Abstract
There is increasing recognition of a widening array of enteric patogens associated with illnesses of the gastrointestinal tract. Along with well-known microorganisms – Salmonella, Shigella and rotaviruses, agents such as enterohemorrhagic E.coli, Cyclospora, Cryptosporidium, Giardia, Campylobacter jejuni, Clostridium difficile, caliciviruses and other enteric virus patogens are increasing cause of acute diarrheal illnesses. Critical to development a cost-effective approach to the evaluation and management of infectious diarrhea is the selective use of available diagnostic methods, therapies, and preventive measures. This article reviews the recommendations that address following: oral rehydration, clinical and epidemiological evaluation, perfomance of selective fecal studies, administration of selective antimicrobial therapy, contradicted antidiarrheals, and available immunizations. This document indicates, which patients to test, what tests are more effective, what medical treatment to use, and what steps to take to ensure that appropriate public health actions are implemented.
-
1.
Gross P.A., Barrett T.L., Dellinger E.P., et al. Purpose of quality standart for infectious diseases. Infectious Diseases Society of America. Cl Infect Dis 1994; 18:421.
-
2.
Bartlett J.G., Breiman R.F., Mandell L.A., Pile T.M.J. Community-acquired pneumonia in adults: guidelines for management. Infectious Diseases Society of America. Clin Infect Dis 1998; 26:811-38.
-
3.
World Health Organization. The World Health report 1996: fighting disease, fostering development. Report of the Director-General. Geneva: World Health Organization, 1996.
-
4.
Guerrant R.L. Why America must care about tropical medicine: threats to global health and security from tropical infectious diseases. Am J Trop Med Hyg 1998; 59:3-16.
-
5.
Herikstadt H., Vergia D., Hadler J., et al. Population-based estimate the burden of diarrheal illnesses: FoodNet 1996-1997. 1st International Conference on Emerging Infecti.ous Diseases (Atlanta), March 1998.
-
6.
Mead P.S., Slutsker L., Dietz V., et al. Food-related illness and death the United States. Emerg Infect Dis 1999; 5:607-25.
-
7.
Nachamkin I., Allos B.M., Ho T. Campylobacter species and Guillain Barre syndrome. Clin Microbiol Rev 1998; 11:555-67.
-
8.
Steiner T.S., Lima A.A.M., Nataro J.P., Guerrant R.L. Enteroaggregative Escherichia coli produce intestinal inflammation and growth impairment and cause interieukin-8 release from intestinal epithelial eel. J Infect Dis 1998; 177:88-96.
-
9.
Checkley W., Gilman R.H., Epstein L.D., et al. The adverse effects of Cryptosporidium parvum infection on the growth of children. In: Program of the 5th Annual Meeting of the National Institute of Allergy and Infectious Diseases (NIAID) International Centers for Tropic Research (ICTDR), 24–26 April 1996. Bethesda, Maryland: NIAID 1996.
-
10.
Guerrant D.I., Moore S.R., Lima A.A.M., Patrick P., Schorling J.B., Guerrant R.L. Association of early childhood diarrhea and cryptosporidiosis with impaired physical fitness and cognitive function 4–7 years later in poor-urban community in Northeast Brazil. Am J Trop Med Hyg 1999; 61:707-13.
-
11.
National Institute of Allergy and Infectious Diseases (NIAID). Foodborne disease fact sheet. 1999. Available at: http://www.niaid. nih.go factsheets/foodbornedis.htm. Accessed 23 January 2001.
-
12.
World Health Organization. The management and prevention of acute diarrhea: practical guidelines. 3d ed. Geneva: WHO, 1993.
-
13.
Bartlett A.V., Moore M., Gary G.W., Starko K.M., Erben J.J., Meredith B.A. Diarrheal illness among infants and toddlers in day care centers. II. Comparison with day care homes and households. J Pediatr 1985; 107:503-9.
-
14.
Ho M-S, Glass R.I., Pinsky P.R., et al. Diarrheal deaths in American children: are they preventable? JAMA l988;260(22):3281-5.
-
15.
DuPont H.L. Guidelines on acute infectious diarrhea in adults. The Practice Parameters Committee of the American College of Gastroenterology. Am J Gastroenterol 1997;92:1962-75.
-
16.
