Article Figures & Data
Figures
- Figure 1
The CH2OPD2 exposure history mnemonic device
Data from Marshall et al.35
Tables
PATHOGEN SYMPTOMS AND UNIQUE FEATURES TREATMENT AND PREVENTION SPECIAL RISK GROUPS Bacteria • Campylobacter Diarrhea, fever; 50% of children have blood in stools
Incubation 3 d (range 1–7 d)Self-limited; rare use of fluoroquinolones or azithromycin Pregnant women, children, the elderly, immunocompromised patients
Users of PPIs
Those handling raw meat, especially poultry
Users of private wells• Salmonella Fever more common; nausea, diarrhea, cramps
Incubation 8–72 h (longer if water-borne than if food-borne)Rehydration
Occasional antibiotics, especially in children younger than 1 y or in severe illnessCorticosteroid users
Patients with AIDS or cancer
Transplant recipients• Shigella Highly infective
Abdominal pain, frequent but low-volume stools
Affects lower GI tract, so dehydration is less commonOral rehydration
Antibiotic use more common
Azithromycin or ceftriaxone in those < 18 y
Fluoroquinolone in those 18 y or older
Avoid antimotility agentsYoung children
Patients with poor nutrition
International travelers• Enteropathogenic Escherichia coli Highly infective, short incubation
Enterotoxin-producing strains cause bloody diarrhea and hemolytic uremic syndrome (higher risk in children)Monitor creatinine
Avoid antibioticsChildren, the elderly
Commonly, those in the same household as the infected patientProtozoan parasites • Giardia Incubation 7–14 d
Loose, foul-smelling stools; flatulence; fatigue
Induces lactose intoleranceOral metronidazole if symptomatic
Lactose avoidance
Avoid swimming until asymptomatic for 14 dThose with immune deficiencies
Children < 5 y
Wilderness water users• Cryptosporidium Incubation 5–7 d
The organism is chlorine-resistantSelf-limiting in immunocompetent patients
Nitazoxanide for young children (some trials have also used it in adults with HIV)Those with immune deficiencies
Solid organ transplant recipients after surgeryViruses • Rotavirus More severe and prolonged diarrhea Rehydration
Vaccine 50% effective for preventionChildren < 5 y
Unimmunized patients• Norovirus (Norwalk-like virus) Short incubation Rehydration
Probiotics (limited evidence)
Zinc if malnourishedYoung children, the elderly
Those with immune deficiencies• Adenovirus Respiratory and GI symptoms Fever, pneumonia, and diarrhea in children
KeratoconjunctivitisSymptomatic treatment Young children
Those with immune deficienciesHarmful algal bloom toxins • Microcystin-LR and many others; released by some algal blooms Exacerbations of asthma; hepatic and neurotoxins; probable carcinogens Supportive treatment
Avoid swimming in water with visible algal bloomsToxic to all age groups -
GI—gastrointestinal, PPI—proton pump inhibitors.
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- Table 2
Clinical dehydration scale: A score of 0 represents no dehydration, 1–4 represents some dehydration, and 5–8 represents moderate to severe dehydration; higher score is predictive of need for IV fluids and longer ED stay after assessment by physician (P < .01).
ASSESSED FEATURE POSSIBLE SCORE General appearance 0–2 Eyes 0–2 Mucous membranes 0–2 Tears 0–2 -
ED—emergency department, IV—intravenous.
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Data from Bailey et al.30
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