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==Risk factors==  
==Risk factors==  
Most common risk factors for [[Acute diarrhea]] include:<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><ref name="pmid29083755">{{cite journal |vauthors=Dunn N, Gossman WG |title= |journal= |volume= |issue= |pages= |year= |pmid=29083755 |doi= |url=}}</ref><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><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><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><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><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><ref name="pmid15880088">{{cite journal |vauthors=Niyogi SK |title=Shigellosis |journal=J. Microbiol. |volume=43 |issue=2 |pages=133–43 |year=2005 |pmid=15880088 |doi= |url=}}</ref><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>
Most common risk factors for [[Acute diarrhea]] include:<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><ref name="pmid29083755">{{cite journal |vauthors=Dunn N, Gossman WG |title= |journal= |volume= |issue= |pages= |year= |pmid=29083755 |doi= |url=}}</ref><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><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><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><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><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><ref name="pmid15880088">{{cite journal |vauthors=Niyogi SK |title=Shigellosis |journal=J. Microbiol. |volume=43 |issue=2 |pages=133–43 |year=2005 |pmid=15880088 |doi= |url=}}</ref><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>
*Travel to endemic areas
**
**Bacteria''':''' Enterotoxigenic E.coli ([[ETEC]]), Shigella, Salmonella, Campylobacter, Aeromonas, Plesiomonas
**Virus: Rota virus, Noro virus (Cruise ship diarrhea), enteric Adenovirus
**Protozoans: Entamoeba histolytica, Cryptosporidium, Giardia
*Epidemics and Outbreaks:  
*Epidemics and Outbreaks:  
**Bacterial: Shigella, Vibrio cholerae
**Bacterial: Shigella, Vibrio cholerae
Line 34: Line 31:
*Old age  
*Old age  
Foodborne
Foodborne
*Foodborne outbreaks in hotels, cruise ships, resorts,restaurants, catered events:Norovirus, nontyphoidal Salmonella, Clostridium perfringens, Bacillus cereus, Staphylococcus aureus, Campylobacter spp, ETEC, STEC, Listeria, Shigella, Cyclospora cayetanensis,Cryptosporidium spp
*Foodborne outbreaks in hotels, cruise ships, resorts, restaurants, catered events
*Consumption of unpasteurized milk or dairy products:Salmonella, Campylobacter, Yersinia enterocolitica, S. aureus toxin, Cryptosporidium, and STEC. Listeria is infrequently associated with diarrhea, Brucella (goat milk cheese),Mycobacterium bovis, Coxiella burnetii
**Norovirus, nontyphoidal Salmonella, Clostridium perfringens, Bacillus cereus, Staphylococcus aureus, Campylobacter spp, ETEC, STEC, Listeria, Shigella, Cyclospora cayetanensis, Cryptosporidium spp
*Consumption of raw or undercooked meat or poultry:STEC (beef), C. perfringens (beef, poultry), Salmonella (poultry), Campylobacter (poultry),Yersinia (pork, chitterlings), S. aureus (poultry), and Trichinella spp (pork, wild game meat)
*Consumption of unpasteurized milk or dairy products  
*Consumption of fruits or unpasteurized fruit juices, vegetables, leafy greens, and sprouts:STEC, nontyphoidal Salmonella, Cyclospora, Cryptosporidium, norovirus, hepatitis A, and Listeria monocytogenes
**Salmonella, Campylobacter, Yersinia enterocolitica, S. aureus toxin, Cryptosporidium, and STEC, Listeria, Brucella (goat milk cheese), Mycobacterium bovis, Coxiella burnetii
*Consumption of undercooked eggs: Salmonella, Shigella (egg salad)
*Consumption of raw or undercooked meat or poultry
*Consumption of raw shellfish:Vibrio species, norovirus, hepatitis A, Plesiomonas
**STEC (beef), C. perfringens (beef, poultry), Salmonella (poultry), Campylobacter (poultry),Yersinia (pork, chitterlings), S. aureus (poultry), and Trichinella spp (pork, wild game meat)
*Consumption of fruits or unpasteurized fruit juices, vegetables, leafy greens, and sprouts
**STEC, nontyphoidal Salmonella, Cyclospora, Cryptosporidium, norovirus, hepatitis A, and Listeria monocytogenes
*Consumption of undercooked eggs  
**Salmonella, Shigella (egg salad)
*Consumption of raw shellfish
**Vibrio species, norovirus, hepatitis A, Plesiomonas


