Severe Diarrhea
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Severe Diarrhea
Determined as diarrhea lasting two weeks or less. One of five leading reasons of
death worldwide. Ninety percent of cases are caused by infectious agents.
Most of these agents are viral, but severe cases are more often caused by
bacteria (1.5–5.6% of mild cases are due to bacterial transmission, vs. 87% of severe
cases). The remaining 10% are due to medicaments, toxin ingestion, and
ischemia. Some chronic cases present acutely, as in IBD or diverticulitis.
Risk factors for serious infection are as follows:
■ Travel: Forty percent of travelers to Asia, Latin America, or Africa get “traveler’s
diarrhea.” The most common infectious agents are enterotoxigenic
E. coli, Campylobacter, Shigella, and Salmonella. Campers, backpackers,
and travelers to Russia are susceptible to Giardia.
■ Contaminated food ingestion: Usually associated with food consumption
at picnics, banquets, or restaurants. Commonly implicated foods include
chicken, hamburger (enterohemorrhagic E. coli), fried rice, mayonnaise,
eggs, and raw seafood.
■ High-risk populations: Include immunocompromised patients, day care
workers and their contacts, and health care workers.
■ Recent antibiotic use: Can be related or unrelated to C. difficile infection.
