Chapter 122. Acute Infectious Diarrheal Diseases and Bacterial Food Poisoning (Part 1)

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Harrison's Internal Medicine Chapter 122. Acute Infectious Diarrheal Diseases and Bacterial Food Poisoning Acute Infectious Diarrheal Diseases and Bacterial Food Poisoning: Introduction Ranging from mild annoyances during vacations to devastating dehydrating illnesses that can kill within hours, acute gastrointestinal illnesses rank second only to acute upper respiratory illnesses as the most common diseases worldwide.

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Chapter 122. Acute Infectious Diarrheal Diseases and Bacterial Food Poisoning (Part 1) Harrison's Internal Medicine > Chapter 122. Acute Infectious Diarrheal Diseases and Bacterial Food Poisoning Acute Infectious Diarrheal Diseases and Bacterial Food Poisoning: Introduction Ranging from mild annoyances during vacations to devastating dehydrating illnesses that can kill within hours, acute gastrointestinal illnesses rank second only to acute upper respiratory illnesses as the most common diseases worldwide. In children
areas, >50% of childhood deaths are directly attributable to acute diarrheal illnesses. In addition, by contributing to malnutrition and thereby reducing resistance to other infectious agents, gastrointestinal illnesses may be indirect factors in a far greater burden of disease. The wide range of clinical manifestations of acute gastrointestinal illnesses is matched by the wide variety of infectious agents involved, including viruses, bacteria, and parasitic pathogens (Table 122-1). This chapter discusses factors that enable gastrointestinal pathogens to cause disease, reviews host defense mechanisms, and delineates an approach to the evaluation and treatment of patients presenting with acute diarrhea. Individual organisms causing acute gastrointestinal illnesses are discussed in detail in subsequent chapters. Table 122-1 Gastrointestinal Pathogens Causing Acute Diarrhea Mechanism Locati Illness Stool Exampl on Findings es of Pathogens Involved Noninflamma Proxi Watery No fecal Vibrio mal small leukocytes; cholerae,
tory (enterotoxin) bowel diarrhea mild or no enterotoxigenic increase in fecal Escherichia lactoferrin coli (LT and/or ST), enteroaggregati ve E. coli, Clostridium perfringens, Bacillus cereus, Staphylococcus aureus, Aeromonas hydrophila, Plesiomonas shigelloides, rotavirus, norovirus, enteric adenoviruses, Giardia
lamblia, Cryptosporidiu m spp., Cyclospora spp., microsporidia Inflammatory Colon Dysent Fecal Shigella (invasion or or distal ery or polymorphonuc spp., cytotoxin) small bowel inflammatory lear leukocytes; Salmonella diarrhea substantial spp., increase in fecal Campylobacter lactoferrin jejuni, enterohemorrha gic E. coli, enteroinvasive E. coli, Yersinia enterocolitica, Vibrio parahaemolytic
us, Clostridium difficile, ?A. hydrophila, ?P. shigelloides, Entamoeba histolytica Penetrating Distal Enteric Fecal Salmone small bowel fever mononuclear lla typhi, Y. leukocytes enterocolitica, ?Campylobacte r fetus Abbreviations: LT, heat-labile enterotoxin; ST, heat-stable enterotoxin. Source: After Guerrant and Steiner.