Acute diarrhea risk factors: Difference between revisions

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Latest revision as of 20:16, 29 July 2020

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Chandrakala Yannam, MD [2] Sudarshana Datta, MD [3]

Overview

The risk factors of acute diarrhea may be assessed based on the epidemiologic associations and the patient exposure histories. Risk factors may be classified based on travel history, epidemics, outbreaks, food history, animal contact, hospitalization and immunosupression. The 2017 Infectious Diseases Society of America Clinical Practice Guidelines for the Diagnosis and Management of Infectious Diarrhea lists the risk factors of diarrhea along with their causative pathogens.

Risk factors

According to the 2017 Infectious Diseases Society of America Clinical Practice Guidelines for the Diagnosis and Management of Infectious Diarrhea, common risk factors along with causative pathogens of diarrhea include the following:^[1]

Contamination:
•Foodborne outbreaks in hotels, cruise ships, resorts, restaurants, catered events
•Consumption of unpasteurized milk or dairy products
•Waterborne
•Animal exposure
•Consumption of raw or undercooked meat or poultry

Exposure:
•Child care facilities
•Long term care facilities
•Hospitalisation
•International travel

RISK FACTORS FOR ACUTE DIARRHEA

Host factors:
•Immunocompromised hosts
•Certain sexual practices
•Age group
•Hemochromatosis or hemoglobinopathy

Side effects of pharmacotherapy:
•Antimicrobial therapy
•Drug side effects

Contamination

Foodborne outbreaks in hotels, cruise ships, resorts, restaurants, catered events^[2]
- Shigella, Vibrio cholerae, Bacillus cereus, Staphylococcus aureus, nontyphoidal Salmonella, Clostridium perfringens, Campylobacter, ETEC, Listeria, Norovirus, Rotavirus, Cryptosporidium, Cyclospora cayetanensis
Consumption of unpasteurized milk or dairy products^[3]
- Salmonella, Campylobacter, Brucella (goat milk cheese), Coxiella burnetii, Yersinia enterocolitica, S. aureus toxin, Cryptosporidium, Listeria, Mycobacterium bovis
Consumption of raw or undercooked meat or poultry^[4]
- C. perfringens (beef, poultry), EHEC (ground beef), Salmonella (poultry), Calcivirus (oysters), Campylobacter (poultry), Vibrio (oysters),Yersinia (pork, chitterlings), S. aureus (poultry), and Trichinella (pork, wild game meat)
Consumption of fruits or unpasteurized fruit juices, vegetables, leafy greens, and sprouts
- Hepatitis A, Listeria monocytogenes, Nontyphoidal Salmonella, Cyclospora, Cryptosporidium, Norovirus
Consumption of undercooked eggs
- Salmonella, Shigella (egg salad)
Consumption of raw shellfish
- Hepatitis A, Vibrio species, Plesiomonas, Norovirus

Swimming in or drinking untreated fresh water^[5]
- Giardia, Campylobacter, Cryptosporidium, Salmonella, Shigella, Plesiomonas shigelloides, Aeromonas
Swimming in recreational water facility with treated water^[5]^[6]
- Cryptosporidium
Exposure to house pets with diarrhea
- Campylobacter, Yersinia
Exposure to pig feces in certain parts of the world
- Balantidium coli
Contact with young poultry or reptiles
- Nontyphoidal Salmonella
Visiting a farm or petting zoo
- Cryptosporidium, Campylobacter

Host factors

Age group
- Birth- 3 months: Nontyphoidal Salmonella
- 6–18 months: Rotavirus
- 1–7 years: Shigella
- Young adults: Campylobacter
- Adults >50 years with a history of atherosclerosis: Nontyphoidal Salmonella

Side effects of pharmacotherapy

Drug side effects^[7]

Recent antimicrobial therapy and hospitalization^[7]
- C. difficile
- Multidrug-resistant Salmonella
- Rotavirus

Exposure

Anal-genital, oral-anal, or digital-anal contact
- Shigella, Giardia lamblia, Campylobacter, E. histolytica, Cryptosporidium and sexually transmitted infections, Salmonella
Healthcare, long-term care, prison exposure, or employment
- Norovirus, Clostridium difficile, Shigella, Cryptosporidium, Giardia, Rotavirus
Day care
- Rotavirus, Cryptosporidium, Giardia, Shigella, Norovirus, Calcivirus, Campylobacter
Travel to endemic areas, poor sanitation and crowding^[8]
- Escherichia coli (enteroaggregative, enterotoxigenic, enteroinvasive), Shigella, Typhi and nontyphoidal Salmonella, Campylobacter, Vibrio cholerae, Aeromonas, Plesiomonas, Rotavirus, Norovirus (Cruise ship diarrhea), enteric Adenovirus, Entamoeba histolytica, Cryptosporidium, Blastocystis, Giardia, Cyclospora, Cystoisospora