Glass R.I., Lew J.P., Gangarosa R.E., Lebaron C.W., Ho M.S. Estimates of morbidity and mortality rates for diarrheal diseases in American children. J Pediatr 1991; 118:S27-33.
-
17.
Lew J.F., Glass W., Gangarosa R.E., Cohen I.P., Bern C., Moe C.L. Diarrheal deaths in the United States, 1979 through 1987: a special problem for the elderly. JAMA 1991; 265:3280-4.
-
18.
Van Gilder T., Christensen D., Shallow S., et al. Variations in stool handling and culturing practices among clinical microbiology laboratories within the Foodborne Active Surveillance Network (FoodNet): do we need practice guidelines? 99th American Society for Microbiology (Chicago), July 1999.
-
19.
Cheney C.P., Wong R.K. Acute infectious diarrhea. Med Clin N Am 1993; 77:1169-96.
-
20.
Hines J., Nachamkin I. Effective use of the clinical microbiology laboratory for diagnosing diarrheal diseases. Clin Infect Dis 1996; 23:1292-301.
-
21.
Wong C.S., Jelacic S., Habeeb R.L., Watkins S.L., Tarr P.I. The risk of the hemolytic-uremic syndrome after antibiotic treatment of Escherichia coli 0157:H7 infections. N Engl J Med 2000;342:1930-6.
-
22.
Ikeda K., Ida 0., Kimoto K., Takatorige T., Nakanishi N., Tatara K. Effect of early fosfomycin treatment on prevention of hemolytic uremic syndrome accompanying Escherichia coli 0157:H7 infection. Clin Nephrol 1999; 52:357-62.
-
23.
Neill M.A., Opal S.M., Heelan J., et al. Failure of ciprofloxacin to eradicate convalescent fecal excretion after acute salmonellosis: experience during and outbreak in health care workers. Ann Intern Med 1991;114:195-9.
-
24.
Cohen M.L., Tauxe R.V. Drug-resistant Salmonella in the United States: an epidemiologic perspective. Science 1986; 234:964-9.
-
25.
Pavia A.T., Shipman L.D., Wells J.G., et al. Epidemiologic evidence that prior antimicrobial exposure decreases resistance to infection by antimicrobial-sensitive Salmonella. J Infect Dis 1990; 161:255-60.
-
26.
Edmond M.B., Ober J.F., Weinbaum D.L., et al. Vancomycin-resistant Enterococcus faecium bacteremia; risk factors for infection. Clin Infect Dis 1995;20:1126-33.
-
27.
Edmond M.B., Ober I.F., Weinbaum D.L., et al. Risk factors for vancomycin-resistant enterococcal bacteremia [abstract 47]. In: Program and abstract of the 34th International Conference on Antimicrobial Agents and Chemotherapy. Washington, DC: American Society for Microbiology, 1994.
-
28.
Fine K.D., Ogunji F., George J., Niehaus M.D., Guerrant R.L. Utility of a rapid fecal latex agglutination test detecting the neutrophil protein, lactoferrin, for diagnosing inflammatory causes of chronic diarrhea. Am J Gastroenterol 1998; 93:1300-5.
-
29.
Hedberg C.W., MacDonald K.L., Osterholm M.T. Changing epidemio.logy of food-home disease: a Minnesota perspective. Clin Infect Dis 1994; 18:671-80.
-
30.
Hedberg C.W., Hirschhorn N. Why foodborne disease surveillance is critical to the safety of our food supply. Am J Public Health 1996; 86:1076-7.
-
31.
Glynn M.K., Bopp C., Dewitt W., Dabney P., Mokhtar M., Angulo F.J. Emergence of multidrug-resistant Salmonella enterica serotype typhimurium DT104 infections in the United States. N Engl J Med 1998; 338:1333-8.
-
32.
Talan D.A., Moran G.J., Ong S., et al. Prevalence of E.coli О157:H7 and other enteropathogens among patients presenting to US emergency departments with bloody diarrhea [abstract]. In: Abstracts of the International Conference on Emerging Infectious Diseases (Atlanta), 8–11 March 1998.
-
33.
Morris A.J., Murray P.R., Reller L.B. Contemporary testing for enteric pathogens: the potential for cost, time, and health care savings. J Clin Microbiol 1996; 34:1776-8.
-
34.
