Gastroenteritis and Diarrhoea and Vomiting (D&V)
Gastroenteritis is inflammation of the stomach and small intestine causing ≥3 liquid or loose stools/diarrhoea in 24 hours with or without vomiting.
Clinical Features
• Liquid or loose stool, which takes the shape of the container it is put in
• Vomiting
• Speed of onset related to infectious cause
- Minutes to hours caused by preformed toxin
- Hours to days caused by viruses and bacteria
• Systemic symptoms, fever, sweats, chills, aches and pains, caused by Campylobacter sp.,
typhoid and paratyphoid
• Chronic symptoms commonly caused by parasites
• Vomiting
• Speed of onset related to infectious cause
- Minutes to hours caused by preformed toxin
- Hours to days caused by viruses and bacteria
• Systemic symptoms, fever, sweats, chills, aches and pains, caused by Campylobacter sp.,
typhoid and paratyphoid
• Chronic symptoms commonly caused by parasites
Causes
CommonPreformed toxin
• Staphylococcus aureus • Bacillus cereus • Clostridium perfringens Viruses • Norovirus • Rotavirus • Adenovirus Bacteria • Campylobacter sp. • Shigella sp. • Salmonella sp. • Escherichia coli, including O157 • Clostridium difficile Parasites • Cryptosporidium parvum • Giardia lamblia |
Returned travellersBacteria
As per common plus: • Vibrio cholerae • Vibrio parahaemolyticus • Salmonella typhi (typhoid) • Salmonella paratyphi (paratyphoid) |
Investigations
• Stool
- Microscopy for ova, cysts and parasites (OCP)
- Culture for bacteria
- Toxin testing for Clostridium difficile
- Antigen testing for viruses
- Microscopy for ova, cysts and parasites (OCP)
- Culture for bacteria
- Toxin testing for Clostridium difficile
- Antigen testing for viruses
Treatment
Supportive treatment only (adequate hydration) in patients with a normal immune system except for:
• Clostridium difficile (see section – Clinical Scenarios, Clostridium difficile Associated Disease)
• Typhoid and paratyphoid
• Giardia lamblia
• Clostridium difficile (see section – Clinical Scenarios, Clostridium difficile Associated Disease)
• Typhoid and paratyphoid
• Giardia lamblia
Total Duration
7-10 days
Dosing
See section - Antibiotics, Empirical Antibiotic Guidelines.
Prognosis and Complications
It is estimated that one in every 1,000 Campylobacter infections (treated or untreated) leads to Guillain-Barre syndrome 1-3 weeks after infection (this equates to up to 40% of Guillain-Barre syndrome cases).
Prophylaxis and Prevention
Most bacterial causes of gastroenteritis e.g. Campylobacter sp., Shigella sp., Salmonella sp. and Escherichia coli O157 are Notifiable Infectious Diseases (see section – Microbiology, Notifiable Infectious Diseases in the UK).
Infection Control Precautions
See section – Infection Control, Diarrhoea and Vomiting.
7-10 days
Dosing
See section - Antibiotics, Empirical Antibiotic Guidelines.
Prognosis and Complications
It is estimated that one in every 1,000 Campylobacter infections (treated or untreated) leads to Guillain-Barre syndrome 1-3 weeks after infection (this equates to up to 40% of Guillain-Barre syndrome cases).
Prophylaxis and Prevention
Most bacterial causes of gastroenteritis e.g. Campylobacter sp., Shigella sp., Salmonella sp. and Escherichia coli O157 are Notifiable Infectious Diseases (see section – Microbiology, Notifiable Infectious Diseases in the UK).
Infection Control Precautions
See section – Infection Control, Diarrhoea and Vomiting.
Other Gastrointestinal Conditions:
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• Gastroenteritis and Diarrhoea and Vomiting (D&V)
• Clostridium difficile Associated Disease (CDAD)
• Peritonitis
• Cholecystitis and Cholangitis
• Viral Hepatitis
All these conditions are covered in the book,
"Microbiology Nuts & Bolts".
• Clostridium difficile Associated Disease (CDAD)
• Peritonitis
• Cholecystitis and Cholangitis
• Viral Hepatitis
All these conditions are covered in the book,
"Microbiology Nuts & Bolts".