References

↑ Dunn N, Gossman WG. PMID 29083755. Missing or empty |title= (help)
↑ Todd EC (1997). "Epidemiology of foodborne diseases: a worldwide review". World Health Stat Q. 50 (1–2): 30–50. PMID 9282385.
↑ Gould LH, Walsh KA, Vieira AR, Herman K, Williams IT, Hall AJ, Cole D (2013). "Surveillance for foodborne disease outbreaks - United States, 1998-2008". MMWR Surveill Summ. 62 (2): 1–34. PMID 23804024.
↑ Somboonwit C, Menezes LJ, Holt DA, Sinnott JT, Shapshak P (2017). "Current views and challenges on clinical cholera". Bioinformation. 13 (12): 405–409. doi:10.6026/97320630013405. PMC 5767916. PMID 29379258.
↑ ^5.0 ^5.1 Guzman-Herrador B, Carlander A, Ethelberg S, Freiesleben de Blasio B, Kuusi M, Lund V, Löfdahl M, MacDonald E, Nichols G, Schönning C, Sudre B, Trönnberg L, Vold L, Semenza JC, Nygård K (2015). "Waterborne outbreaks in the Nordic countries, 1998 to 2012". Euro Surveill. 20 (24). PMID 26111239.
↑ Efstratiou A, Ongerth JE, Karanis P (2017). "Waterborne transmission of protozoan parasites: Review of worldwide outbreaks - An update 2011-2016". Water Res. 114: 14–22. doi:10.1016/j.watres.2017.01.036. PMID 28214721.
↑ ^7.0 ^7.1 "Severe Clostridium difficile-associated disease in populations previously at low risk--four states, 2005". MMWR Morb. Mortal. Wkly. Rep. 54 (47): 1201–5. 2005. PMID 16319813.
↑ Heather CS (2015). "Travellers' diarrhoea". BMJ Clin Evid. 2015. PMC 4415508. PMID 25928418.

[pmid29083755-1] Dunn N, Gossman WG. PMID 29083755. Missing or empty |title= (help)

[pmid9282385-2] Todd EC (1997). "Epidemiology of foodborne diseases: a worldwide review". World Health Stat Q. 50 (1–2): 30–50. PMID 9282385.

[pmid23804024-3] Gould LH, Walsh KA, Vieira AR, Herman K, Williams IT, Hall AJ, Cole D (2013). "Surveillance for foodborne disease outbreaks - United States, 1998-2008". MMWR Surveill Summ. 62 (2): 1–34. PMID 23804024.

[pmid29379258-4] Somboonwit C, Menezes LJ, Holt DA, Sinnott JT, Shapshak P (2017). "Current views and challenges on clinical cholera". Bioinformation. 13 (12): 405–409. doi:10.6026/97320630013405. PMC 5767916. PMID 29379258.

[pmid26111239-5] 5.0 ^5.1 Guzman-Herrador B, Carlander A, Ethelberg S, Freiesleben de Blasio B, Kuusi M, Lund V, Löfdahl M, MacDonald E, Nichols G, Schönning C, Sudre B, Trönnberg L, Vold L, Semenza JC, Nygård K (2015). "Waterborne outbreaks in the Nordic countries, 1998 to 2012". Euro Surveill. 20 (24). PMID 26111239.

[pmid28214721-6] Efstratiou A, Ongerth JE, Karanis P (2017). "Waterborne transmission of protozoan parasites: Review of worldwide outbreaks - An update 2011-2016". Water Res. 114: 14–22. doi:10.1016/j.watres.2017.01.036. PMID 28214721.

[pmid16319813-7] 7.0 ^7.1 "Severe Clostridium difficile-associated disease in populations previously at low risk--four states, 2005". MMWR Morb. Mortal. Wkly. Rep. 54 (47): 1201–5. 2005. PMID 16319813.

[pmid25928418-8] Heather CS (2015). "Travellers' diarrhoea". BMJ Clin Evid. 2015. PMC 4415508. PMID 25928418.

