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{{Acute diarrhea}}
{{Acute diarrhea}}


{{CMG}}; {{AE}}  
{{CMG}}; {{AE}} {{CK}}
 
==Overview==
==Overview==
The majority of patients with [disease name] are asymptomatic.
The hallmark of acute diarrhea is the sudden onset of 3 or more stools per day, lasting less than 4 weeks. The most common [[symptoms]] of acute diarrhea include increased frequency of [[Bowel movement|bowel movements]], [[abdominal pain]], [[Fever|elevation of body temperature]] and [[symptoms]] of fluid loss (dark or scant [[urine]], excessive thirst, [[dizziness]], [[fatigue]]).


OR
==History and Symptoms==
*Acute diarrhea is usually self limiting.
*Medical evaluation for acute diarrhea is recommended for patients with [[fever]], mucoid or [[Dysentery|bloody diarrhea]], [[abdominal pain]] and [[symptoms]] of [[dehydration]] ([[dizziness]] or [[Dizziness|light headedness]], dark [[urine]], [[fatigue]]).
*Hospital admission is required for individuals who present with acute diarrhea, if there is a medical history of [[immunosuppression]] (eg, treatment for [[Cancer|malignancy]], [[Organ transplant|transplantation]], or advanced [[HIV AIDS|HIV infection]]), with preexisting [[Intestine|bowel]] disease ( such as [[inflammatory bowel disease]] or [[ischemic colitis]]) or with significant [[vascular]] or [[Circulatory system|cardiovascular]] disease.
*[[Symptoms]] of acute diarrhea include loose [[stools]] (watery, bloody or mucoid), [[fever]], [[abdominal pain]], excessive thirst, dark or scant [[urine]] and [[Dizziness|light headedness]].
===History===
*Initial evaluation of patients who present with acute diarrhea include:<ref name="pmid18666921">{{cite journal |vauthors=Greenwood Z, Black J, Weld L, O'Brien D, Leder K, Von Sonnenburg F, Pandey P, Schwartz E, Connor BA, Brown G, Freedman DO, Torresi J |title=Gastrointestinal infection among international travelers globally |journal=J Travel Med |volume=15 |issue=4 |pages=221–8 |year=2008 |pmid=18666921 |doi=10.1111/j.1708-8305.2008.00203.x |url=}}</ref><ref name="pmid16395094">{{cite journal |vauthors=Vernacchio L, Vezina RM, Mitchell AA, Lesko SM, Plaut AG, Acheson DW |title=Diarrhea in American infants and young children in the community setting: incidence, clinical presentation and microbiology |journal=Pediatr. Infect. Dis. J. |volume=25 |issue=1 |pages=2–7 |year=2006 |pmid=16395094 |doi= |url=}}</ref><ref name="pmid17357047">{{cite journal |vauthors=Fischer TK, Viboud C, Parashar U, Malek M, Steiner C, Glass R, Simonsen L |title=Hospitalizations and deaths from diarrhea and rotavirus among children <5 years of age in the United States, 1993-2003 |journal=J. Infect. Dis. |volume=195 |issue=8 |pages=1117–25 |year=2007 |pmid=17357047 |doi=10.1086/512863 |url=}}</ref><ref name="pmid22675542">{{cite journal |vauthors=Talbert A, Thuo N, Karisa J, Chesaro C, Ohuma E, Ignas J, Berkley JA, Toromo C, Atkinson S, Maitland K |title=Diarrhoea complicating severe acute malnutrition in Kenyan children: a prospective descriptive study of risk factors and outcome |journal=PLoS ONE |volume=7 |issue=6 |pages=e38321 |year=2012 |pmid=22675542 |pmc=3366921 |doi=10.1371/journal.pone.0038321 |url=}}</ref>
**'''Duration of symptoms'''
**'''Frequency and nature of stools:'''
***It can suggest whether the diarrhea is originating in the [[Small intestine|small]] or the [[Large intestine|large bowel]].
****Diarrhea of [[Small intestine|small bowel]] origin is typically watery, of large volume and associated with [[Abdominal pain|abdominal cramping]], [[bloating]], and gas. [[Fever]] is less common and [[Human feces|stools]] are mostly watery.
****Diarrhea of [[Large intestine|large intestinal]] origin often presents with frequent, regular, small volume, and painful [[Defecation|bowel movements]]. [[Fever]] and bloody or mucoid stools are common.
**'''History of associated symptoms:''' [[Fever]], [[abdominal pain]], [[nausea and vomiting]]
**'''Symptoms of volume depletion:''' Dark or scant urine, [[dizziness]], [[confusion]]
**'''History of immunosuppression and other bowel diseases:''' [[Inflammatory bowel disease]], [[Human Immunodeficiency Virus (HIV)|HIV]], history of [[malignancy]] and [[Organ transplant|transplantation]]
**'''History towards potential exposure:''' Food history, travel history, exposure to pets
***'''Travel history:'''
****Travel history may be helpful in identifying a cause for diarrhea. 