Bauer T.M., Lalvani A., Fahrenbach J., et al. Derivation and validation of guidelines for stool cultures for enteropathogenic bacteria other than Clostridium difficile in hospitalized adults. JAMA 2001; 285:313-19.
-
35.
Siegel D.L., Edelstein P.H., Nachamkin I. Inappropriate testing for diarrheal diseases in the hospital. JAMA 1990; 263:979-82.
-
36.
Choi S.W., Park C.H., Silva T.M.J., Zaenker E.I., Guerrant R.L. To culture or not to culture: fecal lactoferrin screening for inflammatory bacterial diarrhea. J Clin Microbiol 1996; 34:928-32.
-
37.
Eidlitz-Marcus T., Cohen Y.H., Nussinovitch M., Elian I., Varsano I. Comparative efficacy of two- and five-day courses of ceftriaxone for treatment of severe shigellosis in children. J Pediatr 1993; 123:822-4.
-
38.
Slutsker L., Ries A.A., Greene K.D., Wells J.G., Hutwagner L., Griffin P.M. Escherichia coli О157:H7 diarrhea in the United States: clinical and epidemiologic features. Ann Intern Med 1997; 126:505-13.
-
39.
Guerrant R.L., Wanke C.A., Barren L.J., Schwartzman J.D. A cost effective and effective approach to the diagnosis and management of acute infectious diarrhea. Bull NY Acad Med 1987; 63:484-99.
-
40.
Mead P.S., Griffin P.M. Escherichia coli О157-H7. Lancet 1998; 352: 1207-12.
-
41.
Tarr P.I., Neill M.A. Perspective: the problem of non-О157:H7 Shiga toxin (verocytotoxin)-producing Escherichia coli. J Infect Dis 1996;174:1136-9.
-
42.
Kehl K.S., Havens P., Behnke C.E., Acheson D.W. Evaluation of the premier EHEC assay for detection of Shiga toxin-producing Esche.richia coli. J Clin Microbiol 1997; 35:2051-4.
-
43.
Lee L.A., Taylor J., Carter G.P., Quinn B., Fanner J.J., Tauxe R.V. Yersinia enterocolitica O:3: an emerging cause of pediatric gastroenteritis in the United States. The Yersinia enterocolitica Collaborative Study Group. J Infect Dis 1991; 163:660-3.
-
44.
Morris A.J., Wilson M.L., Reller L.B. Application of rejection criteria for stool ovum and parasite examinations. J Clin Microbiol 1992; 30:3213-6.
-
45.
Guerrant R.L., Bobak D.A. Bacterial and protozoal gastroenteritis. N Engl I Med 1991; 325:327-40.
-
46.
Subcommittee on Acute Gastroenteritis. Practice parameter: the management of acute gastroenteritis in young children. American Academy of Pediatrics, Provisional Committee on Quality Improvement. Pediatrics 1996:97:424-35.
-
47.
Anonymous. Water with sugar and salt [editorial]. Lancet 1978; 2:300-1.
-
48.
Avery M.E., Snyder J.D. Oral therapy for acute diarrhea: the underused simple solution. N Engl J Med 1990; 323:891-4.
-
49.
Molla A.M., Molla A., Nath S.K., Khatun M. Food-based oral rehydration salt solutions for acute childhood diarrhoea. Lancet 1989; 2:429-31.
-
50.
Silva A.C., Santos-Neto M.S., Scares A.M., Fonteles M.C., Guerrant R.L., Lima A.A.M. Efficacy of a glutamine-based oral rehydration solution on the electrolyte and water absorption in a rabbit model of secretory diarrhea induced by cholera toxin. J Pediatr Gastroenterol Nutr 1998; 26:513-9;533-5.
-
51.
Thielman N.M., Guerrant R.L. An algorithmic approach to the workup and management of HIV-related diarrhea. J Clin Outcomes Management 1997; 4:36-47.
-
52.
Tacconelh E., Tumbarello M., Donati K.D., Leone F., Mazzella P., Cauda R. Clostridium difficile-associated diarrhea in human immunodeficiency virus infection: a changing scenario. Clin Infect Dis 1999; 28:936-7.
-
53.
McNeely W.S., DuPont H.L., Mathewson J.J., Oberhelman R.A., Ericsson C.D. Occult blood versus fecal leukocytes in the diagnosis of bacterial diarrhea: a study of US travelers to Mexico and Mexican children. Am J Trop Med Hyg 1996; 55:430-3.
