. Most cases are mild, self-limited, and caused by viruses.

CASES/YEAR
200,000,000 (US); 1,700,000,000 (Global)
CATEGORY
Localized Infections
AGENT TYPE
Mixed
OTHER NAMES
Acute diarrhea;
ACUITY
Acute-Moderate
INCUBATION
Estimated: hours to weeks;
INITIAL SYMPTOMS
Diarrhea
PRECAUTIONS
Standard; Use Contact Precautions for diapered or incontinent persons for the duration of illness or to control institutional outbreaks for gastroenteritis caused by adenovirus, Campylobacter species, Cholera, C. difficile, Cryptosporidium species, E. coli, Giardia lamblia, Noroviruses, Rotavirus, Salmonella species, Shigella species, Vibrio parahaemolyticus, viral not covered elsewhere, and Yersinia enterocolitica. [CDC 2007 Guideline for Isolation Precautions]
COMMENTS
Most acute diarrheal illnesses are caused by intestinal infections. Most cases are mild, self-limited, and caused by viruses. [Merck Manual, p. 124-5] For cases that do not resolve within one day, explore history of antibiotic use, travel, seafood, outbreak, sexual experience (fecal exposure), and immunosuppression. Obtain stool sample for leucocytes and, if diarrhea >10 days, parasites. If leucocytes present (or fecal lactoferrin positive), culture for shigella, salmonella, and C. jejuni, and consider C. difficile toxin. Consider empirical antibiotic therapy. If noninflammatory, continue symptomatic therapy. For parasites, give specific treatment. If stool grossly bloody, especially in patient with no fever, test for Shiga toxin-producing E. coli, a common cause of bloody diarrhea in the U.S. [See Figure 93-2: Approach to diagnosis and management of infectious diarrhea. [PPID 7th Ed., p. 1345] Complications include reactive arthritis (Shigella, Salmonella, Campylobacter, and Yersinia), hemolytic-uremic syndrome (Shigella dysenteriae type 1 and enterohemorrhagic E. coli), and Guillain-Barre syndrome (Campylobacter jejuni). [Harrison ID, p. 291t] See the diseases in the Foodborne Intoxications and Gastroenteritis categories.
DIAGNOSTIC
Culture; Stool leucocytes or lactoferrin; O & P (include trichrome stain); Giardia Ag; C. difficile and toxin if abx exposure; Test for STEC if HUS presentation--consider sending to CDC for immunomagnetic separation techniques; [ABX Guide]
SCOPE
Global
SIGNS & SYMPTOMS
  • >fatigue, weakness
  • >fever
  • >myalgia
  • G abdominal pain
  • G blood in stool
  • G diarrhea
  • G nausea, vomiting
  • H anemia
  • H leukocytosis
  • H thrombocytopenia
  • N headache
  • *acute renal failure
  • *arthritis
  • *paralysis
  • *sepsis
  • *shock
ANTIMICROBIC

Yes

VACCINE

No

ENTRY
Ingestion, Swimming, Sexual Contact
SOURCE
Person-to-Person, Human Fecal-Oral, Fecally Contaminated Soil, Animal Excreta, Animal Tissue, Soil or Dust (Ingesting or Inhaling), Eating Contaminated Food, Eating Contaminated or Infected Meat, Eating Infected or Toxin-Containing Fish, Eating Contaminated Mollusks or Crustacean, Eating Unpasteurized Milk or Cheese, Eating Contaminated Produce, Waterborne (Ingesting, Inhaling, or Swimming)
RESERVOIR
Birds and Poultry, Cattle, Goats and Sheep, Cats, Deer, Elk and Antelope, Dogs, Fish and Shellfish, Horses, Monkeys, Rabbits, Rodents, Swine, Human, Wild Animals
RISK FACTORS
  • AIDS patients
  • Cancer patients
DRUG LINK
Merck Manual: Gastroenteritis
REFERENCES FOR CASES/YEAR
1. (US) 200-375 million episodes of acute diarrhea every year; About 38 million of these are due to known pathogen; About 14 million of the total is due to foodborne pathogens; [Gorbach, p. 10] Use lower figure: 200,000/year;
2. (Global) 760,000 children <5 years old die every year; 1.9 million deaths per year; 1.7 billion cases per year; [Fact sheets from WHO] 1.7 billion episodes per year worldwide in children in low and medium income countries with 1.4 million deaths per year; [Harrison ID, p. 287]