Contact or exposure
Contact or exposure
*Swimming in or drinking untreated fresh water:Campylobacter, Cryptosporidium, Giardia, Shigella, Salmonella, STEC, Plesiomonas shigelloides
*Swimming in or drinking untreated fresh water
*Swimming in recreational water facility with treated water:Cryptosporidium and other potentially waterborne pathogens when disinfectant concentrations are inadequately maintained
**Campylobacter, Cryptosporidium, Giardia, Shigella, Salmonella, STEC, Plesiomonas shigelloides
*Healthcare, long-term care, prison exposure, or employment:Norovirus, Clostridium difficile, Shigella, Cryptosporidium, Giardia, STEC, rotavirus
*Swimming in recreational water facility with treated water
*Child care center attendance or employment:Rotavirus, Cryptosporidium, Giardia, Shigella, STEC
**Cryptosporidium and other potentially waterborne pathogens when disinfectant concentrations are inadequately maintained
*Recent antimicrobial therapy:C. difficile, multidrug-resistant Salmonella
*Healthcare, long-term care, prison exposure, or employment
*Travel to resource-challenged countries:Escherichia coli (enteroaggregative, enterotoxigenic, enteroinvasive), Shigella, Typhi and
**Norovirus, Clostridium difficile, Shigella, Cryptosporidium, Giardia, STEC, rotavirus
nontyphoidal Salmonella, Campylobacter, Vibrio cholerae, Entamoeba histolytica, Giardia,
*Child care center attendance or employment
Blastocystis, Cyclospora, Cystoisospora, Cryptosporidium
**Rotavirus, Cryptosporidium, Giardia, Shigella, STEC
*Exposure to house pets with diarrhea:Campylobacter, Yersinia
*Recent antimicrobial therapy
*Exposure to pig feces in certain parts of the world:Balantidium coli
**C. difficile, multidrug-resistant Salmonella
*Contact with young poultry or reptiles: Nontyphoidal Salmonella
*Travel to endemic areas
*Visiting a farm or petting zoo:STEC, Cryptosporidium, Campylobacter
**Bacteria: Escherichia coli (enteroaggregative, enterotoxigenic, enteroinvasive), Shigella, Typhi and nontyphoidal Salmonella, Campylobacter, Vibrio cholerae, Aeromonas, Plesiomonas
**Virus: Rota virus, Noro virus (Cruise ship diarrhea), enteric Adenovirus
**Protozoans: Entamoeba histolytica, Cryptosporidium, Blastocystis, Giardia, Cyclospora, Cystoisospora
 
*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
**STEC, Cryptosporidium, Campylobacter


Exposure or condition
Exposure or condition
*Age group: Rotavirus (6–18 months of age), nontyphoidal Salmonella (infants from birth to 3 months of
*Age group
age and adults >50 years with a history of atherosclerosis), Shigella (1–7 years of age),
**Rotavirus (6–18 months of age), nontyphoidal Salmonella (infants from birth to 3 months of age and adults >50 years with a history of atherosclerosis), Shigella (1–7 years of age),Campylobacter (young adults)
Campylobacter (young adults)
 
*Underlying immunocompromising condition:Nontyphoidal Salmonella, Cryptosporidium, Campylobacter, Shigella, Yersinia
*Underlying immunocompromising condition
*Hemochromatosis or hemoglobinopathy:Y. enterocolitica, Salmonella
**Nontyphoidal Salmonella, Cryptosporidium, Campylobacter, Shigella, Yersinia
*AIDS, immunosuppressive therapies:Cryptosporidium, Cyclospora, Cystoisospora, microsporidia, Mycobacterium avium–intercellulare
*Hemochromatosis or hemoglobinopathy
complex, cytomegalovirus
**Y. enterocolitica, Salmonella
*Anal-genital, oral-anal, or digital-anal contact:Shigella, Salmonella, Campylobacter, E. histolytica, Giardia lamblia, Cryptosporidium as well as
*AIDS, immunosuppressive therapies
sexually transmitted infections
**Cryptosporidium, Cyclospora, Cystoisospora, microsporidia, Mycobacterium avium–intercellulare complex, cytomegalovirus


*Anal-genital, oral-anal, or digital-anal contact
**Shigella, Salmonella, Campylobacter, E. histolytica, Giardia lamblia, Cryptosporidium as well as sexually transmitted infections


==References==
==References==
{{Reflist|2}}
{{Reflist|2}}

Revision as of 15:19, 8 February 2018

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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 risk factors of Acute diarrhea can be assessed based on the epidemiologic associations and the patient exposure histories. Some of theses factors can be classified based on travel history, epidemics and outbreaks, Food history, Animal contact, Hospitalization and immunosupression.

