Acute diarrhea classification

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sudarshana Datta, MD [2]

Overview

Diarrhea is defined as passage of unformed or abnormally liquid stools at an increased frequency. Acute diarrhea has a duration of <2 weeks and may be classified on the basis of etiology and presentation. On the basis of etiology, acute diarrhea may be classified into infectious and non-infectious subtypes. Based on the type of presentation, acute diarrhea may be classified into watery and inflammatory types. Watery diarrhea may further be classified into secretory and osmotic types of diarrhea.

Classification

Classification based on etiology

• Acute diarrhea may be classified according to etiology into infectious and non-infectious subtypes/groups. The infectious group may further be classified into bacterial, viral, fungal and protozoal subgroups. The non-infectious group is further classified into diarrhea due to medications, poisoning and systemic illnesses.

Acute diarrhea

Infectious

Non-Infectious

Bacterial

Viral

Fungal

Protozoa

Medications

Poisoning

Systemic illness

•Shigella species ( S.dysentriae, S.flexneri, S.sonneii, S.boydii) •E.coli species (Enterotoxigenic E.coli, Enterohemorrhagic E.coli, Enteroinvasive E.coli, EPEC, EAEC) •Cryptosporidium parvum •Vibrio cholerae, Vibrio parahemolyticus •Clostridium perfringens •Non Typhoidal Salmonella: S.typhimurium, S.enterica •Campylobacter jejuni •Clostridium difficle •Yersinia enterocolitica •Staphylococcus aureus (staphylococcal toxic shock syndrome [TSS] •Aeromonas •Plesiomonas shigelloides •Hemolytic uraemic syndrome (Shiga toxin producing E. coli ETEC) •Mycobacterium Avium complex •Bacillus cereus •Listeria monocytogenes

•Astro virus •Calcivirus •Noro virus •Rota virus •CMV •Norwalk virus •Influenza virus •Rubeola virus •Dengue virus •Human immunodeficiency virus

•Cryptococcus •Candida albicans

•Giardia lamblia •Microsporidia •Isospora

•Digoxin •Cephalosporins •Thiazide diuretics •Triptans •Lactulose •Anti retroviral agents •Chemotherapeutic agents •Antifungals •Magnesium

•Organophosphate Poisoning •Opium withdrawal

•Hyperthyroidism •Irritable bowel syndrome •Lactose intolerance •Tumors: VIPoma •Short bowel syndrome •Radiation enteritis

Classification based on presentation

• Based on the type of presentation, acute diarrhea may be classified into watery and inflammatory types. Watery diarrhea may further be classified into secretory and osmotic types of diarrhea.

Acute diarrhea

Watery

Inflammatory

•Crohn’s disease or ulcerative colitis •Cytomegalovirus •Herpes simplex •Strongyloidiasis •Aeromonas •Plesiomonas •Ischemic colitis •Radiation colitis

Secretory

Osmotic

•Cholera •Enterotoxigenic strains of E. coli •Factitious diarrhea from laxative abuse •Aeromonas •Plesiomonas •Microsporidia •Giardia •Coccidia •Cryptosporidium

•Lactase deficiency •Lactulose •Laxative use/abuse •Whipple's disease