Diarrhea

	Diarrhea Microchapters
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Overview
Patient Information
Classification Acute Diarrhea Chronic diarrhea
Differential Diagnosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor-In-Chief: Sadaf Sharfaei M.D.[2], Seyedmahdi Pahlavani, M.D. [3], Cafer Zorkun, M.D., Ph.D. [4], M.Umer Tariq [5]

Synonyms and keywords: Loose stools

Overview

Diarrhea is defined as the passage of unformed or abnormally liquid stools at an increased frequency. Diarrhea can be classified as acute or chronic. 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. Although chronic diarrhea has multiple definitions, a current working definition is the production of loose stools for longer than 4 weeks. Frequent defecation with normal consistency is termed psuedodiarrhea. There are 3 basic categories of chronic diarrhea: watery, fatty (malabsorption), and inflammatory (with blood and pus).

Classification

Diarrhea can be classified as acute or chronic depending on the duration of onset of symptoms. Acute and chronic diarrhea can be further classified as follows:

Classification of Acute Diarrhea

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

•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 uremic 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

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 abuse

•Whipple's disease

Chronic diarrhea

Chronic diarrhea may be classified into:^[1]^[2]^[3]^[4]

Inflammatory diarrhea
- Idiopathic inflammatory bowel disease, such as Crohn’s disease or ulcerative colitis
- Infectious diseases such as:
  - Cytomegalovirus
  - Herpes simplex
  - Tuberculosis
  - Strongyloidiasis
  - Aeromonas
  - Plesiomonas
- Ischemic colitis
- Radiation colitis
- Neoplasia

Watery diarrhea
- Osmotic diarrhea (stools with high osmotic gap >100 mosm/kg). Causes of osmotic diarrhea include:
- Secretory diarrhea (stools with low osmotic gap <50 mosm/kg). Causes of secretory diarrhea include:
  - Cholera
  - Enterotoxigenic strains of E. coli
  - Medullary thyroid carcinoma
  - Factitious diarrhea from laxative abuse^[5]
  - Villous adenoma
  - Aeromonas
  - Plesiomonas
  - Microsporidia
  - Giardia
  - Coccidia
  - Cryptosporidium
- Structural and endocrine diseases should also be considered. These diseases include the following:
  - Diabetes
  - Hyperthyroidism
  - Addison's disease
  - Peptide secreting endocrine tumors

A normal gap is between 50 and 100 mosm/kg.^[6]

Fatty diarrhea
Maldigestion results from pancreatic exocrine insufficiency

Differential Diagnosis of Diarrhea of other diseases

To review the differential diagnosis of diarrhea, click here.

To review the differential diagnosis of acute diarrhea, click here.

To review the differential diagnosis of chronic diarrhea, click here.

To review the differential diagnosis of traveler's diarrhea, click here.

To review the differential diagnosis of acute watery diarrhea, click here.

To review the differential diagnosis of acute bloody diarrhea, click here.

To review the differential diagnosis of acute fatty diarrhea, click here.

To review the differential diagnosis of chronic watery diarrhea, click here.

To review the differential diagnosis of chronic bloody diarrhea, click here.

To review the differential diagnosis of chronic fatty diarrhea, click here.

To review the differential diagnosis of acute diarrhea and fever, click here.

To review the differential diagnosis of chronic diarrhea and fever, click here.

To review the differential diagnosis of acute diarrhea and abdominal pain, click here.

To review the differential diagnosis of chronic diarrhea and abdominal pain, click here.

To review the differential diagnosis of acute diarrhea and weight loss, click here.

To review the differential diagnosis of chronic diarrhea and weight loss, click here.

To review the differential diagnosis of acute diarrhea, fever, and abdominal pain, click here.

To review the differential diagnosis of chronic diarrhea, fever, and abdominal pain, click here.

To review the differential diagnosis of acute diarrhea, abdominal pain, and weight loss, click here.

To review the differential diagnosis of chronic diarrhea, abdominal pain, and weight loss, click here.

Diarrhea

The following table outlines the major differential diagnoses of diarrhea.^[7]^[8]^[9]^[10]^[11]^[12]^[13]^[14]^[15]^[16]^[17]^[18]^[19]^[20]^[21]^[22]^[23]^[24]^[25]^[26]^[27]^[28]^[29]^[30]^[31]^[32]^[33]^[34]^[35]^[36]

Abbreviations: GI: Gastrointestinal, CBC: Complete blood count, WBC: White blood cell, RBC: Red blood cell, Plt: Platelet, Hgb: Hemoglobin, ESR: Erythrocyte sedimentation rate, CRP: C–reactive protein, IgE: Immunoglobulin E, IgA: Immunoglobulin A, ETEC: Escherichia coli enteritis, EPEC: Enteropathogenic Escherichia coli, EIEC: Enteroinvasive Escherichia coli, EHEC: Enterohemorrhagic Escherichia coli, EAEC: Enteroaggregative Escherichia coli, Nl: Normal, ASCA: Anti saccharomyces cerevisiae antibodies, ANCA: Anti–neutrophil cytoplasmic antibody, DNA: Deoxyribonucleic acid, CFTR: Cystic fibrosis transmembrane conductance regulator, SLC10A2: Solute carrier family 10 member 2, SeHCAT: Selenium homocholic acid taurine or tauroselcholic acid, IEL: Intraepithelial lymphocytes, MRCP: Magnetic resonance cholangiopancreatography, ANA: Antinuclear antibodies, AMA: Anti-mitochondrial antibody, LDH: Lactate dehydrogenase, CPK: Creatine phosphokinase, PCR: Polymerase chain reaction, ELISA: Enzyme–linked immunosorbent assay, LT: Heat–labile enterotoxin, ST: Heat–stable enterotoxin, RT-PCR: Reverse–transcriptase polymerase chain reaction, CD4: Cluster of differentiation 4, HIV: Human immunodeficiency virus, RUQ: Right-upper quadrant, VIP: Vasoactive intestinal peptide, GI: Gastrointestinal, FAP: Familial adenomatous polyposis, HNPCC: Hereditary nonpolyposis colorectal cancer, MTP: Microsomal triglyceride transfer protein, Scl‑70: Anti–topoisomerase I, TSH: Thyroid-stimulating hormone, T4: Thyroxine, T3: Triiodothyronine, DTR: Deep tendon reflex, RNA: Ribonucleic acid

