Chapter 040. Diarrhea and Constipation (Part 5)

Table 40-2 Association between Pathobiology of Causative Agents and Clinical Features in Acute Infectious DiarrheaPathobiolo gy/Agents bationIncu mitingVoAbd ominal Pain everF rrheaDiaPeriodToxin producersPreforme d toxinBacillus cereus, Staphylococcus aureus, h1–8 4+3–1–2+ –1+0 4+, watery3–Clostridi um perfringens h8–24Enterotox inVibrio cholerae, enterotoxigenic Escherichia coli, Klebsiella pneumoniae, Aeromonas h8–72 4+2–1–2+ –1+0 4+, watery3–speciesEnteroadhe rentEnteropat hogenic and d1–8 1+0–1–3+ –2+0 2+,1–enteroadherent E. coli, Giardiawatery, mushyorganisms, cryptosporidiosis, helminthsCytotoxinproducersClostridiu m difficile d1–3 1+0–3–4+ –2+1 3+,1–usually watery, occasionally bloody ...
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Chapter 040. Diarrhea and Constipation (Part 5) Chapter 040. Diarrhea and Constipation (Part 5) Table 40-2 Association between Pathobiology of Causative Agents andClinical Features in Acute Infectious Diarrhea Pathobiolo Incu Vo Abd F Diagy/Agents bation miting ominal ever rrhea Period Pain Toxinproducers Preformed toxin Bacillus 1–8 3– 1–2+ 0 3–cereus, h 4+ –1+ 4+,Staphylococcus wateryaureus, Clostridi 8–24um perfringens h Enterotoxin Vibrio 8–72 2– 1–2+ 0 3–cholerae, h 4+ –1+ 4+,enterotoxigenic wateryEscherichia coli,Klebsiellapneumoniae,Aeromonasspecies Enteroadherent Enteropat 1–8 0– 1–3+ 0 1–hogenic and d 1+ –2+ 2+,enteroadherent E. watery,coli, Giardia mushyorganisms,cryptosporidiosis,helminths Cytotoxin-producers Clostridiu 1–3 0– 3–4+ 1 1–m difficile d 1+ –2+ 3+, usually watery, occasional ly bloody Hemorrha 12– 0– 3–4+ 1 1–gic E. coli 72 h 1+ –2+ 3+, initially watery, quickly bloody Invasiveorganisms Minimalinflammation Rotaviru 1–3 1– 2–3+ 3 1–s and Norwalk d 3+ –4+ 3+,agent watery Variableinflammation Salmone 12 0– 2–4+ 3 1–lla, h–11 d 3+ –4+ 4+,Campylobacter, watery orand Aeromonas bloodyspecies, Vibrioparahaemolyticus,Yersinia Severeinflammation Shigella 12 0– 3–4+ 3 1–species, h–8 d 1+ –4+ 2+,enteroinvasive E. bloodycoli, Entamoebahistolytica Source: Adapted from DW Powell, in T Yamada (ed): Textbook ofGastroenterology and Hepatology, 4th ed. Philadelphia, Lippincott Williams &Wilkins, 2003; and DR Syndman, in SL Gorbach (ed): Infectious Diarrhea.London, Blackwell, 1986. Finally, infectious diarrhea may be associated with systemicmanifestations. Reiters syndrome (arthritis, urethritis, and conjunctivitis) mayaccompany or follow infections by Salmonella, Campylobacter, Shigella, andYersinia. Yersiniosis may also lead to an autoimmune-type thyroiditis,pericarditis, and glomerulonephritis. Both enterohemorrhagic E. coli (O157:H7)and Shigella can lead to the hemolytic-uremic syndrome with an attendant highmortality rate. The syndrome of postinfectious IBS has now been recognized as acomplication of infectious diarrhea. Acute diarrhea can also be a major symptomof several systemic infections including viral hepatitis, listeriosis, legionellosis,and toxic shock syndrome.