Risk factors

Most common risk factors for Acute diarrhea include:[1][2][3][4][5][6][7][8][9]

  • Epidemics and Outbreaks:
    • Bacterial: Shigella, Vibrio cholerae
    • Virus: Noro virus, Rotavirus
    • Protozoan: Cryptosporidium
  • Animal contact: Non typhoidal Salmonella, Campylobacter
  • Day care: Common organisms include Noro virus, Rota virus, Calci virus, Campylobacter, Shigella, Cryptosporidium.
  • Poor sanitation and crowding
  • Water exposure: Swimming pools and Marine environment (Shigella, Aeromonas, Giardia, Cryptosporidium)
  • Food history: Consumption of raw or undercooked food is a common risk factor in the development of acute diarrhea.
    • Raw eggs: Salmonella
    • Diary food: Campylobacter, Salmonella
    • Ground beef: EHEC
    • Poultry: Campylobacter
    • Oysters: Calci virus, Vibrio
  • Antibiotic use and hospitalization:
    • Clostridium difficle, Rota virus.
  • Drug side effects: Broad spectrum antibiotics, Anti fungals, Immunosuppressants)
  • Homosexual men
  • Immunosupression: HIV, CMV, Cryptosporidia, Mycobacterium Avium complex,
  • Transplant recipients
  • Old age

Foodborne

  • Foodborne outbreaks in hotels, cruise ships, resorts, restaurants, catered events
    • Norovirus, nontyphoidal Salmonella, Clostridium perfringens, Bacillus cereus, Staphylococcus aureus, Campylobacter spp, ETEC, STEC, Listeria, Shigella, Cyclospora cayetanensis, Cryptosporidium spp
  • Consumption of unpasteurized milk or dairy products
    • Salmonella, Campylobacter, Yersinia enterocolitica, S. aureus toxin, Cryptosporidium, and STEC, Listeria, Brucella (goat milk cheese), Mycobacterium bovis, Coxiella burnetii
  • Consumption of raw or undercooked meat or poultry
    • STEC (beef), C. perfringens (beef, poultry), Salmonella (poultry), Campylobacter (poultry),Yersinia (pork, chitterlings), S. aureus (poultry), and Trichinella spp (pork, wild game meat)
  • Consumption of fruits or unpasteurized fruit juices, vegetables, leafy greens, and sprouts
    • STEC, nontyphoidal Salmonella, Cyclospora, Cryptosporidium, norovirus, hepatitis A, and Listeria monocytogenes
  • Consumption of undercooked eggs
    • Salmonella, Shigella (egg salad)
  • Consumption of raw shellfish
    • Vibrio species, norovirus, hepatitis A, Plesiomonas

Contact or exposure

  • Swimming in or drinking untreated fresh water
    • Campylobacter, Cryptosporidium, Giardia, Shigella, Salmonella, STEC, Plesiomonas shigelloides
  • Swimming in recreational water facility with treated water
    • Cryptosporidium and other potentially waterborne pathogens when disinfectant concentrations are inadequately maintained
  • Healthcare, long-term care, prison exposure, or employment
    • Norovirus, Clostridium difficile, Shigella, Cryptosporidium, Giardia, STEC, rotavirus
  • Child care center attendance or employment
    • Rotavirus, Cryptosporidium, Giardia, Shigella, STEC
  • Recent antimicrobial therapy
    • C. difficile, multidrug-resistant Salmonella
  • Travel to endemic areas
    • Bacteria: Escherichia coli (enteroaggregative, enterotoxigenic, enteroinvasive), Shigella, Typhi and nontyphoidal Salmonella, Campylobacter, Vibrio cholerae, Aeromonas, Plesiomonas
    • Virus: Rota virus, Noro virus (Cruise ship diarrhea), enteric Adenovirus
    • Protozoans: Entamoeba histolytica, Cryptosporidium, Blastocystis, Giardia, Cyclospora, Cystoisospora
  • 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
    • STEC, Cryptosporidium, Campylobacter

Exposure or condition

  • Age group
    • Rotavirus (6–18 months of age), nontyphoidal Salmonella (infants from birth to 3 months of age and adults >50 years with a history of atherosclerosis), Shigella (1–7 years of age),Campylobacter (young adults)
  • Underlying immunocompromising condition
    • Nontyphoidal Salmonella, Cryptosporidium, Campylobacter, Shigella, Yersinia
  • Hemochromatosis or hemoglobinopathy
    • Y. enterocolitica, Salmonella
  • AIDS, immunosuppressive therapies
    • Cryptosporidium, Cyclospora, Cystoisospora, microsporidia, Mycobacterium avium–intercellulare complex, cytomegalovirus
  • Anal-genital, oral-anal, or digital-anal contact
    • Shigella, Salmonella, Campylobacter, E. histolytica, Giardia lamblia, Cryptosporidium as well as sexually transmitted infections

References

  1. ↑ Heather CS (2015). "Travellers' diarrhoea". BMJ Clin Evid. 2015. PMC 4415508. PMID 25928418.
  2. ↑ Dunn N, Gossman WG. PMID 29083755. Missing or empty |title= (help)
  3. ↑ Todd EC (1997). "Epidemiology of foodborne diseases: a worldwide review". World Health Stat Q. 50 (1–2): 30–50. PMID 9282385.
  4. ↑ 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.
  5. ↑ "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.
  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.
  7. ↑ 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.
  8. ↑ Niyogi SK (2005). "Shigellosis". J. Microbiol. 43 (2): 133–43. PMID 15880088.
  9. ↑ 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.
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