Bacterial gastroenteritis: Difference between revisions
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''See [[Acute gastroenteritis (peds)]] for pediatric patients''
<languages/>
<translate>
''See [[Special:MyLanguage/Acute gastroenteritis (peds)|Acute gastroenteritis (peds)]] for pediatric patients''
 
==Background==
==Background==
*Most acute gastroenteritis (AGE) is viral, not bacterial
*Most acute gastroenteritis (AGE) is viral, not bacterial
*Blood diarrhea suggests bacterial etiology
*[[Special:MyLanguage/rectal bleeding|Bloody diarrhea]] suggests bacterial etiology
*Do NOT diagnosis isolated vomiting as AGE
*Do NOT diagnose isolated vomiting as AGE
 


===Clinical Features and Causes===
===Clinical Features and Causes===
{| class="wikitable"
{| class="wikitable"
|+ Noninvasive AGE
|+ Noninvasive AGE
|-
|-
! Species!! Onset !! Symptoms !! Transmisison !! Preformed Toxin
! Species!! Onset !! Symptoms !! Transmission !! Preformed Toxin
|-
|-
| Viral (norovirus, adenovirus, rotavirus)
| Viral ([[Special:MyLanguage/norovirus|norovirus]], [[Special:MyLanguage/adenovirus|adenovirus]], [[Special:MyLanguage/rotavirus|rotavirus]])
|| 11-72 hrs
|| 11-72 hrs
||  
||  
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|| No
|| No
|-
|-
| [[S. aureus|Staph]]
| [[Special:MyLanguage/S. aureus|Staph]]
|| 1-6 hrs
|| 1-6 hrs
||  
||  
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|| Yes
|| Yes
|-
|-
| [[Bacillus cereus|B. cereus]]
| [[Special:MyLanguage/Bacillus cereus|B. cereus]]
|| 1-6 hrs
|| 1-6 hrs
||  
||  
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|| Yes
|| Yes
|-
|-
| [[Clostridium (not difficile)|C. perfringens]]
| [[Special:MyLanguage/Clostridium (not difficile)|C. perfringens]]
|| 8-24 hrs
|| 8-24 hrs
||  
||  
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|| Yes
|| Yes
|-
|-
| [[Vibrio cholera|V. cholerae]]|| 11-72 hrs ||  
| [[Special:MyLanguage/Vibrio cholera|V. cholerae]]|| 11-72 hrs ||  
*Explosive rice-water diarrhea
*Explosive rice-water diarrhea
*Vomiting, abdominal cramps
*Vomiting, abdominal cramps
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|| No
|| No
|-
|-
| [[Giardia]]
| [[Special:MyLanguage/Giardia|Giardia]]
|| 1-4 wks
|| 1-4 wks
||  
||  
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! scope="col" | '''Transmission'''
! scope="col" | '''Transmission'''
|-
|-
| [[Salmonella]]||6-72 hours||
| [[Special:MyLanguage/Salmonella|Salmonella]]||6-72 hours||
*[[Fever]], relative bradycardia
*[[Special:MyLanguage/Fever|Fever]], relative bradycardia
*[[Abdominal pain]]
*[[Special:MyLanguage/Abdominal pain|Abdominal pain]]
*Bloody diarrhea
*Bloody diarrhea
*[[Headache]]
*[[Special:MyLanguage/Headache|Headache]]
*Osteomyelitis in sickle cell
*Osteomyelitis in sickle cell
||
||
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*Reptiles
*Reptiles
|-
|-
| [[Shigella]]||1-3 days||
| [[Special:MyLanguage/Shigella|Shigella]]||1-3 days||
*[[Fever]]
*[[Special:MyLanguage/Fever|Fever]]
*[[Abdominal pain]]
*[[Special:MyLanguage/Abdominal pain|Abdominal pain]]
*Bloody diarrhea
*Bloody diarrhea
*[[Headache]]
*[[Special:MyLanguage/Headache|Headache]]
*1-5 years old
*1-5 years old
*Seizures in children
*Seizures in children
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*Fecal-Oral
*Fecal-Oral
|-
|-
| [[Yersinia]]||1-5 days||
| [[Special:MyLanguage/Yersinia|Yersinia]]||1-5 days||
*[[Appendicitis]] mimic, [[RLQ pain]]
*[[Special:MyLanguage/Appendicitis|Appendicitis]] mimic, [[Special:MyLanguage/RLQ pain|RLQ pain]]
*[[Fever]]
*[[Special:MyLanguage/Fever|Fever]]
*[[Vomiting]]
*[[Special:MyLanguage/Vomiting|Vomiting]]
*Kids and Young Adults
*Kids and Young Adults
||
||
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*Fecal-Oral
*Fecal-Oral
|-
|-
| [[Campylobacter]]||1-7 days||
| [[Special:MyLanguage/Campylobacter|Campylobacter]]||1-7 days||
*Low grade [[fever]]
*Low grade [[Special:MyLanguage/fever|fever]]
*[[Abdominal pain]]
*[[Special:MyLanguage/Abdominal pain|Abdominal pain]]
*Kids and Young Adults
*Kids and Young Adults
*Guillain-Barre
*Guillain-Barre
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*Pets/Animals
*Pets/Animals
|-
|-
| [[C. Diff]]||1-11 Weeks||
| [[Special:MyLanguage/C. Diff|C. Diff]]||1-11 Weeks||
*Copious FOUL diarrhea
*Copious FOUL diarrhea
||
||
*Antibiotic use: [[PCN]], [[Clinda]], [[Cephalosporins]]
*Antibiotic use: [[Special:MyLanguage/PCN|PCN]], [[Special:MyLanguage/Clinda|Clinda]], [[Special:MyLanguage/Cephalosporins|Cephalosporins]]
|-
|-
| [[Entamoeba]]||1-11 weeks||
| [[Special:MyLanguage/Entamoeba|Entamoeba]]||1-11 weeks||
*[[Appendicitis]] Mimic
*[[Special:MyLanguage/Appendicitis|Appendicitis]] Mimic
*[[Abdominal pain]], [[nausea/vomiting]], [[diarrhea]]
*[[Special:MyLanguage/Abdominal pain|Abdominal pain]], [[Special:MyLanguage/nausea/vomiting|nausea/vomiting]], [[Special:MyLanguage/diarrhea|diarrhea]]
||
||
*Water
*Water
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*Travel
*Travel
|}
|}
==Differential Diagnosis==
==Differential Diagnosis==
</translate>
{{Abdominal Pain DDX Diffuse}}
{{Abdominal Pain DDX Diffuse}}
<translate>
</translate>
{{Nausea and vomiting DDX}}
{{Nausea and vomiting DDX}}
<translate>
==Evaluation==
==Evaluation==
*Assess hydration status
*Assess hydration status
**Cap refill, skin turgor, respiratory rate
**Cap refill, skin turgor, respiratory rate
*Consider stool studeies if:
*Consider stool studies if:
**>10 stools in previous 24hr
**>10 stools in previous 24hr
**[[Traveler's diarrhea|Travel to high-risk country]]
**[[Special:MyLanguage/Traveler's diarrhea|Travel to high-risk country]]
**Fever
**Fever
**Bloody stool
**Bloody stool
**Persistent diarrhea
**Persistent diarrhea