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@@ Line 1: / Line 1: @@
 __NOTOC__
 {{Acute diarrhea}}
-{{CMG}}; {{AE}} {{CK}}
+{{CMG}}; {{AE}} {{CK}} {{Cherry}}
 ==Overview==
+The [[risk factors]] of acute diarrhea may be assessed based on the [[epidemiologic]] associations and the patient exposure histories. [[Risk factors]] may be classified based on travel history, [[Epidemic|epidemics]], [[Outbreak|outbreaks]], food history, animal contact, [[Hospital|hospitalization]] and [[immunosupression]]. The 2017 Infectious Diseases Society of America Clinical Practice Guidelines for the Diagnosis and Management of Infectious Diarrhea lists the [[risk factors]] of diarrhea along with their causative [[Pathogen|pathogens]].
 ==Risk factors==
-Most common risk factors for [[Acute diarrhea]] include: <ref name="pmid29083755">{{cite journal |vauthors=Dunn N, Gossman WG |title= |journal= |volume= |issue= |pages= |year= |pmid=29083755 |doi= |url=}}</ref> <ref name="pmid23804024">{{cite journal |vauthors=Gould LH, Walsh KA, Vieira AR, Herman K, Williams IT, Hall AJ, Cole D |title=Surveillance for foodborne disease outbreaks - United States, 1998-2008 |journal=MMWR Surveill Summ |volume=62 |issue=2 |pages=1–34 |year=2013 |pmid=23804024 |doi= |url=}}</ref>
+According to the '''2017 Infectious Diseases Society of America Clinical Practice Guidelines for the Diagnosis and Management of Infectious Diarrhea''', common [[risk factors]] along with causative [[Pathogen|pathogens]] of diarrhea include the following:<ref name="pmid29083755">{{cite journal |vauthors=Dunn N, Gossman WG |title= |journal= |volume= |issue= |pages= |year= |pmid=29083755 |doi= |url=}}</ref>
-*'''Travel''':
+{{Family tree/start}}
-**Bacteria: Examples: Enterotoxigenic E.coli [[ETEC]], Shigella, Salmonella, Campylobacter, Aeromonas, Plesiomonas.
+{{familytree |boxstyle=text-align: left; | | | | | | B01 | | | |B01='''Contamination''': <br> •Foodborne outbreaks in hotels, cruise ships, resorts, restaurants, catered events  <br> •Consumption of unpasteurized milk or dairy products <br> •Waterborne <br> •Animal exposure <br> •Consumption of raw or undercooked meat or poultry}}
-**Virus: Examples: Rota virus, Noro virus (Cruise ship diarrhea), Enteric Adenovirus.
+{{Family tree | | | | | | |!| | | | | }}
-**Parasites and Protozoans: Examples: Entamoeba histolytica, Cryptosporidium, Giardia.
+{{Family tree | | | | | | |!| | | | | }}
-*'''[[Epidemics]] and [[Outbreaks]]''':
+{{familytree |boxstyle=text-align: left; | A01 |-|-| A02 |-|-|-| A03 | |A01= '''Exposure''': <br> •Child care facilities <br>•Long term care facilities <br>•[[Hospitalisation]] <br>•International travel| A02= '''RISK FACTORS FOR ACUTE DIARRHEA'''| A03='''Host factors''': <br>•[[Immunocompromised]] hosts <br>•Certain sexual practices <br>•Age group <br>•[[Hemochromatosis]] or [[hemoglobinopathy]]}}
-**Bacterial:Shigella, Vibrio cholerae
-**Viral:Noro virus, Rota virus.
+{{Family tree | | | | | | |!| | | | | }}
-**Protozoan: Example: Cryptosporidium
+{{Family tree | | | | | | |!| | | | | }}
-*'''Animal contact:''' Examples: Non typhoidal Salmonella, Campylobacter
+{{familytree |boxstyle=text-align: left; | | | | | | B01 | | | |B01= '''Side effects of pharmacotherapy''': <br>•[[Antimicrobial]] therapy <br>•Drug side effects}}
-*'''Day care:''' Common organisms include Noro virus, Rota virus, Shigella, Cryptosporidium.
+{{Family tree/end}}
-*'''Poor sanitation and crowding'''
-*'''Water exposure:''' Swimming pools and Marine environment (Shigella, Aeromonas, Giardia, Cryptosporidium)
+==== Contamination ====
-*'''Food history:'''
