Chapter 040. Diarrhea and Constipation (Part 5)

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Table 40-2 Association between Pathobiology of Causative Agents and Clinical Features in Acute Infectious Diarrhea Pathobiolo gy/Agents bation Incu miting Vo Abd ominal Pain ever F rrhea Dia Period Toxin producers Preforme d toxin Bacillus cereus, Staphylococcus aureus, h 1–8 4+ 3– 1–2+ –1+ 0 4+, watery 3– Clostridi um perfringens h 8–24 Enterotox in Vibrio cholerae, enterotoxigenic Escherichia coli, Klebsiella pneumoniae, Aeromonas h 8–72 4+ 2– 1–2+ –1+ 0 4+, watery 3– species Enteroadhe rent Enteropat hogenic and d 1–8 1+ 0– 1–3+ –2+ 0 2+, 1– enteroadherent E. coli, Giardia watery, mushy organisms, cryptosporidiosis, helminths Cytotoxinproducers Clostridiu m difficile d 1–3 1+ 0– 3–4+ –2+ 1 3+, 1– usually watery, occasional ly bloody ...

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Chapter 040. Diarrhea and Constipation (Part 5) Table 40-2 Association between Pathobiology of Causative Agents and Clinical Features in Acute Infectious Diarrhea Pathobiolo Incu Vo Abd F Dia gy/Agents bation miting ominal ever rrhea Period Pain Toxin producers
Preforme d toxin Bacillus 1–8 3– 1–2+ 0 3– cereus, h 4+ –1+ 4+, Staphylococcus watery aureus, Clostridi 8–24 um perfringens h Enterotox in Vibrio 8–72 2– 1–2+ 0 3– cholerae, h 4+ –1+ 4+, enterotoxigenic watery Escherichia coli, Klebsiella pneumoniae, Aeromonas
species Enteroadhe rent Enteropat 1–8 0– 1–3+ 0 1– hogenic and d 1+ –2+ 2+, enteroadherent E. watery, coli, Giardia mushy organisms, cryptosporidiosis, helminths Cytotoxin- producers Clostridiu 1–3 0– 3–4+ 1 1– m difficile d 1+ –2+ 3+, usually watery, occasional
ly bloody Hemorrha 12– 0– 3–4+ 1 1– gic E. coli 72 h 1+ –2+ 3+, initially watery, quickly bloody Invasive organisms Minimal inflammation Rotaviru 1–3 1– 2–3+ 3 1– s and Norwalk d 3+ –4+ 3+, agent watery Variable inflammation
Salmone 12 0– 2–4+ 3 1– lla, h–11 d 3+ –4+ 4+, Campylobacter, watery or and Aeromonas bloody species, Vibrio parahaemolyticus, Yersinia Severe inflammation Shigella 12 0– 3–4+ 3 1– species, h–8 d 1+ –4+ 2+, enteroinvasive E. bloody coli, Entamoeba histolytica Source: Adapted from DW Powell, in T Yamada (ed): Textbook of Gastroenterology and Hepatology, 4th ed. Philadelphia, Lippincott Williams & Wilkins, 2003; and DR Syndman, in SL Gorbach (ed): Infectious Diarrhea. London, Blackwell, 1986.
Finally, infectious diarrhea may be associated with systemic manifestations. Reiter's syndrome (arthritis, urethritis, and conjunctivitis) may accompany or follow infections by Salmonella, Campylobacter, Shigella, and Yersinia. Yersiniosis may also lead to an autoimmune-type thyroiditis, pericarditis, and glomerulonephritis. Both enterohemorrhagic E. coli (O157:H7) and Shigella can lead to the hemolytic-uremic syndrome with an attendant high mortality rate. The syndrome of postinfectious IBS has now been recognized as a complication of infectious diarrhea. Acute diarrhea can also be a major symptom of several systemic infections including viral hepatitis, listeriosis, legionellosis, and toxic shock syndrome.