				Symptoms								GI signs
Categories		Cause		Clinical manifestation									Lab findings									Extra intestinal findings	Cause/Pathogenesis	Gold standard diagnosis
				Duration		Diarrhea			Fever	Abdominal pain	Weight loss
				Duration		Diarrhea							Stool exam					CBC			Other lab findings
				Acute	Chronic	Watery	Bloody	Fatty					WBC	RBC	Ova/Parasite	Osmotic gap	Other	WBC	Hgb	Plt	Other lab findings
Gastrointestinal		Crohn's disease		–	+	+	+	+	±	+	+	Abdominal tenderness Oral mucosal lesions	+	+	–	Nl	–	↑	↓	↑	Anti saccharomyces cerevisiae antibodies (ASCA) Vitamin B12 deficiency Elevated ESR Elevated CRP	Uveitis Arthritis Erythema nodosum Pyoderma gangrenosum Amyloidosis Venous and arterial thromboembolism Renal stones Bronchiectasis	Abnormal immune response to self antigens	Colonoscopy with biopsy
		Ulcerative colitis		–	+	+	+	+	±	+	+	Abdominal tenderness Blood on rectal examination	+	+	–	Nl	–	↑	↓	↑	Anti–neutrophil cytoplasmic antibody (P–ANCA) Hypoalbuminemia Hypokalemia Hypomagnesemia Elevated ESR Elevated CRP	Skin rash Iritis Uveitis Seronegative arthritis Clubbing Erythema nodosum	Abnormal immune response to self antigens	Colonoscopy with biopsy
		Celiac disease		–	+	±	–	±	–	+	+	Abdominal distention Increased bowel sounds Oral mucosal lesions Hepatosplenomegaly Ascites	–	–	–	Nl	Fat droplets on sudan stain	Nl	↓	Nl	IgA endomysial antibody Anti–tissue transglutaminase antibody Anti–gliadin antibody Fat soluble vitamins deficiency	Malabsorption Dementia Dermatitis herpetiformis	HLA–DQ2 HLA–DQ8 Innate responses to wheat proteins	IgA endomysial antibody Anti–tissue transglutaminase antibody
		Cause		Duration		Diarrhea			Fever	Abdominal pain	Weight loss	GI signs	Stool exam					CBC			Other lab findings	Extra intestinal findings	Cause/Pathogenesis	Gold standard diagnosis
		Cause		Acute	Chronic	Watery	Bloody	Fatty	Fever	Abdominal pain	Weight loss	GI signs	WBC	RBC	Ova/Parasite	Osmotic gap	Other	WBC	Hgb	Plt	Other lab findings	Extra intestinal findings	Cause/Pathogenesis	Gold standard diagnosis
		Cystic fibrosis		–	+	–	–	+	±	+	+	Abdominal distention Hepatosplenomegaly Rectal prolapse	–	–	–	Nl	Fat droplets on sudan stain	Nl	↓	Nl	Positive DNA analysis for cystic fibrosis transmembrane conductance regulator (CFTR) Nasal transepithelial potential difference Fat soluble vitamins deficiency	Malabsorption Recurrent respiratory tract infection Bronchiectasis Diabetes mellitus Scoliosis Infertility	Mutations in the cystic fibrosis transmembrane conductance regulator (CFTR) protein	Positive genetic testing Elevated sweat chloride ≥60 mmol/L
		Chronic pancreatitis		–	+	+	–	+	–	+	+	Abdominal tenderness	–	–	–	Nl	Fat droplets on sudan stain Positive fecal elastase measurement	Nl	Nl	Nl	Slightly elevated amylase and lipase Abnormal pancreatic function test Secretin stimulation test	Malabsorption Diabetes mellitus Pancreatic pseudocyst	Toxins Recurrent acute pancreatitis Genetic predesposition Autoimmune	Magnetic resonance cholangiopancreatography (MRCP)
		Bile acid malabsorption		–	+	+	–	+	–	–	+		–	–	–	Nl	Fat droplets on sudan stain	Nl	Nl	Nl	Reduced cholesterol level	Malabsorption Hypotension Tachycardia	Genetic defects in SLC10A2	SeHCAT test
		Microscopic colitis		–	+	+	–	–	–	+	+	Abdominal tenderness Fecal incontinence	–	–	–	Nl	–	Nl	↓	Nl	Hypokalemia Elevated CRP Positive autoantibodies include: RF ANA AMA ANCA	Arthritis Uveitis Idiopathic thrombocytopenic purpura Pleuro pericarditis Hypothyroidism Psoriasis	Mucosal immune responses to luminal factors in a genetically predisposed individual Drug–induced	Colonoscopy with mucosal biopsy with mononuclear infiltrates: Collagenous colitis is characterized by a colonic subepithelial collagen band >10 micrometers in diameter Lymphocytic colitis is characterized by ≥20 intraepithelial lymphocytes (IEL) per 100 surface epithelial cells
		Cause		Duration		Diarrhea			Fever	Abdominal pain	Weight loss	GI signs	Stool exam					CBC			Other lab findings	Extra intestinal findings	Cause/Pathogenesis	Gold standard diagnosis
		Cause		Acute	Chronic	Watery	Bloody	Fatty	Fever	Abdominal pain	Weight loss	GI signs	WBC	RBC	Ova/Parasite	Osmotic gap	Other	WBC	Hgb	Plt	Other lab findings	Extra intestinal findings	Cause/Pathogenesis	Gold standard diagnosis
		Infective colitis		–	+	+	+	–	+	+	+	Rebound abdominal tenderness	+	+	+	Nl	Positive stool culture Positive fecal calprotectin Positive fecal lactoferrin	↑	↓	↑	Elevated CRP Elevated ESR	Arthritis Uveitis	Salmonella Shigella Campylobacter E. coli 0157:H7 Clostridium difficile Entamoeba histolytica Adenovirus Cytomegalovirus Herpes simplex virus	Stool culture Blood culture