+*Foodborne outbreaks in hotels, cruise ships, resorts, restaurants, catered events<ref name="pmid9282385">{{cite journal |vauthors=Todd EC |title=Epidemiology of foodborne diseases: a worldwide review |journal=World Health Stat Q |volume=50 |issue=1-2 |pages=30–50 |year=1997 |pmid=9282385 |doi= |url=}}</ref>
-**Consumption of raw or undercooked meats,Fish, Canned foods, Raw eggs,Frozen food (Examples: Salmonella, STEC, Clostridium perfringens, L.monocytogenes)
+**[[Shigella]], [[Vibrio cholerae]], [[Bacillus cereus]], [[Staphylococcus aureus]], [[Salmonella|nontyphoidal Salmonella]], [[Clostridium perfringens]], [[Campylobacter]], [[ETEC]], [[Listeria monocytogenes|Listeria]], [[Norovirus]], [[Rotavirus]], [[Cryptosporidium]], [[Cyclospora cayetanensis]]
-*'''Antibiotic use and Hospitalization:'''
+*Consumption of unpasteurized milk or dairy products<ref name="pmid23804024">{{cite journal |vauthors=Gould LH, Walsh KA, Vieira AR, Herman K, Williams IT, Hall AJ, Cole D |title=Surveillance for foodborne disease outbreaks - United States, 1998-2008 |journal=MMWR Surveill Summ |volume=62 |issue=2 |pages=1–34 |year=2013 |pmid=23804024 |doi= |url=}}</ref>
-**[[Clostridium difficile]]
+**[[Salmonella]], [[Campylobacter]], [[Brucella]] (goat milk cheese), [[Coxiella burnetii]], [[Yersinia enterocolitica]], [[Staphylococcus aureus infections|S. aureus toxin]], [[Cryptosporidium]], [[Listeria monocytogenes|Listeria]], [[Mycobacterium bovis]]
-** Drug side effects( eg: Broad spectrum antibiotics, Anti fungals, Immunosuppressants)
+*Consumption of raw or undercooked meat or poultry<ref name="pmid29379258">{{cite journal |vauthors=Somboonwit C, Menezes LJ, Holt DA, Sinnott JT, Shapshak P |title=Current views and challenges on clinical cholera |journal=Bioinformation |volume=13 |issue=12 |pages=405–409 |year=2017 |pmid=29379258 |pmc=5767916 |doi=10.6026/97320630013405 |url=}}</ref>
-**Ischemic colitis(initially acute then chronic)
+**[[Clostridium perfringens|C. perfringens]] (beef, poultry), [[EHEC]] (ground beef), [[Salmonella]] (poultry), Calcivirus (oysters), [[Campylobacter]] (poultry), [[Vibrio]] (oysters),[[Yersinia]] (pork, chitterlings), [[Staphylococcus aureus|S. aureus]] (poultry), and [[Trichinella]] (pork, wild game meat)
-*Homosexual men
+*Consumption of fruits or unpasteurized fruit juices, vegetables, leafy greens, and sprouts
-*'''Immunosupression:''' HIV,CMV, Cryptosporidia, [[Mycobacterium Avium complex]], Medications, Transplant recipients.
+**[[Hepatitis A]],  [[Listeria monocytogenes]], [[Salmonella|Nontyphoidal Salmonella]], [[Cyclospora cayetanensis|Cyclospora]], [[Cryptosporidium]], [[Norovirus]]
-*Old age
+*Consumption of undercooked eggs
+**[[Salmonella]], [[Shigella]] (egg salad)
+*Consumption of raw shellfish
+**[[Hepatitis A]], [[Vibrio]] species, [[Plesiomonas shigelloides|Plesiomonas]], [[Norovirus]]
+*Swimming in or drinking untreated fresh water<ref name="pmid26111239">{{cite journal |vauthors=Guzman-Herrador B, Carlander A, Ethelberg S, Freiesleben de Blasio B, Kuusi M, Lund V, Löfdahl M, MacDonald E, Nichols G, Schönning C, Sudre B, Trönnberg L, Vold L, Semenza JC, Nygård K |title=Waterborne outbreaks in the Nordic countries, 1998 to 2012 |journal=Euro Surveill. |volume=20 |issue=24 |pages= |year=2015 |pmid=26111239 |doi= |url=}}</ref>
+**[[Giardia lamblia|Giardia]], [[Campylobacter]], [[Cryptosporidium]], [[Salmonella]], [[Shigella]], [[Plesiomonas shigelloides]], [[Aeromonas]]
+*Swimming in recreational water facility with treated water<ref name="pmid26111239" /><ref name="pmid28214721">{{cite journal |vauthors=Efstratiou A, Ongerth JE, Karanis P |title=Waterborne transmission of protozoan parasites: Review of worldwide outbreaks - An update 2011-2016 |journal=Water Res. |volume=114 |issue= |pages=14–22 |year=2017 |pmid=28214721 |doi=10.1016/j.watres.2017.01.036 |url=}}</ref>
