Infectious Diarrhea: IDSA Updates Guidelines for Diagnosis and Management
Am Fam Physician. 2018 May 15;97(10):676-677.
Author disclosure: No relevant financial affiliations.
Key Points for Practice
• Diagnostic testing is not routinely recommended in patients with uncomplicated traveler's diarrhea.
• If diarrhea is accompanied by fever, bloody stools, abdominal cramping, or signs of sepsis, stool should be tested for Salmonella, Shigella, Campylobacter, Yersinia, Clostridium difficile, and STEC.
• Clinicians should evaluate patients with diarrhea for postinfectious and extraintestinal manifestations associated with enteric infections.
From the AFP Editors
There are many possible sources of infectious diarrhea, including consumption of shellfish, raw milk, unpasteurized juice, undercooked meats, fish, or eggs, or contaminated fruits or vegetables; exposure to contaminated drinking or recreational water; exposure in health care and child care settings; international travel; contact with infected animals or feces; and recent antimicrobial therapy. Pathogens can also be spread through anal or oral contact. Infectious diarrhea is usually self-limited, but diagnostic testing and treatment are indicated in some cases.
The Infectious Diseases Society of America (IDSA) has updated its 2001 guidelines for the management of children and adults with suspected or confirmed infectious diarrhea. The main points are highlighted here. Other topics can be found in the original guideline.
CLINICAL, DEMOGRAPHIC, AND EPIDEMIOLOGIC FEATURES
A detailed history should be obtained from any patient with diarrhea. Diarrhea caused by foodborne and waterborne illness is especially important to identify to help prevent outbreaks. Local reporting recommendations should be followed if a patient with diarrhea works in a child care center, long-term care facility, health care center, food service, or recreational water venues (e.g., pools, lakes).
Patients with fever or bloody diarrhea should be evaluated for enteropathogens for which antimicrobial agents may be beneficial, including Salmonella enterica, Shigella, and Campylobacter. Identifying these bacteria can avoid unnecessary antibiotic therapy and procedures such as colonoscopy, abdominal surgery, or ulcerative colitis treatment. Additionally, stool tests that are negative for infectious pathogens increase suspicion for a noninfectious cause (e.g., inflammatory bowel disease).
Enteric fever should be considered in those with fever, with or without diarrhea, and a relevant history (e.g., recent travel to an endemic area, consumption of foods prepared by a recent traveler to an endemic area, or laboratory exposure to Salmonella typhi or Salmonella paratyphi. Enteric fever is rarely associated with diarrhea.
All patients with diarrhea should be
Coverage of guidelines from other organizations does not imply endorsement by AFP or the AAFP.
This series is coordinated by Sumi Sexton, MD, Editor-in-Chief.
A collection of Practice Guidelines published in AFP is available at https://www.aafp.org/afp/practguide.
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