		Ischemic colitis		+	+	+	+	–	+	+	+	Hyperactive then absent bowel sounds Abdominal tenderness	+	+	–	Nl	–	↑	↓	↑	Elevated CRP Elevated ESR Elevated serum lactate Elevated lactate dehydrogenase (LDH) Elevated creatine phosphokinase (CPK) Elevated amylase Hypoalbuminemia	IgA vasculitis	Hypercoagulability Nonocclusive colonic ischemia Embolic and thrombotic arterial occlusion Mesenteric vein thrombosis	Abdominal CT scan
		Lactose intolerance		+	+	+	–	–	–	+	–	Abdominal tenderness Abdominal distention	–	–	–	↑	–	Nl	Nl	Nl	Lactose tolerance test Genetic testing	Headache Vertigo Memory impairment Lethargy	Reduction of lactase enzyme activity or inability to produce persistent lactase Congenital lactase deficiency Secondary lactose malabsorption	Small bowel biopsy Lactose breath hydrogen test
		Irritable bowel syndrome		–	+	±	–	±	–	±	–	Abdominal tenderness Abdominal distention Normal bowel sounds	–	–	–	Nl	–	Nl	Nl	Nl	Nl	Anxiety Palpitation	Unknown	Diagnosis of exclusion
Infection	Bacterial	Cause		Duration		Diarrhea			Fever	Abdominal pain	Weight loss	GI signs	Stool exam					CBC			Other lab findings	Extra intestinal findings	Cause/Pathogenesis	Gold standard diagnosis
		Cause		Acute	Chronic	Watery	Bloody	Fatty	Fever	Abdominal pain	Weight loss	GI signs	WBC	RBC	Ova/Parasite	Osmotic gap	Other	WBC	Hgb	Plt	Other lab findings	Extra intestinal findings	Cause/Pathogenesis	Gold standard diagnosis
		Whipple's disease		–	+	+	–	+	±	+	+	Hepatosplenomegaly Ascites	–	–	–	Nl	Positive fecal fat	↓	↓	↓/↑	Hypoalbuminemia Fat soluble vitamins deficiency	Malabsorption Abnormal extraocular movement Lymphadenopathy Hyperpigmentation Uveitis Endocarditis Encephalitis Dementia Pleural effusion	Tropheryma whipplei	Small intestine biopsy for Tropheryma whipplei testing PCR testing
		Tropical sprue		+	+	+	–	+	+	+	+	Angular stomatitis Oral mucosal lesion	+	–	–	Nl	Positive stool culture	Nl	↓	Nl	Fat soluble vitamins deficiency Vitamin B12 deficiency Folate deficiency Hypokalemia	Myalgia Neuropathy Edema	Escherichia coli Klebsiella pneumoniae Enterobacter cloacae	Diagnosis of exclusion
		Small bowel bacterial overgrowth		–	+	+	–	+	–	+	+	Abdominal distention	+	–	–	Nl	Positive stool culture Positive fecal fat	Nl	↓	Nl	Hypoalbuminemia Abnormal hydrogen breath test Lactic acidosis	Malabsorption Rosacea	Excess bacteria in the small intestine Alterations in intestinal anatomy or GI motility	Diagnosis of exclusion
		Pseudomembranous enterocolitis		+	–	+	±	–	+	+	±	Generalized abdominal tenderness Abdominal distention Rebound abdominal tenderness	+	+	–	Nl	Enzyme–linked immunosorbent assay (ELISA) Polymerase chain reaction (PCR) assay or C. difficile antigen	↑	↓	↓	Elevated serum creatinine Hypoalbuminemia Elevated lactic acid	Dehydration Acute kidney injury Bacteremia Reactive arthritis Necrotizing fasciitis	Clostridium difficile Recent antibiotics use Recent surgery	Stool exam Pseudomembranes on colonoscopy
		Cause		Duration		Diarrhea			Fever	Abdominal pain	Weight loss	GI signs	Stool exam					CBC			Other lab findings	Extra intestinal findings	Cause/Pathogenesis	Gold standard diagnosis
		Cause		Acute	Chronic	Watery	Bloody	Fatty	Fever	Abdominal pain	Weight loss	GI signs	WBC	RBC	Ova/Parasite	Osmotic gap	Other	WBC	Hgb	Plt	Other lab findings	Extra intestinal findings	Cause/Pathogenesis	Gold standard diagnosis
		Campylobacteriosis		+	–	+	+	–	+	+	–	Diffuse abdominal tenderness	+	+	–	Nl	Positive stool culture	↑	Nl	Nl	Nl	Toxic megacolon Sepsis Arthritis Endocarditis Guillain–Barré syndrome	Campylobacter jejuni	Stool culture
		Salmonellosis		+	+	+	+	–	+	+	–	Abdominal distention Diffuse abdominal tenderness Hepatosplenomegaly	+	+	–	Nl	Positive stool culture Positive serologic testing	↑	Nl	↑	Hypokalemia Hypernatremia Hyponatremia Hypercalciuria Hypocitraturia	Post–infectious arthritis Obtundation Bacteremia Pericarditis Pyelonephritis Brain abscess	Salmonella	Stool culture
		Shigellosis		+	–	+	+	–	+	+	–	Abdominal distention Hyperactive bowel sounds Diffuse abdominal tenderness	+	+	–	Nl	Positive stool culture	↑/↓	↓	↓	Elevated CRP Elevated ESR Hyponatremia Hypoglycemia Azotemia	Headache Lethargy Seizures Delirium Post–infectious arthritis Myocarditis	Shigella	Stool culture
		Cause		Duration		Diarrhea			Fever	Abdominal pain	Weight loss	GI signs	Stool exam					CBC			Other lab findings	Extra intestinal findings	Cause/Pathogenesis	Gold standard diagnosis
		Cause		Acute	Chronic	Watery	Bloody	Fatty	Fever	Abdominal pain	Weight loss	GI signs	WBC	RBC	Ova/Parasite	Osmotic gap	Other	WBC	Hgb	Plt	Other lab findings	Extra intestinal findings	Cause/Pathogenesis	Gold standard diagnosis
		Escherichia coli enteritis	ETEC (Traveler's diarrhea)	+	–	+	–	–	+	–	–	Diffuse abdominal tenderness	+	–	–	Nl	Positive stool culture	↑	Nl	Nl	–	–	Enterotoxigenic escherichia coli Enterotoxins: Heat–labile enterotoxin (LT) Heat–stable enterotoxin (ST)	Stool culture
