Definition
- Diarrhea: Change in normal bowel movements characterized by increase in frequency, water content or volume of stools
- ≥3 episodes/day or at least 250 g/stool per day
- Acute diarrhea: Diarrhea lasting ≤14 days duration
- Patient should not have had antibiotic treatment within the past 3 months, no prior hospitalizations and/or no diarrhea after >48 hours of hospital admission
- Prolonged diarrhea: Diarrhea lasting 7-13 days
- Persistent diarrhea: Diarrhea lasting >14 days but <30 days
- Chronic diarrhea: May be considered as diarrhea lasting ≥30 days
- Infectious diarrhea: Diarrhea of infectious origin (bacterial, viral, protozoal, fungal) and is usually associated with symptoms of nausea and vomiting (N/V), abdominal cramps and fever
- Commonly transmitted by the fecal-oral route via food, water and person-to-person contact
- Dysentery (invasive diarrhea): Presence of visible blood in diarrheic stool
Signs and Symptoms
- Determine abrupt or gradual onset, duration and progression of symptoms
- Onset and frequency of bowel movement
- Amount of stool excreted
- If dysenteric symptoms are present (eg fever, tenesmus, blood/pus in stool)
Associated Symptoms
- Frequency and intensity of N/V, abdominal pain, cramps, myalgia, headache, altered sensorium
Stool Characteristics
- Watery, bloody, purulent, greasy, with mucus
Signs and Symptoms of Volume Depletion
- Thirst
- Tachycardia
- Orthostasis
- Decreased urination
- Lethargy
Risk Factors
Epidemiological Risk Factors
- Place of residence
- Likely pathogens from long-term care residence or prisons include norovirus, rotavirus, Clostridioides difficile, Shiga toxin-producing Escherichia coli (STEC), Shigella, Giardia
- Travel to a developing country
- Potential pathogens include norovirus, enteroaggregative E coli (EAEC), enteropathogenic E coli (EPEC), enterotoxigenic E coli (ETEC), Campylobacter, Shigella, non-typhoidal Salmonella, Cryptosporidia, Cyclospora spp, Entamoeba histolytica, Giardia, rarely Vibrio cholerae, Balantidium coli
- Cyclospora spp is a likely pathogen from traveling to tropical or semitropical regions
- Cruise ship travel
- Common pathogen is norovirus, occasionally ETEC
- Daycare attendance, employment
- Potential pathogens from a daycare include norovirus, rotavirus, Shigella, STEC, Cryptosporidia, Giardia
- Ingestion of unsafe, rotten or ill-prepared foods (eg raw meats, eggs, shellfish, etc)
- Foodborne infection may be due to Campylobacter spp and Salmonella spp; raw shellfish may contain norovirus, Vibrio spp, Plesiomonas shigelloides
- Swimming/drinking untreated fresh water
- Cryptosporidia is a likely pathogen from swimming in public pools while Giardia may be present in untreated fresh water
- Visit to farm or contact with pets with diarrhea
- Potential pathogens from a petting farm or pets include STEC, Campylobacter, Yersinia, Cryptosporidia; pig feces may contain Yersinia enterocolitica or B coli
- Contact with other ill persons
- Recent or regular medications (eg antibiotics, antacids, antimotility agents)
- Potential pathogen for prior antibiotic use may include C difficile
- Underlying medical conditions (acquired immunodeficiency syndrome [AIDS], immunosuppressed, elderly)
- Potential pathogens in immunosuppressed individuals include cytomegalovirus, Herpes simplex virus, Mycobacterium avium complex, Cryptosporidia, Cystoisospora belli, Histoplasma, microsporidia
- Receptive anal or oral-anal sexual contact
- Likely pathogens from anal contact include Shigella (including multidrug resistant species); other pathogens such as E histolytica spread via fecal-oral contact
- Occupation as food-handler or caregiver