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 (types 5-7 on the Bristol Stool Chart, see Appendix 2)
• Vomiting
• Speed of onset related to infectious cause
- Minutes to hours caused by pre-formed toxin
- Hours to days caused by viruses and bacteria
• Systemic symptoms, fever, sweats, chills, aches and pains, caused by Campylobacter spp., typhoid and paratyphoid
• Chronic symptoms (>2 weeks) commonly caused by parasites
• Vomiting
• Speed of onset related to infectious cause
- Minutes to hours caused by pre-formed toxin
- Hours to days caused by viruses and bacteria
• Systemic symptoms, fever, sweats, chills, aches and pains, caused by Campylobacter spp., typhoid and paratyphoid
• Chronic symptoms (>2 weeks) commonly caused by parasites
Common CausesPre-formed 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 |
Causes in Returned travellersBacteria
As per common plus: • Vibrio cholerae • Vibrio parahaemolyticus • Salmonella typhi (typhoid) • Salmonella paratyphi (paratyphoid) |
Investigations
• Stool
- Culture or PCR for bacteria
- Toxin testing for Clostridium difficile
- Antigen testing or PCR for viruses
- Microscopy is not routinely performed:
(request ova, cysts and parasites (OCP) only if these are clinically suspected)
o PCR for Cryptosporidium spp. and Giardia lamblia if available
- Culture or PCR for bacteria
- Toxin testing for Clostridium difficile
- Antigen testing or PCR for viruses
- Microscopy is not routinely performed:
(request ova, cysts and parasites (OCP) only if these are clinically suspected)
o PCR for Cryptosporidium spp. and Giardia lamblia if available
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
Vaccinate against Rotavirus as part of the primary course of childhood immunisations.
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
Vaccinate against Rotavirus as part of the primary course of childhood immunisations.
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.
Topics in Clinical Scenarios - Gastrointestinal Infections:
All these topics are covered in the book...Ready to buy your copy? Click here to buy your copy of "Microbiology Nuts & Bolts" Its updated and amazingly only slightly larger considering its got 1/3 more in it! (11cmx18cmx2.5cm).
- Gastroenteritis and Diarrhoea and Vomiting (D&V)
- Clostridium difficile Associated Disease (CDAD)
- Necrotising Pancreatitis
- Cholecystitis and Cholangitis
- Peritonitis
- Viral Hepatitis
- Peptic Ulcer Disease
All these topics are covered in the book...Ready to buy your copy? Click here to buy your copy of "Microbiology Nuts & Bolts" Its updated and amazingly only slightly larger considering its got 1/3 more in it! (11cmx18cmx2.5cm).