			EPEC	+	+	+	+	–	+	+	+	Diffuse abdominal tenderness	+	+	–	Nl	Positive stool culture	↑	Nl	Nl	–	–	Enteropathogenic E. coli	DNA probe or polymerase chain reaction (PCR) of the EPEC adherence factor Stool culture
			EIEC	+	–	+	+	–	+	+	–	Diffuse abdominal tenderness	+	+	–	Nl	Positive stool culture	↑	Nl	Nl	–	–	Enteroinvasive E. coli	DNA probe Stool culture
			EHEC	+	–	+	+	–	–	+	–	Diffuse abdominal tenderness	+	+	–	Nl	Positive stool culture	↑	↓	↓	Azotemia	Hemolytic uremic syndrome (HUS) Renal failure	Enterohemorrhagic E. coli Shiga toxins	Stool culture
			EAEC	+	+	+	+	–	–	+	–	Diffuse abdominal tenderness	+	+	–	Nl	Positive stool culture	↑	↓	↓	–	Chronic infection in immunocompromised patients	Enteroaggregative E. coli	Stool culture
		Cause		Duration		Diarrhea			Fever	Abdominal pain	Weight loss	GI signs	Stool exam					CBC			Other lab findings	Extra intestinal findings	Cause/Pathogenesis	Gold standard diagnosis
		Cause		Acute	Chronic	Watery	Bloody	Fatty	Fever	Abdominal pain	Weight loss	GI signs	WBC	RBC	Ova/Parasite	Osmotic gap	Other	WBC	Hgb	Plt	Other lab findings	Extra intestinal findings	Cause/Pathogenesis	Gold standard diagnosis
		Yersinia enterocolitica		+	–	+	+	–	+	+	–	Abdominal distention Hyperactive bowel sounds Diffuse abdominal tenderness	+	+	–	Nl	Positive stool culture	↑	Nl	Nl	–	Bacteremia Reactive arthritis Glomerulonephritis Endocarditis Erythema nodosum Abscess	Yersinia enterocolitica	Stool culture
		Vibrio cholera		+	–	+	–	–	–	+	–		+	–	–	Nl	Positive stool culture	↑	Nl	Nl	Azotemia	Severe dehydration Decreased skin turgor Oliguria Renal failure Muscle cramps Seizure Somnolence	Cholera toxin	Stool culture
		Aeromonas		+	+	+	+	–	+	+	–	Abdominal distention Hyperactive bowel sounds Diffuse abdominal tenderness	+	+	–	Nl	Positive stool culture	↑	Nl	Nl	–	Wound infection Bacteremia Hemolytic uremic syndrome Meningitis Ocular infection Pneumonia Urinary tract infection Osteomyelitis Peritonitis Acute cholecystitis Opportunistic infections in immunocompromised patients	Aeromonas virulence factors including endotoxins, hemolysins, enterotoxins, and adherence factors	Blood culture Wound culture
		Cause		Duration		Diarrhea			Fever	Abdominal pain	Weight loss	GI signs	Stool exam					CBC			Other lab findings	Extra intestinal findings	Cause/Pathogenesis	Gold standard diagnosis
		Cause		Acute	Chronic	Watery	Bloody	Fatty	Fever	Abdominal pain	Weight loss	GI signs	WBC	RBC	Ova/Parasite	Osmotic gap	Other	WBC	Hgb	Plt	Other lab findings	Extra intestinal findings	Cause/Pathogenesis	Gold standard diagnosis
		Plesiomonas		+	–	+	+	–	+	+	–	Hyperactive bowel sounds Diffuse abdominal tenderness	+	+	–	Nl	Positive stool culture	↑	Nl	Nl	–	Opportunistic infections in immunocompromised patients or hepatobiliary disease Bacteremia Cellulitis and skin abscesses Peritonitis Meningoencephalitis Ocular infection Pneumonia Prosthetic joint infection Septic abortion	Plesiomonas shigelloides	Blood culture
		Mycobacterium avium complex		+	+	+	+	–	+	+	–	Abdominal distention Hepatosplenomegaly	+	+	–	Nl	–	↓	↓	Nl	Elevated liver enzymes	Opportunistic infection in immunocompromised patients Pulmonary infection Adenopathy Night sweats	Mycobacterium avium complex	Blood culture
		Food poisoning Staphylococcus aureus Bacillus cereus Clostridium perfringens		+	–	+	±	–	+	+	±	Abdominal distention	+	±	–	Nl	Positive stool culture	↑	Nl	Nl	–	History of travel or ingestion of infected food	Enterotoxins	Stool culture
	Virus	Cause		Duration		Diarrhea			Fever	Abdominal pain	Weight loss	GI signs	Stool exam					CBC			Other lab findings	Extra intestinal findings	Cause/Pathogenesis	Gold standard diagnosis
		Cause		Acute	Chronic	Watery	Bloody	Fatty	Fever	Abdominal pain	Weight loss	GI signs	WBC	RBC	Ova/Parasite	Osmotic gap	Other	WBC	Hgb	Plt	Other lab findings	Extra intestinal findings	Cause/Pathogenesis	Gold standard diagnosis
		Norovirus		+	–	+	–	–	+	+	–	Abdominal distention	–	–	–	Nl	Positive stool reverse–transcriptase polymerase chain reaction (RT–PCR)	↓	Nl	Nl	–	Myalgia Headache Seizure Encephalopathy	Norovirus	Clinical diagnosis
		Rotavirus		+	–	+	–	–	+	–	–	Hyperactive bowel sounds Diffuse abdominal tenderness	+	–	–	Nl	–	Nl	Nl	Nl	Elevated blood urea nitrogen Hyperchloremic acidosis Hypocalcemia	Necrotizing enterocolitis Intussusception Biliary atresia Central nervous system involvement	Rotavirus	Stool immune–based assays
		Echovirus		+	–	+	–	–	+	+	–	Abdominal distention	–	–	–	Nl	–	Nl	Nl	Nl	–	Liver failure Myocarditis	Echovirus	Clinical diagnosis
		Adenovirus		+	–	+	–	–	+	+	–	Abdominal distention	–	–	–	Nl	Viral antigen assay	Nl	Nl	Nl	–	Respiratory disease Follicular conjunctivitis Epidemic keratoconjunctivitis Hepatitis Urethritis Myocarditis Meningitis Bacteremia	Adenovirus	Clinical diagnosis
