Gastroenteritis%20-%20bacterial Signs and Symptoms

Watery Diarrhea

• Semi-formed to loose-watery stools without the presence of blood
• Often clinical presentation of enterotoxin-induced diarrhea

Bloody Diarrhea

• Bloody diarrhea is considered if macroscopic exam of stools contains blood

• Diarrhea is defined as any change in normal bowel movements characterized by increase in frequency, water content or volume of stools or with bloody stools
  • Usual stool output is 10 g/kg/day

• Infectious diarrhea is defined as diarrhea of infectious origin and is usually associated with symptoms of nausea and vomiting (N/V), fever  and abdominal cramps

• Usually affects children >2 years of age
• Second leading cause of mortality in children <5 years of age globally
• Transmission is through fecal-oral route, ingestion of contaminated meat, or exposure to poultry and other farm animals

• Common pathogens causing pediatric bacterial gastroenteritis include Escherichia coli, Salmonella sp, Shigella sp, Clostridiodes difficile, Campylobacter jejuni, and Yersinia enterocolitica

Traveler's Diarrhea 

• Causes of acute traveler’s diarrhea will vary from one geographical area to another
• Enterotoxigenic E coli is one of the most frequently identified organisms
• Campylobacter infections seem to predominate as the cause of traveler’s diarrhea in North Africa and Southeast Asia
• Other common bacterial causes: Enteroaggregative E coli (EAEC), Salmonella, Shigella sp, Campylobacter jejuni

Watery Diarrhea

• Severe dehydration with severe watery diarrhea is most likely caused by Vibrio cholerae subgroup O1 
• Vibrio O139, other non-O1 vibrios and occasionally Vibrio parahaemolyticus, Aeromonas sp and enteropathogenic/enterotoxigenic Escherichia coli can cause a similar clinical picture (though diarrhea by these organisms usually causes milder forms of diarrheal illness)

Bloody Diarrhea 

• Shigella sp and Campylobacter jejuni
  • Shigella dysenteriae and Shigella flexneri may cause a more severe disease with high fever
  • Shigella boydii and Shigella sonnei cause a milder disease
• Salmonella enteritidis, Yersinia enterocolitica, C difficile, Balantidium coli, Plesiomonas, enterohemorrhagic E coli (EHEC) and enteroinvasive E coli (EIEC) can produce bloody diarrhea

Associated Symptoms  

• Frequency and intensity of nausea and vomiting, abdominal pain, cramps, myalgia, headache, altered sensorium

Symptoms of Volume Depletion

• Thirst
• Tachycardia
• Orthostasis
• Decreased urination
• Decrease in skin turgor
• Lethargy

Cholera

• Highly suggested by severe profuse watery diarrhea and dehydration
• Other clinical features: Very abrupt onset of acute diarrhea with rapid progression to severe dehydration, the presence of muscle cramps but no fever or abdominal pain
• Stools are usually greenish-yellow, clear, watery with little food residue

Bloody Diarrhea

• Patients often have fever that may last >2 days and might be high (>38.5°C)
• May initially suffer with watery diarrhea that rapidly changes to bloody diarrhea and dysentery
• Mild dehydration
• Red blood cell (RBC) and white blood cell (WBC) are found on microscopic exam of the stools
• Dysentery
  • Suggested by frequent passage (10-30x/day) of small-volume stools that consist of blood, mucus and pus
  • Patient usually suffers abdominal cramps and tenesmus

• Travel to developing/underdeveloped areas
• Daycare attendance
• Ingestion of unsafe foods (eg unpasteurized dairy products, undercooked meats, seafood)
• Swimming/drinking untreated fresh water
• Poor personal and public hygiene (eg seldom practice of handwashing)
• Visit to farm or contact with pets with diarrhea
• Knowledge of other ill persons
• Recent or regular medications (eg antibiotics)
• Underlying medical conditions (eg AIDS, immunosuppressants)