Bacterial gastroenteritis

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