==Management==
==Management==
#Rehydration (PO preferred)
 
#[[Special:MyLanguage/oral rehydration therapy|Rehydration]] (PO preferred)
#*30mL(1oz)/kg/hr
#*30mL(1oz)/kg/hr
#*[[Reduced-osmolarity oral rehydration solution]]
#*[[Special:MyLanguage/Reduced-osmolarity oral rehydration solution|Reduced-osmolarity oral rehydration solution]]
#Antiemetic
#Antiemetic
#*[[Ondansetron]] 0.15mg/kg/dose IV/PO
#*[[Special:MyLanguage/Ondansetron|Ondansetron]] 0.15mg/kg/dose IV/PO
#[[Antibiotics]]
#[[Special:MyLanguage/Antibiotics|Antibiotics]]
#*Only consider in patients with invasive infection
#*Only consider in patients with invasive infection
#**[[Shigella]], [[campylobacter]], [[E. coli]], [[yersinia]], [[vibrio]]
#**[[Special:MyLanguage/Shigella|Shigella]], [[Special:MyLanguage/campylobacter|campylobacter]], [[Special:MyLanguage/E. coli|E. coli]], [[Special:MyLanguage/yersinia|yersinia]], [[Special:MyLanguage/vibrio|vibrio]]
#**Bloody stool with mucus and fever
#**Bloody stool with mucus and fever
#*NOT indicated for [[E. coli]] O157:H7
#*NOT indicated for [[Special:MyLanguage/E. coli|E. coli]] O157:H7
#*NOT routinely indicated for salmonella
#*NOT routinely indicated for salmonella
#**Exceptions: SCD, [[IBD]], <3mo
#**Exceptions: [[Special:MyLanguage/sickle cell|SCD]], [[Special:MyLanguage/IBD|IBD]], <3mo
#*[[Azithromycin]] (able to tolerate PO)
#*[[Special:MyLanguage/Azithromycin|Azithromycin]] (able to tolerate PO)
#*OR [[ciprofloxacin]]
#*'''OR''' [[Special:MyLanguage/ciprofloxacin|ciprofloxacin]]
#*OR [[TMP-SMX]]
#*'''OR''' [[Special:MyLanguage/TMP-SMX|TMP-SMX]]
#*[[Ceftriaxone]] (parenteral)
#*[[Special:MyLanguage/Ceftriaxone|Ceftriaxone]] (parenteral)
 