		CMV colitis		+	+	–	+	–	±	+	–	Diffuse abdominal tenderness	+	+	–	Nl	Viral antigen assay	↓	Nl	Nl	Decreased CD4 level Abnormal liver function test	Encephalitis Guillain–Barré syndrome Pneumonia Retinitis Pericarditis and myocarditis Atherosclerosis Venous thrombosis	Cytomegalovirus	Quantitative PCR tests
		HIV		–	+	+	–	–	+	+	+	Abdominal distention Diffuse abdominal tenderness	+	–	–	Nl	–	↓	↓	Nl	Decreased CD4 level Electrolyte imbalance	Lymphadenopathy Disseminated infection	HIV	HIV virologic (viral load) test Immunoassay
	Parasite	Cause		Duration		Diarrhea			Fever	Abdominal pain	Weight loss	GI signs	Stool exam					CBC			Other lab findings	Extra intestinal findings	Cause/Pathogenesis	Gold standard diagnosis
		Cause		Acute	Chronic	Watery	Bloody	Fatty	Fever	Abdominal pain	Weight loss	GI signs	WBC	RBC	Ova/Parasite	Osmotic gap	Other	WBC	Hgb	Plt	Other lab findings	Extra intestinal findings	Cause/Pathogenesis	Gold standard diagnosis
		Entamoeba histolytica		+	+	+	+	–	+	+	–	Abdominal distention Diffuse abdominal tenderness	+	+	+	Nl	–	↑	Nl	Nl	–	Liver abscess Pleuropulmonary infection Cardiac infection Brain abscess Cutaneous infection	Entamoeba histolytica	Antigen testing Serology
		Giardia		–	+	+	–	+	–	+	+	Abdominal distention Diffuse abdominal tenderness	–	–	+	Nl	–	Nl	Nl	Nl	–	Malabsorption Urticaria Depression	Giardia lamblia	Antigen detection assays
		Cryptosporidium		–	+	+	–	–	–	+	+	Abdominal distention Diffuse abdominal tenderness	–	–	+	Nl	Positive stool microscopy	Nl	Nl	Nl	Elevated alkaline phosphatase	Chronic, life–threatening illness in immunocompromised patients	Cryptosporidium	Polymerase chain reaction
		Microsporidia		+	+	+	–	–	+	+	–	Abdominal distention Diffuse abdominal tenderness	–	–	+	Nl	Positive stool microscopy	Nl	Nl	Nl	Decreased CD4 count	Malabsorption Keratitis Seizure Myositis	Microsporidia	Antigen detection assays
		Isospora		+	+	+	–	+	+	+	+	Abdominal distention Diffuse abdominal tenderness	+	+	+	Nl	Positive stool microscopy Positive fecal fat	↑	Nl	Nl	Elevated eosinophils Hypokalemia Increased creatinine	Chronic illness in immunocompromised patients	Isospora	Detecting oocysts in the feces
Tumors		Cause		Duration		Diarrhea			Fever	Abdominal pain	Weight loss	GI signs	Stool exam					CBC			Other lab findings	Extra intestinal findings	Cause/Pathogenesis	Gold standard diagnosis
		Cause		Acute	Chronic	Watery	Bloody	Fatty	Fever	Abdominal pain	Weight loss	GI signs	WBC	RBC	Ova/Parasite	Osmotic gap	Other	WBC	Hgb	Plt	Other lab findings	Extra intestinal findings	Cause/Pathogenesis	Gold standard diagnosis
		Carcinoid tumor		–	+	+	+	–	–	+	+	Abdominal distention	–	+	–	↓	–	Nl	Nl	Nl	Elevated urinary 5–hydroxyindoleacetic acid (5–HIAA) level High chromogranin A	Facial flushing Jaundice Edema Valvular heart disease Right–sided heart failure	Well–differentiated neuroendocrine tumor	Blood chromogranin A level
		VIPoma		+	+	+	–	+	–	+	+	Abdominal distention Abdominal RUQ tenderness Nausea Vomiting	–	–	–	↓	–	Nl	Nl	Nl	Elevated VIP level Hypokalemia Hypochlorhydria or achlorhydria Low osmotic gap (<50 mOsm/kg)	Rash Facial flushing Dehydration Lethargy Muscle weakness	Primary secretory tumor	Blood VIP levels Followed by imaging
		Zollinger–Ellison syndrome		–	+	+	+	+	–	+	+	Epigastric tenderness	–	–	–	↓	–	Nl	↓	Nl	Positive secretin stimulation test Elevated serum chromogranin A	Jaundice	Gastrin producing tumor mainly in duodenum	Secretin stimulation test
		Somatostatinoma		–	+	+	–	–	–	+	+	Epigastric tenderness	–	–	–	↓	–	Nl	Nl	Nl	Elevated fasting plasma somatostatin	Diabetes mellitus Cholelithiasis Jaundice	Neuroendocrine tumors of D–cell origin	Plasma somatostatin level Followed by imaging
		Cause		Duration		Diarrhea			Fever	Abdominal pain	Weight loss	GI signs	Stool exam					CBC			Other lab findings	Extra intestinal findings	Cause/Pathogenesis	Gold standard diagnosis
		Cause		Acute	Chronic	Watery	Bloody	Fatty	Fever	Abdominal pain	Weight loss	GI signs	WBC	RBC	Ova/Parasite	Osmotic gap	Other	WBC	Hgb	Plt	Other lab findings	Extra intestinal findings	Cause/Pathogenesis	Gold standard diagnosis
		Lymphoma		–	+	+	+	–	+	+	+	Diffuse abdominal tenderness Hepatosplenomegaly	–	+	–	Nl	–	Nl	↓	Nl	Paraproteinemia	Malabsorption Lactose intolerance Ascites	Primary tumor of GI tract	Colonoscopy with biopsy
		Colorectal cancer		–	+	+	+	+	–	+	+	Diffuse abdominal tenderness	–	+	–	Nl	–	Nl	↓	Nl	Positive carcinoembryonic antigen	Metastasis	FAP gene HNPCC gene	Colonoscopy and biopsy
Medication/Toxicity		Medications ACE inhibitors Digoxin Cephalosporins Statins Thiazide diuretics Triptans Lactulose Anti retroviral agents Chemotherapeutic agents Antifungals Magnesium		+	+	+	–	±	±	+	+	Abdominal distention Dehydration	–	–	–	↑/↓	–	↑	Nl	Nl	Elevated plasma level of drug	–	Inflammation Pseudomembranous colitis	Clinical evaluation after discontinuation of the drugs