-
54.
Munoz C., Baqar S., van de Verg L., et al. Characteristics of Shigella sonnei infection of volunteers: signs, symptoms, immune responses, changes in selected cytokines and acute-phase substances. Am J Trop Med Hyg 1995; 53:47-54.
-
55.
Speelman P., McGlaughlin R., Kabir I., Butler T. Differential clinical features and stool findings in shigellosis and amoebic dysentery. Trans Roy Soc Trop Med Hyg 1987; 81:549-51.
-
56.
Iida T., Naka A., Suthienkul O., Sakaue Y., Guerrant R.L., Honda T. Measurement of fecal lactoferrin for rapid diagnosis of enterohemorrhagic Escherichia coli infection. Clin Infect Dis 1997; 25:167.
-
57.
Centers for Disease Control and Prevention. Foodborne outbreaks of enterotoxigenic Escherichia coli; Rhode Island and New Hampshire, 1993 [published erratum appears in MMWR Morb Mortal Wkly Rep 1994; 43:127]. MMWR Morb Mortal Wkly Rep 1994; 43:81-9.
-
58.
Donowitz M., Kokke F.T., Saidi R. Evaluation of patients with chronic diarrhea. N Engl J Med 1995; 332:725-9.
-
59.
Bennish M.L., Salam M.A., Khan W.A., Khan A.M. Treatment of shigel.losis: III. Comparison of one- or two-dose ciprofloxacin with standard 5-day therapy. A randomized, blinded trial. Ann Intern Med 1992; 117:727-34.
-
60.
Khan W.A., Seas C., Dhar U., Salam M.A., Bennish M.L. Treatment of shigellosis: V. Comparison of azithromycin and ciprofloxacin. A double-blind, randomized, controlled trial. Ann Intern Med 1997; 126:697-703.
-
61.
Mandal B.K., Ellis M.E., Dunbar E.M., Whale K. Double-blind placebo-controlled trial of erythromycin in the treatment of clinical Campylobacter infection. J Antimicrob Chemother 1984; 13:619-23.
-
62.
Smith K.E., Besser J.M., Hedberg C.W., et al. Quinolone-resistant Campylobacter jejuni infections in Minnesota, 1992-1998. N Engl J Med 1999; 340:1525-32.
-
63.
Segreti J., Gootz T.D., Goodman L.J., et al. High-level quinolone resistance in clinical isolates of Campylobacter jejuni. J Infect Dis 1992; 165:667-70.
-
64.
Williams M.D., Schorling J.B., Barrett L.J., et al. Early treatment of Campylobacter jejuni enteritis [published erratum appears in Antimicrob Agents Chemother 1989;33 (7):1129]. Antimicrob Agents Chemother 1989; 33:248-50.
-
65.
Olsen S.J., Debess E., Marano N., et al. Transmission of multidrug-resistant Salmonella associated with fluoroquinolone use in a nursing home [abstract 61]. In: Program and abstracts of the 37th Annual Meeting of the Infectious Diseases Society of America. Alexandria, Virginia; Infectious Diseases Society of America, 1999:34.
-
66.
Bell B.P., Griffin P.M., Lozano P., Christie D.L., Kobayashi J.M., Tarr P.I. Predictors of hemolytic uremic syndrome in children during a large outbreak of Escherichia coli O157:H7 infections. Pediatrics 1997; 100:E12.
-
67.
Zhang X.P., McDaniel A.D., Wolf L.E., Keusch G.T., Waldor M.K., Acheson D.K. Quinolone antibiotics induce Shiga toxin—encoding bacteriophages, toxin production, and death in mice. J Infect Dis 2000; 181:664-70.
-
68.
Cimolai N., Morrison B.J., Carter J.E. Risk factors for the central nervous system manifestations of gastroenteritis-associated hemolytic-uremic syndrome. Pediatrics 1992; 90:616-21.
-
69.
Conteas C.N., Berlin O.G., Speck C.E., Pandhumas S.S., Lariviere M.I., Fu C. Modification of the clinical course of intestinal microsporidiosis in acquired immunodeficiency syndrome patients by immune status and anti-human immunodeficiency virus therapy. Am J Trop Med Hyg 1998; 58:555-8.