 
==Disposition==
==Disposition==
*Most can be discharged
*Most can be discharged
*Admit
*Admit
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**Hemodynamic instability
**Hemodynamic instability
**Significant comorbidities
**Significant comorbidities


==See Also==
==See Also==
*[[Acute gastroenteritis]]
 
*[[Nausea and Vomiting]]
*[[Special:MyLanguage/Acute gastroenteritis|Acute gastroenteritis]]
*[[Acute gastroenteritis (peds)]]
*[[Special:MyLanguage/Nausea and Vomiting|Nausea and Vomiting]]
*[[Dehydration]]
*[[Special:MyLanguage/Acute gastroenteritis (peds)|Acute gastroenteritis (peds)]]
*[[Acute diarrhea]]
*[[Special:MyLanguage/Dehydration|Dehydration]]
*[[Special:MyLanguage/Acute diarrhea|Acute diarrhea]]
 


==External Links==
==External Links==


==References==
==References==
<references/>
<references/>


[[Category:ID]] [[Category:GI]]
[[Category:ID]] [[Category:GI]]
</translate>

Revision as of 21:43, 4 January 2026

Other languages:

See Acute gastroenteritis (peds) for pediatric patients

Background

  • Most acute gastroenteritis (AGE) is viral, not bacterial
  • Bloody diarrhea suggests bacterial etiology
  • Do NOT diagnose isolated vomiting as AGE


Clinical Features and Causes

Noninvasive AGE
Species Onset Symptoms Transmission Preformed Toxin
Viral (norovirus, adenovirus, rotavirus) 11-72 hrs
  • Nausea, vomiting, watery diarrhea
  • Mild abdominal cramps, myalgia
  • Fecal-oral
  • Contaminated food or water
 No
Staph 1-6 hrs
  • Nausea, severe vomiting, diarrhea,
  • Mild abdominal cramping
  • Previously cooked foods (mayonaise, ham, salads)
 Yes
B. cereus 1-6 hrs
  • Abrupt onset of nausea, vomiting, mild diarrhea
  • Previously cooked foods (rice, vegetables, dried fruits, meat)
 Yes
C. perfringens 8-24 hrs
  • Nausea, minimal vomiting, watery diarrhea
  • Abd cramps
  • Previously cooked or reheated meats and poultry
 Yes
V. cholerae 11-72 hrs
  • Explosive rice-water diarrhea
  • Vomiting, abdominal cramps
  • Fever
  • Fecal-oral
  • Contaminated food or water
 No
Giardia 1-4 wks
  • Flatus, bloating
  • Foul-smelling and fatty stools (steatorrhea)
  • Fecal-oral
  • Contaminated water
 No
Invasive AGE
Species Onset Symptoms Transmission
Salmonella 6-72 hours
  • Eggs
  • Poultry
  • Water
  • Reptiles
Shigella 1-3 days
  • Food
  • Fecal-Oral
Yersinia 1-5 days
  • Water
  • Milk
  • Pork
  • Wild Animals
  • Fecal-Oral
Campylobacter 1-7 days
  • Water
  • Poultry
  • Pets/Animals
C. Diff 1-11 Weeks
  • Copious FOUL diarrhea
Entamoeba 1-11 weeks
  • Water
  • Sanitation
  • Travel

Differential Diagnosis

Diffuse Abdominal pain

Nausea and vomiting

Critical

Emergent

Nonemergent


Evaluation

  • Assess hydration status
    • Cap refill, skin turgor, respiratory rate
  • Consider stool studies if:


Management

  1. Rehydration (PO preferred)
  2. Antiemetic
  3. Antibiotics


Disposition

  • Most can be discharged
  • Admit
    • Unable to tolerate PO
    • Hemodynamic instability
    • Significant comorbidities


See Also


External Links

References

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