****The risk of [[traveler's diarrhea]] is high in regions where hygienic practices and [[sanitation]] are poor.
****[[Traveler's diarrhea]] risk also varies with season of the year, higher risk during warmer months and rainy seasons.
****'''Risk by geographic regions:'''
*****High risk: South and Southeast Asia, Central and western Africa, South and Central America, and Mexico
*****Moderate risk:  Caribbean Islands, South Africa, Central and East Asia, Eastern Europe, and the Middle East
*****Low risk: the United States, Canada, Singapore, Japan,Northern and Western Europe, Australia and New Zealand
****Common organisms that cause diarrhea among travelers include:
*****[[Enterotoxigenic Escherichia coli|Enterotoxigenic E.coli]] [[ETEC]] (leading cause)
*****[[Shigella]]
*****[[Salmonella]]
*****[[Campylobacter]]
*****[[Rotavirus]]
***Other [[Organism|organisms]] that are prevalent in particular parts of the world include the following:
****Nonspecific foreign travel history: Consider [[Escherichia coli enteritis|Enterotoxigenic E coli]] ([[ETEC]]), [[Aeromonas]], [[Giardia lamblia|Giardia]], [[Plesiomonas shigelloides|Plesiomonas]], [[Salmonella]], and [[Shigella]] species
****Travel to Africa: [[Entamoeba]] species, [[Vibrio cholerae]]
****Travel to South America and Central America: [[Entamoeba|Entamoeba species]], [[Vibrio|V. cholerae]], [[Enterotoxigenic Escherichia coli|enterotoxigenic E coli]]
****Travel to Asia: [[Vibrio|V. cholerae]]
****Travel to Australia: [[Yersinia|Yersinia species]]
****Travel to Canada: [[Yersinia|Yersinia species]]
****Travel to Europe: [[Yersinia|Yersinia species]]
****Travel to India: [[Entamoeba|Entamoeba species]], [[Vibrio|V. cholerae]]
****Travel to Japan: [[Vibrio parahaemolyticus]]
****Travel to Mexico: [[Aeromonas]], [[Entamoeba]], [[Plesiomonas shigelloides|Plesiomonas]], and [[Yersinia|Yersinia species]]
****New Guinea: [[Clostridium|Clostridium species]]
**'''Day care history:''' Certain [[Pathogen|pathogens]] spread very quickly in daycare.
***[[Virus]]:
****[[Rotavirus]]
****[[Astrovirus]]
****Calcivirus
***[[Bacteria]]:
****[[Campylobacter]]
****[[Shigella]]
***[[Protozoa]]:
****[[Giardia lamblia|Giardia]]
****[[Cryptosporidium|Cryptosporidium species]]
*'''Food history:'''
**Intake of raw or uncooked food is a common cause of infectious diarrhea. Consumption of undercooked or raw meat or fish, unpasteurized dairy products, or certain organic [[vitamin]] preperations may suggest certain [[Pathogen|pathogens]].
***Meats: [[Clostridium perfringens|C. perfringens]], [[Aeromonas]], [[Campylobacter]], and [[Salmonella]] species
***Dairy food: [[Campylobacter]], [[Salmonella]] species, [[Listeria monocytogenes|Listeria]] especially in pregnancy.
***Eggs: [[Salmonella|Salmonella species]]
***Seafood: [[Astrovirus]], [[Aeromonas]], [[Plesiomonas shigelloides|Plesiomonas]], and [[Vibrio|Vibrio species]]
***Poultry: [[Campylobacter|Campylobacter species]]
***Oysters: [[Caliciviridae|Calicivirus]] and [[Plesiomonas shigelloides|Plesiomonas]] and [[Vibrio|Vibrio species]]
***Vegetables: [[Aeromonas]] species and [[Clostridium perfringens|C. perfringens]]
***Ground beef: [[Escherichia coli enteritis|EHEC]]
***Pork: [[Clostridium perfringens|C. perfringens]], [[Yersinia Enterocolitica Infection|Y. enterocolitica]]
**Although it is often difficult to know which food exposure was the potential cause, the timing of onset of [[symptoms]] following exposure to the suspected food can be an important clue to find the [[diagnosis]].
***Up to 6 hrs: Ingestion of a preformed [[toxin]] produced by [[Staphylococcus aureus]] or [[Bacillus cereus]], if [[Nausea and vomiting|nausea]] and [[Nausea and vomiting|vomiting]] were the initial [[symptoms]].
***Between 8 to 16 hours: Suggests [[infection]] with [[Clostridium perfringens]]
***After 16 hours: Most commonly either [[Virus|viral]] or other [[Bacteria|bacterial]] infection (eg, [[Pollution|contamination]] of food with [[ETEC|enterotoxigenic E.coli]], [[EHEC]] or other pathogens).


