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Diarrhea, Acute

For further information, see CMDT Part 15-06: Diarrhea

Key Features

Essentials of Diagnosis

  • Diarrhea of less than 2 weeks' duration is most commonly caused by invasive or noninvasive pathogens and their enterotoxins

Acute noninflammatory diarrhea

  • Watery, nonbloody

  • Usually mild, self-limited

  • Caused by a virus or noninvasive bacteria

  • Diagnostic evaluation is limited to patients with diarrhea that is severe or persists beyond 7 days

Acute inflammatory diarrhea

  • Blood or pus, fever

  • Usually caused by an invasive or toxin-producing bacterium

  • Diagnostic evaluation requires routine stool bacterial testing (including Escherichia coli O157:H5 and O157:H7) in all and testing as clinically indicated for Clostridioides difficile and parasites

General Considerations

  • Most commonly caused by infectious agents, bacterial toxins (Table 30–3), or drugs

  • Recent illnesses in family members suggests infectious diarrhea

  • Community outbreaks (schools, nursing homes, cruise ships) suggest viral etiology or common food source

  • Ingestion of improperly stored or prepared food implicates toxin-secreting or invasive bacteria

  • Exposure to unpurified water suggests Giardia or Cryptosporidium

  • Large Cyclospora outbreaks have been traced to contaminated produce

  • Recent travel abroad suggests "traveler's diarrhea"

  • Antibiotic administration suggests C difficile colitis

  • HIV infection or sexually transmitted diseases suggest AIDS-associated diarrhea

  • Proctitis and rectal discharge suggest gonorrhea, syphilis, lymphogranuloma venereum, and herpes simplex

Table 30–3.Acute bacterial diarrheas and “food poisoning” (listed in alphabetical order).
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Table 30–3. Acute bacterial diarrheas and “food poisoning” (listed in alphabetical order).
Organism Incubation Period Vomiting Diarrhea Fever Associated Foods Diagnosis Clinical Features and Treatment
Bacillus cereus (diarrheal toxin) 10–16 hours ± +++ – Toxin in meats, stews, and gravy. Clinical. Food and stool can be tested for toxin. Abdominal cramps, watery diarrhea, and nausea lasting 24–48 hours. Supportive care.
Bacillus cereus (preformed toxin) 1–8 hours +++ ± – Reheated fried rice causes vomiting or diarrhea. Clinical. Food and stool can be tested for toxin. Acute onset, severe nausea and vomiting lasting 24 hours. Supportive care.
Campylobacter jejuni 2–5 days ± +++ + Raw or undercooked poultry, unpasteurized milk, water. Stool culture on special medium. Fever, diarrhea that can be bloody, cramps. Usually self-limited in 2–10 days. Treat with azithromycin and secondarily fluoroquinolones for severe disease. May be associated with Guillain-Barré syndrome.
Clostridium botulinum 12–72 hours ± – – Clostridia grow in anaerobic acidic environment eg, canned foods, fermented fish, foods held warm for extended periods. Stool, serum, and food can be tested for toxin. Stool and food can be cultured. Diplopia, dysphagia, dysphonia, respiratory embarrassment. Treatment requires clear airway, ventilation, and intravenous polyvalent antitoxin (see text). Symptoms can last for days to months.
Clostridioides difficile Usually occurs after 7–10 days of antibiotics. Can occur after a single dose or several weeks after completion of antibiotics. – +++ ++ Associated with ...

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