+**[[Cryptosporidium]]
+*Exposure to house pets with diarrhea
+**[[Campylobacter]], [[Yersinia]]
+*Exposure to pig feces in certain parts of the world
+**[[Balantidium coli]]
+*Contact with young poultry or reptiles
+**[[Salmonella|Nontyphoidal Salmonella]]
+*Visiting a farm or petting zoo
+**[[Cryptosporidium]], [[Campylobacter]]
+==== Host factors ====
+*Age group
+**Birth- 3 months: [[Salmonella|Nontyphoidal Salmonella]]
+**6–18 months: [[Rotavirus]]
+**1–7 years: [[Shigella]]
+**Young adults: [[Campylobacter]]
+**Adults >50 years with a history of [[atherosclerosis]]: [[Salmonella|Nontyphoidal Salmonella]]
+*[[Immunocompromised|Immunocompromised individuals]]
+**[[Salmonella|Nontyphoidal Salmonella]], [[Yersinia]], [[Shigella]], [[Cryptosporidium]], [[Campylobacter]]
+*[[Hemochromatosis]] or [[hemoglobinopathy]]
+**[[Salmonella]], [[Yersinia Enterocolitica Infection|Y. enterocolitica]]
+*[[HIV AIDS|AIDS]], [[Immunosuppression|immunosuppressive therapies]], [[homosexual men]], [[Transplant|transplant recipients]]
+**[[Cytomegalovirus]], [[Mycobacterium avium intracellulare|Mycobacterium avium–intercellulare complex]], [[Cryptosporidium]], [[Cyclospora cayetanensis|Cyclospora]], [[Cystoisospora belli|Cystoisospora]], [[Microsporidia]], [[Human Immunodeficiency Virus (HIV)|HIV]]
+==== Side effects of pharmacotherapy ====
+*Drug side effects<ref name="pmid16319813">{{cite journal |vauthors= |title=Severe Clostridium difficile-associated disease in populations previously at low risk--four states, 2005 |journal=MMWR Morb. Mortal. Wkly. Rep. |volume=54 |issue=47 |pages=1201–5 |year=2005 |pmid=16319813 |doi= |url=}}</ref>
+**[[Antibiotic|Broad spectrum antibiotics]]
+**[[Immunosuppressive drug|Immunosuppressants]]
+**[[Antifungal drug|Antifungals]]
+*Recent [[Antimicrobial|antimicrobial therapy]] and [[Hospital|hospitalization]]<ref name="pmid16319813" />
+**[[Clostridium difficile infection|C. difficile]]
+**Multidrug-resistant [[Salmonella]]
+**[[Rotavirus]]
+==== Exposure ====
+*[[Anal]]-[[Sex organ|genital]], oral-anal, or digital-anal contact
+**[[Shigella]], [[Giardia lamblia]], [[Campylobacter]], [[Entamoeba histolytica|E. histolytica]], [[Cryptosporidium]] and [[Sexually transmitted disease|sexually transmitted infections]], [[Salmonella]]
+*Healthcare, long-term care, prison exposure, or employment
+**[[Norovirus]], [[Clostridium difficile]], [[Shigella]], [[Cryptosporidium]], [[Giardia lamblia|Giardia]], [[Rotavirus]]
+*Day care
+**[[Rotavirus]], [[Cryptosporidium]], [[Giardia lamblia|Giardia]], [[Shigella]], [[Norovirus]], Calcivirus, [[Campylobacter]]
+*Travel to endemic areas, poor [[sanitation]] and crowding<ref name="pmid25928418">{{cite journal |vauthors=Heather CS |title=Travellers' diarrhoea |journal=BMJ Clin Evid |volume=2015 |issue= |pages= |year=2015 |pmid=25928418 |pmc=4415508 |doi= |url=}}</ref>
+**[[Escherichia coli]] ([[EAEC|enteroaggregative]], [[Enterotoxigenic Escherichia coli|enterotoxigenic]], [[Enteroinvasive Escherichia coli infection|enteroinvasive]]), [[Shigella]], [[Salmonella|Typhi and nontyphoidal Salmonella]], [[Campylobacter]], [[Vibrio cholerae]], [[Aeromonas]], [[Plesiomonas shigelloides|Plesiomonas]], [[Rotavirus]], [[Norovirus]] (Cruise ship diarrhea), [[Adenoviridae|enteric Adenovirus]], [[Entamoeba histolytica]], [[Cryptosporidium]], [[Blastocystis]], [[Giardia lamblia|Giardia]], [[Cyclospora cayetanensis|Cyclospora]], [[Cystoisospora belli|Cystoisospora]]
+==References==
+{{Reflist|2}}
+[[Category:Medicine]]
+[[Category:Gastroenterology]]
+[[Category:Up-To-Date]]