The hallmark of [disease name] is [finding]. A positive history of [finding 1] and [finding 2] is suggestive of [disease name]. The most common symptoms of [disease name] include [symptom 1], [symptom 2], and [symptom 3]. Common symptoms of [disease] include [symptom 1], [symptom 2], and [symptom 3]. Less common symptoms of [disease name] include [symptom 1], [symptom 2], and [symptom 3].
* '''Water exposure''': 
** Water is the main source for organisms that cause diarrhea. 
** Swimming pools have been associated with outbreaks of [[infection]] with [[Shigella]] species.
** [[Aeromonas]] infection is associated with exposure to the marine environment. 
** Certain [[organisms]] are resistant to [[chlorination]] ([[Giardia lamblia|Giardia]], [[Cryptosporidium]], and [[Entamoeba]]), so exposure to contaminated water should raise the suspicion of [[infection]] with these [[Pathogen|pathogens]].
** Camping history with exposure to water sources may also suggest infection with [[Giardia lamblia|Giardia]].  


==History and Symptoms==
*'''Exposure to animals:'''
*The majority of patients with [disease name] are asymptomatic.
**Poultry, petting zoos has been associated with [[Salmonella]] and [[Campylobacter]] infections.
OR
*'''Medical history:'''
*The hallmark of [disease name] is [finding]. A positive history of [finding 1] and [finding 2] is suggestive of [disease name]. The most common symptoms of [disease name] include [symptom 1], [symptom 2], and [symptom 3].
**Various medical conditions can make patients prone to [[Infection|infections]].
*Symptoms of [disease name] include [symptom 1], [symptom 2], and [symptom 3]. 
***[[Clostridium difficile infection|C. difficile]]: [[Hospital|Hospitalization]], [[antibiotic]] administration
===History===
***[[Plesiomonas shigelloides|Plesiomonas]] species: [[Liver]] diseases or [[Cancer|malignancy]]
Patients with [disease name]] may have a positive history of:
***[[Salmonella]] species: [[Intestine|Intestinal]] [[Motility|dysmotility]], [[malnutrition]], [[achlorhydria]], [[hemolytic anemia]] (especially [[Sickle-cell disease|sickle cell disease]]), [[immunosuppression]], [[malaria]]
*[History finding 1]
***[[Rotavirus]]: [[Hospital|Hospitalization]]
*[History finding 2]
***[[Giardia lamblia|Giardia]] species: [[X-linked agammaglobulinemia|Agammaglobulinemia]], [[chronic pancreatitis]], [[achlorhydria]], [[cystic fibrosis]]
*[History finding 3]
***[[Cryptosporidium|Cryptosporidia]] species: [[Immunodeficiency|Immunocompromised]] state
===Common Symptoms===
***[[Vibrio]]: [[Cirrhosis]]
Common symptoms of [disease] include:
***[[Yersinia]]: [[Hemochromatosis]]
*[Symptom 1]
*Intake of fruit or vegetable juices (particularly in children)
*[Symptom 2]
*[[Lactose intolerance]]
*[Symptom 3]
*History of [[abdominal]] or [[Gallbladder|gall bladder]] removal surgery
 