		Factitious diarrhea		+	+	+	–	–	–	+	+	Abdominal distention	–	–	–	↑/↓	–	Nl	Nl	Nl	Hypokalemia Metabolic alkalosis Hypermagnesemia	Malabsorption Lethargy Generalized weakness Acute renal failure	Medications	Clinical evaluation after discontinuation of the drugs
		Cause		Duration		Diarrhea			Fever	Abdominal pain	Weight loss	GI signs	Stool exam					CBC			Other lab findings	Extra intestinal findings	Cause/Pathogenesis	Gold standard diagnosis
		Cause		Acute	Chronic	Watery	Bloody	Fatty	Fever	Abdominal pain	Weight loss	GI signs	WBC	RBC	Ova/Parasite	Osmotic gap	Other	WBC	Hgb	Plt	Other lab findings	Extra intestinal findings	Cause/Pathogenesis	Gold standard diagnosis
		Heavy metal ingestion		–	+	+	–	–	–	+	+	Abdominal distention	–	–	–	Nl	–	Nl	Nl	Nl	Elevated plasma heavy metal level	Headache Numbness Alopecia Vertigo	Heavy metal ingestion	Plasma level of heavy metal
		Organophosphate poisoning		+	+	+	–	–	–	+	–	Salivation Vomiting	–	–	–	Nl	–	Nl	Nl	Nl	Reduced RBC acetylcholinesterase Plasma cholinesterase activity	Autonomic dysfunction Motor deficit Sensory deficit Bronchospasm Urination Miosis Bradycardia Lacrimation Sweating Cardiac arrhythmias Acute renal injury	Neurotoxins bind to acetylcholinesterase (AChE)	Clinical diagnosis
		Opium withdrawal		+	+	+	–	–	–	+	–	Hyperactive bowel sounds	–	–	–	Nl	–	Nl	Nl	Nl	Azotemia Hypokalemia Metabolic alkalosis	Dysphoria Restlessness Sweating Rhinorrhea Lacrimation Myalgia Arthralgia	Opium withdrawal	Clinical diagnosis following opium withdrawal
Iatrogenic		Cause		Duration		Diarrhea			Fever	Abdominal pain	Weight loss	GI signs	Stool exam					CBC			Other lab findings	Extra intestinal findings	Cause/Pathogenesis	Gold standard diagnosis
		Cause		Acute	Chronic	Watery	Bloody	Fatty	Fever	Abdominal pain	Weight loss	GI signs	WBC	RBC	Ova/Parasite	Osmotic gap	Other	WBC	Hgb	Plt	Other lab findings	Extra intestinal findings	Cause/Pathogenesis	Gold standard diagnosis
		Short bowel syndrome		+	+	+	–	+	–	–	+	Abdominal distention Abdominal tenderness	–	–	–	Nl	Positive fecal fat	Nl	↓	↑	Hypoalbuminemia High level of acute phase reactant Abnormal liver function tests	Prior intestinal surgery Malabsorption Crohn's disease Malignancy Peripheral edema Muscle atrophy	Surgical bowel resection	Clinical diagnosis following bowel resection
		Radiation enteritis		+	+	+	+	+	–	+	+	Abdominal tenderness	+	+	–	Nl	Positive fecal fat	Nl	↓	Nl	Vitamin B12 deficiency Hypoalbuminemia	Prior history of malignancy and radiation therapy Malabsorption Telangiectasias	Radiation	Segmental bowel inflammation on endoscopy or colonoscopy
		Dumping syndrome		–	+	+	–	+	–	–	+	Hyperactive bowel sound	–	–	–	Nl	–	Nl	Nl	Nl	Hypoglycemia Hydrogen breath test	Malnutrition Fat soluble vitamin deficiency	Postgastrectomy	Clinical diagnosis following gastrectomy
Others		Cause		Duration		Diarrhea			Fever	Abdominal pain	Weight loss	GI signs	Stool exam					CBC			Other lab findings	Extra intestinal findings	Cause/Pathogenesis	Gold standard diagnosis
		Cause		Acute	Chronic	Watery	Bloody	Fatty	Fever	Abdominal pain	Weight loss	GI signs	WBC	RBC	Ova/Parasite	Osmotic gap	Other	WBC	Hgb	Plt	Other lab findings	Extra intestinal findings	Cause/Pathogenesis	Gold standard diagnosis
		Abetalipoproteinemia		–	+	+	–	+	–	+	+	Abdominal distension	–	–	–	Nl	–	Nl	Nl	Nl	Low triglyceride Low total cholesterol levels Acanthocytes Low vitamin E levels	Ataxia Visual field defect Dysarthria	Autosomal recessive disorder caused by mutations encoding the microsomal triglyceride transfer protein (MTP)	Clinical findings and low triglyceride and cholesterol level
		Hyperthyroidism		–	+	+	–	–	±	+	+	–	–	–	–	Nl	Positive fecal fat	Nl	Nl	Nl	Elevated T4 Elevated T3 Decreased TSH High serum alkaline phosphatase	Lump in the neck Lid lag Malabsorption Sweating Hyperpigmentation Proptosis Tremor Increased DTR	Graves' disease Hashimoto's thyroiditis Toxic adenoma	TSH
		Diabetic neuropathy		–	+	+	–	+	–	+	+	Fecal incontinence	–	–	–	Nl	Positive fecal fat	Nl	↓	Nl	Hyperglycemia Azotemia Hypokalemia	Malabsorption	Unclear Disordered motility Increased intestinal secretion Small intestinal bacterial overgrowth	Clinical diagnosis in a patient with long lasting diabetes mellitus
		Systemic sclerosis		–	+	+	±	+	–	+	+	Epigastric tenderness Fecal incontinence	–	+	–	Nl	Positive fecal fat	Nl	↓	Nl	Anti–topoisomerase I (Scl‑70) antibodies Antinuclear antibodies (ANA) Anti–centromere antibodies Anti–RNA polymerase III antibody	Malabsorption Skin changes Raynaud phenomenon Pulmonary hypertension Arthritis Telangiectasia Chronic renal failure	Autoimmune reaction	Clinical diagnosis Followed by serologic tests

