Acute infectious diarrheal diseases

B. cereus can produce either a syndrome with a short incubation period— the emetic form, mediated by a staphylococcal type of enterotoxin—or one with a longer incubation period (8–16 h)—the diarrheal form, caused by an enterotoxin resembling E. coli LT, in which diarrhea and abdominal cramps are characteristic but vomiting is uncommon. The emetic form of B. cereus food poisoning is associated with contaminated fried rice; the organism is common in uncooked rice, and its heat-resistant spores survive boiling. If cooked rice is not refrigerated, the spores can germinate and produce toxin.

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Loperamide should not be used by patients with fever or dysentery; its use may prolong diarrhea in patients with infection due to Shigella or other invasive organisms. b The recommended antibacterial drugs are as follows: Travel to high-risk country other than Thailand: Adults: (1) A fluoroquinolone such as ciprofloxacin, 750 mg as a single dose or 500 mg bid for 3 days; levofloxacin, 500 mg as a single dose or 500 mg qd for 3 days; or norfloxacin, 800 mg as a single dose or 400 mg bid for 3 days. (2) Azithromycin, 1000 mg as a single dose or 500 mg qd...

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Age Most of the morbidity and mortality from enteric pathogens involves children

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History The answers to questions with high discriminating value can quickly narrow the range of potential causes of diarrhea and help determine whether treatment is needed. Important elements of the narrative history are detailed in Fig. 122-1. Physical Examination The examination of patients for signs of dehydration provides essential information about the severity of the diarrheal illness and the need for rapid therapy. Mild dehydration is indicated by thirst, dry mouth, decreased axillary sweat, decreased urine output, and slight weight loss.

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Host Defenses Given the enormous number of microorganisms ingested with every meal, the normal host must combat a constant influx of potential enteric pathogens. Studies of infections in patients with alterations in defense mechanisms have led to a greater understanding of the variety of ways in which the normal host can protect itself against disease. Normal Flora The large numbers of bacteria that normally inhabit the intestine act as an important host defense by preventing colonization by potential enteric pathogens.

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Pathogenic Mechanisms Enteric pathogens have developed a variety of tactics to overcome host defenses. Understanding the virulence factors employed by these organisms is important in the diagnosis and treatment of clinical disease. Inoculum Size The number of microorganisms that must be ingested to cause disease varies considerably from species to species. For Shigella, enterohemorrhagic Escherichia coli, Giardia lamblia, or Entamoeba, as few as 10–100 bacteria or cysts can produce infection, while 105–108Vibrio cholerae organisms must be ingested orally to cause disease.

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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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