*Age>50 yrs
===Less Common Symptoms===
Less common symptoms of [disease name] include
*[Symptom 1]
*[Symptom 2]
*[Symptom 3]


=== Common symptoms ===
Common [[symptoms]] of acute diarrhea include:
*Loose stools: watery or mucoid or bloody
*[[Fever]]
*[[Abdominal pain]]
*Urgency to have a [[bowel movement]]
*[[Nausea and vomiting|Nausea or vomiting]]
*[[Bloating]]
*[[Symptoms]] of [[dehydration]]:
**Excessive thirst
**[[Dry mouth]] or [[tongue]]
**Scant or no urination, dark-colored [[urine]]
**Weakness
**[[Dizziness]] or lightheadedness
**[[Fatigue]]
===Less common symptoms===
Less common [[symptoms]] of acute diarrhea include:
*[[Weight loss]] if diarrhea persists longer
*[[Malnutrition]]
*[[Confusion]] or agitation
*[[Confusion|Disorientation]]
*[[Syncope|Fainting]]
*[[Seizure|Seizures]]
*[[Abdominal guarding]]
*[[Stupor]] or [[coma]]
==References==
==References==
{{Reflist|2}}
{{Reflist|2}}
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[[Category:Medicine]]
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Latest revision as of 20:16, 29 July 2020

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Chandrakala Yannam, MD [2]

Overview

The hallmark of acute diarrhea is the sudden onset of 3 or more stools per day, lasting less than 4 weeks. The most common symptoms of acute diarrhea include increased frequency of bowel movements, abdominal pain, elevation of body temperature and symptoms of fluid loss (dark or scant urine, excessive thirst, dizziness, fatigue).

History and Symptoms

History

Common symptoms

Common symptoms of acute diarrhea include:

Less common symptoms

Less common symptoms of acute diarrhea include:

References

  1. ↑ Greenwood Z, Black J, Weld L, O'Brien D, Leder K, Von Sonnenburg F, Pandey P, Schwartz E, Connor BA, Brown G, Freedman DO, Torresi J (2008). "Gastrointestinal infection among international travelers globally". J Travel Med. 15 (4): 221–8. doi:10.1111/j.1708-8305.2008.00203.x. PMID 18666921.
  2. ↑ Vernacchio L, Vezina RM, Mitchell AA, Lesko SM, Plaut AG, Acheson DW (2006). "Diarrhea in American infants and young children in the community setting: incidence, clinical presentation and microbiology". Pediatr. Infect. Dis. J. 25 (1): 2–7. PMID 16395094.
  3. ↑ Fischer TK, Viboud C, Parashar U, Malek M, Steiner C, Glass R, Simonsen L (2007). "Hospitalizations and deaths from diarrhea and rotavirus among children <5 years of age in the United States, 1993-2003". J. Infect. Dis. 195 (8): 1117–25. doi:10.1086/512863. PMID 17357047.
  4. ↑ Talbert A, Thuo N, Karisa J, Chesaro C, Ohuma E, Ignas J, Berkley JA, Toromo C, Atkinson S, Maitland K (2012). "Diarrhoea complicating severe acute malnutrition in Kenyan children: a prospective descriptive study of risk factors and outcome". PLoS ONE. 7 (6): e38321. doi:10.1371/journal.pone.0038321. PMC 3366921. PMID 22675542.

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