-
70.
Fekety R. Guidelines for the diagnosis and management of Clostridium difficile-associated diarrhea and colitis. American College of Gastroenterology Practice Parameters Committee. Am J Gastroenterol 1997; 92:739-50.
-
71.
Benenson A.S. Salmonellosis. In: American Public Health Association, ed. Control of communicable diseases manual. Washington, DC: American Public Health Association, 1995:410-5.
-
72.
American Academy of Pediatrics. Report of the Committee on Infectious Diseases. Evanston, IL: American Academy of Pediatrics, 1997.
-
73.
Angulo F.J., Swerdlow D.L. Bacterial enteric infections in persons infected with human immunodeficiency virus. Clin Infect Dis 1995;21(Suppl):93.
-
74.
Mandal B.K. Treatment of multiresistant typhoid fever. Lancet 1990; 336:1383.
-
75.
Mattila L., Peltola H., Siitonen A., Kyronseppa H., Simula I., Kataja M. Short-term treatment of traveler’s diarrhea with norfloxacin: a double-blind, placebo-controlled study during two seasons. Clin Infect Dis 1993; 17:779-82.
-
76.
Prado D., Lopez E., Liu H., et al. Ceftibuten and trimethoprim-sulfamethoxazole for treatment of shigella and enteroinvasive Escherichia coli disease. Pediatr Infect Dis J 1992; 11:644-7.
-
77.
Proulx F., Turgeon J.P., Delage G., Lafleur L., Chicoine L. Randomized, controlled trial of antibiotic therapy for Escherichia coli O157:H7 enteritis. J Pediatr 1992; 121:299-303.
-
78.
Kain K.C., Kelly M.T. Clinical features, epidemiology, and treatment of Plesiomonas shigelloides diarrhea. J Clin Microbiol 1989; 27:998-1001.
-
79.
Nathwani D., Laing R.B.,-Harvey G., Smith C.C. Treatment of symptomatic enteric Aeromonas hydrophila infection with ciprofloxacin Scand J Infect Dis 1991; 23:653-4.
-
80.
Ostroff S.M., Kapperud G., Lassen J., Aasen S., Tauxe R.V. Clinical features of sporadic Yersinia enterocolitica infections in Norway. J Infect D 1992; 166:812-7.
-
81.
Scavizzi M. Yersinia enterocolitica. In: Yu V.L., Merlgan T.C., Barrie S.L., eds. Antimicrobial therapy and vaccines. Baltimore: Williams Wilkins; 1999:481-8.
-
82.
Khan W.A., Bennish M.L., Seas C., et al. Randomised controlled comparison of single-dose Ciprofloxacin and doxycycline for cholera caused by Vibrio cholerae O1 or O139. Lancet 1996; 348:296-300.
-
83.
Wenisch C., Parschalk B., Hasenhundl M., Hirschl A.M., Graninger W. Comparison of vancomycin, teicoplanin, metronidazole, and fusidic acid for the treatment of Clostridium difficile-associated diarrhea [published erratum appears in Clin Infect Dis 1996;23(2):423]. Clin Infect Dis 1996; 22:813-8.
-
84.
Lerman S.J., Walker R.A. Treatment of giardiasis: literature review and recommendations. Clin Pediatr (Phila) 1982; 21:409-14.
-
85.
Wanke C.A., Gerrior J., Blais V., Mayer H., Acheson D. Successful treatment of diarrheal disease associated with enteroaggregative Escherichia coli in adults infected with human immunodeficiency virus. J Infect Dis 1998;178:1369-72.
-
86.
Foudraine N.A., Weverling G.J., van Gool T., et al. Improvement of chronic diarrhoea in patients with advanced HIV-1 infection during potent antiretroviral therapy. AIDS 1998; 12:35-41.
-
87.
Hoge C.W., Shilm D.R., Ghimire M., et al. Placebo-controlled trial of co-trimoxazole for cyclospora infections among travellers and foreign residents in Nepal [published erratum appears in Lancet 1995; 345: 1060]. Lancet 1995; 345:691-3.
-
88.
Molina J.M., Chastang C., Goguel J., et al. Albendazole for treatment and prophylaxis of microsporidiosis due to Encephalitozoon intestina in patients with AIDS: a randomized double-blind controlled trial Infect Dis 1998; 177:1373-7.