Medical Therapy

Fluid resuscitation (oral, if not IV)
Patients should be advised to do the following until symptoms subside:
- Hydrate with liquids that are caffeine free and contain glucose
- Avoid lactose
- Chew gum that is free of sorbitol
- Eat raw fruit
For patients with lactose intolerance, a lactose-free diet is advised
For patients with malabsorption diseases, a gluten free diet is advised
Consultation with oncology, surgery and/or gastroenterology may be required for intestinal neoplasm
Control blood sugar (diabetic neuropathy)

Empirical Therapy

Empirical therapy is used as an initial treatment before diagnostic testing or after diagnostic testing has failed to confirm a diagnosis or when there is no specific treatment or when specific treatment fails to effect a cure.

Empirical trials of antimicrobial therapy like metronidazole for protozoal diarrhea or fluoroquinolone for enteric bacterial diarrhea if the prevalence of bacterial or protozoal infection is high in a specific community or situation.

Most cases of diarrhea, except for high-volume secretory states, respond to a sufficiently high dose of opium or morphine. Codeine, synthetic opioids diphenoxylate and loperamide are less potent. However loperamide is generally used because of its less abuse potential.

The somatostatin analogue octreotide has proven effectiveness in carcinoid tumors and other peptide-secreting tumors, dumping syndrome, and chemotherapy-induced diarrhea.

Intraluminal agents include adsorbants, such as activated charcoal, and binding resins like bismuth and stool modifiers, such as medicinal fiber.

Pharmacotherapy

Antibiotics (malabsorption diseases)
Anticholinergics (IBS)
Antimolality agents
Antibiotic therapy (severe disease)
Metoclopramide (diabetic neuropathy)
Nonspecific antidiarrheal agents

Symptomatic Treatment

Symptomatic treatment for diarrhea involves the patient consuming adequate amounts of water to replace that loss, preferably mixed with electrolytes to provide essential salts and some amount of nutrients. For many people, further treatment is unnecessary.
The following types of diarrhea indicate medical supervision is required:
- Diarrhea in infants;
- Moderate or severe diarrhea in young children;
- Diarrhea associated with blood;
- Diarrhea that continues for more than two weeks;
- Diarrhea that is associated with more general illness such as non-cramping abdominal pain, fever, weight loss, etc;
- Diarrhea in travelers, since they are more likely to have exotic infections such as parasites;
- Diarrhea in food handlers, because of the potential to infect others;
- Diarrhea in institutions such as hospitals, child care centers, or geriatric and convalescent homes.

A severity score is used to aid diagnosis.^[37]

Pathogen Specific

Immunocompetent

Bacterial ^[38]

1. Shigella species

Preferred regimen (1):

Adult dose: TMP-SMZ, 160 and 800 mg, respectively bid for 3 days (if susceptible ) OR Fluoroquinolone (e.g., 300 mg Ofloxacin, 400 mg Norfloxacin, OR 500 mg Ciprofloxacin bid for 3 days)
Pediatric dose: TMP-SMZ, 5 and 25 mg/kg, respectively bid for 3 days

Preferred regimen (2):

Adult dose: Nalidixic acid 1 g/d for 5 days OR Ceftriaxone; Azithromycin
Pediatric dose: Nalidixic acid, 55 mg/kg/d for 5 days

2. Non-typhi species of Salmonella

Preferred regimen: Not recommended routinely, but if severe or patient is younger than 6 monthes or older than 50 year old or has prostheses, valvular heart disease, severe atherosclerosis, malignancy, or uremia, TMP-SMZ (if susceptible) OR Fluoroquinolone, bid for 5 to 7 days; Ceftriaxone, 100 mg/kg/d in 1 or 2 divided doses

3. Campylobacter species

Preferred regimen: Erythromycin 500 mg bid for 5 days

4. Escherichia coli species

4.1. Enterotoxigenic

Preferred regimen: TMP-SMZ, 160 and 800 mg, respectively, bid, for 3 days (if susceptible), OR Fluoroquinolone (e.g., 300 mg Ofloxacin, 400 mg Norfloxacin, or 500 mg Ciprofloxacin bid for 3 days)

4.2. Enteropathogenic

Preferred regimen: TMP-SMZ, 160 and 800 mg, respectively, bid, for 3 days (if susceptible), OR Fluoroquinolone (e.g., 300 mg Ofloxacin, 400 mg Norfloxacin, or 500 mg Ciprofloxacin bid for 3 days)

4.3. Enteroinvasive

Preferred regimen: TMP-SMZ, 160 and 800 mg, respectively, bid, for 3 days (if susceptible), OR Fluoroquinolone (e.g., 300 mg Ofloxacin, 400 mg Norfloxacin, or 500 mg Ciprofloxacin bid for 3 days)

4.4. Enterohemorrhagic

Preferred regimen: Avoid antimotility drugs; role of antibiotics unclear, and administration should be avoided.

5. Aeromonas/Plesiomonas

Preferred regimen: TMP-SMZ, 160 and 800 mg, respectively, bid for 3 days (if susceptible), Fluoroquinolone (e.g., 300 mg Ofloxacin, 400 mg Norfloxacin, or 500 mg Ciprofloxacin bid for 3 days)

6. Yersinia species

Preferred regimen: Antibiotics are not usually required; Deferoxamine therapy should be withheld; for severe infections or associated bacteremia treat as for immunocompromised hosts, using combination therapy with Doxycycline, Aminoglycoside, TMP-SMZ, OR Fluoroquinolone

7. Vibrio cholerae O1 or O139

Preferred regimen (1): Doxycycline 300-mg single dose
Preferred regimen (2): Tetracycline 500 mg qid for 3 days
Preferred regimen (3): TMP-SMZ 160 and 800 mg, respectively, bid for 3 days
Preferred regimen (4): single-dose Fluoroquinolone

8. Toxigenic Clostridium difficile

Preferred regimen: Offending antibiotic should be withdrawn if possible; Metronidazole, 250 mg qid to 500 mg tid for 3 to 10 days

Parasites ^[38]

1. Giardia

Preferred regimen: Metronidazole 250-750 mg tid for 7-10 days

2. Cryptosporidium species

Preferred regimen: If severe, consider Paromomycin, 500 mg tid for 7 days

3. Isospora species

Preferred regimen: TMP-SMZ, 160 and 800 mg, respectively, bid for 7 to 10 days

4. Cyclospora species

Preferred regimen: TMP/SMZ, 160 and 800 mg, respectively, bid for 7 days

5. Microsporidium species

Preferred regimen: Not determined

6. Entamoeba histolytica

Preferred regimen (1): Metronidazole 750 mg tid for 5 to 10 days AND Diiodohydroxyquin 650 mg tid for 20 days
Preferred regimen (2): Metronidazole 750 mg tid for 5 to 10 days AND Paromomycin 500 mg tid for 7 days

Immunocompromised

Bacterial ^[38]

1. Shigella species:

Preferred regimen (1):

Adult dose: TMP-SMZ, 160 and 800 mg, respectively bid for 7 to 10 days (if susceptible ) OR Fluoroquinolone (e.g., 300 mg Ofloxacin, 400 mg Norfloxacin, OR 500 mg Ciprofloxacin bid for 7 to 10 days)
Pediatric dose:TMP-SMZ, 5 and 25 mg/kg, respectively bid for 7 to 10 days

Preferred regimen (2):

Adult dose: Nalidixic acid 1 g/d for 7 to 10 days OR Ceftriaxone; Azithromycin
Pediatric dose: Nalidixic acid, 55 mg/kg/d for 7 to 10 days

2. Non-typhi species of Salmonella

Preferred regimen: Not recommended routinely, but if severe or patient is younger than 6 monthes or older than 50 old or has prostheses, valvular heart disease, severe atherosclerosis, malignancy, or uremia, TMP-SMZ (if susceptible) OR Fluoroquinolone, bid for 14 days (or longer if relapsing); ceftriaxone, 100 mg/kg/d in 1 or 2 divided doses

3. Campylobacter species

Preferred regimen: Erythromycin, 500 mg bid for 5 days (may require prolonged treatment)

4. Escherichia coli species

4.1. Enterotoxigenic

Preferred regimen: TMP-SMZ, 160 and 800 mg, respectively, bid for 3 days (if susceptible), OR Fluoroquinolone (e.g., 300 mg Ofloxacin, 400 mg Norfloxacin, or 500 mg Ciprofloxacin bid for 3 days) (Consider fluoroquinolone as for enterotoxigenic E. coli)

4.2. Enteropathogenic

Preferred regimen: TMP-SMZ, 160 and 800 mg, respectively, bid,for 3 days (if susceptible), OR Fluoroquinolone (e.g., 300 mg Ofloxacin, 400 mg Norfloxacin, or 500 mg Ciprofloxacin bid for 3 days)

4.3. Enteroinvasive

Preferred regimen: TMP-SMZ, 160 and 800 mg, respectively, bid,for 3 days (if susceptible), OR Fluoroquinolone (e.g., 300 mg Ofloxacin, 400 mg Norfloxacin, or 500 mg Ciprofloxacin bid for 3 days)

4.4. Enterohemorrhagic

Preferred regimen: Avoid antimotility drugs; role of antibiotics unclear, and administration should be avoided.

5. Aeromonas/Plesiomonas

Preferred regimen: TMP-SMZ, 160 and 800 mg, respectively, bid for 3 days (if susceptible), Fluoroquinolone (e.g., 300 mg ofloxacin, 400 mg norfloxacin, or 500 mg Ciprofloxacin bid for 3 days)

6. Yersinia species

Preferred regimen: Doxycycline, Aminoglycoside (in combination) or TMP-SMZ or Fluoroquinolone

7. Vibrio cholerae O1 or O139

Preferred regimen: Doxycycline, 300-mg single dose; or Tetracycline, 500 mg qid for 3 days; or TMP-SMZ, 160 and 800 mg, respectively, bid for 3 days; or single-dose Fluoroquinolone

8. Toxigenic Clostridium difficile

Preferred regimen: Offending antibiotic should be withdrawn if possible; Metronidazole, 250 mg qid to 500 mg tid for 3 to 10 days

Parasites ^[38]

1. Giardia

Preferred regimen: Metronidazole, 250-750 mg tid for 7-10 days

2. Cryptosporidium species

Preferred regimen: Paromomycin, 500 mg tid for 14 to 28 days, then bid if needed; highly active antiretroviral therapy including a protease inhibitor is warranted for patients with AIDS

3. Isospora species

Preferred regimen: TMP-SMZ, 160 and 800 mg, respectively, qid for 10 days, followed by TMP-SMZ thrice weekly, or weekly Sulfadoxine (500 mg) and Pyrimethamine (25 mg) indefinitely for patients with AIDS

4. Cyclospora species

Preferred regimen: TMP-SMZ, 160 and 800 mg, respectively, qid for 10 days, followed by TMP-SMZ thrice weekly indefinitely

5. Microsporidium species

Preferred regimen: Albendazole, 400 mg bid for 3 weeks; highly active antiretroviral therapy including a protease inhibitor is warranted for patients with AIDS

6. Entamoeba histolytica

Preferred regimen: Metronidazole, 750 mg tid for 5 to 10 days, plus either Diiodohydroxyquin, 650 mg tid for 20 days, or Paromomycin, 500 mg tid for 7 days

Related Chapters

External Links

Travelers' Diarrhea

References

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[FineSchiller1999-1] Fine, K; Schiller, L (1999). "AGA Technical Review on the Evaluation and Management of Chronic Diarrhea☆". Gastroenterology. 116 (6): 1464–1486. doi:10.1016/S0016-5085(99)70513-5. ISSN 0016-5085.

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Diarrhea

Overview

Classification

Classification of Acute Diarrhea

Based on Etiology

Based on Presentation

Chronic diarrhea

Differential Diagnosis of Diarrhea of other diseases

Diarrhea

Medical Therapy

Empirical Therapy

Pharmacotherapy

Symptomatic Treatment

Pathogen Specific

Immunocompetent

Immunocompromised

Related Chapters

External Links

References

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