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| {{CMG}}; {{AE}} | | {{CMG}}; {{AE}} |
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| ==History and Symptoms== | | ==History and Symptoms== |
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| *The majority of patients with [disease name] are asymptomatic. | | *The majority of patients with [disease name] are asymptomatic. |
| OR | | OR |
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| *Symptoms of [disease name] include [symptom 1], [symptom 2], and [symptom 3]. | | *Symptoms of [disease name] include [symptom 1], [symptom 2], and [symptom 3]. |
| ===History=== | | ===History=== |
| *Initial evaluation of patients who present with acute diarrhea include:
| | Patients with [disease name]] may have a positive history of: |
| **Duration of symptoms
| | *[History finding 1] |
| **Frequency of stools
| | *[History finding 2] |
| **Characteristics of stools
| | *[History finding 3] |
| **History of associated symptoms(Fever, abdominal pain, nausea and vomiting)
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| **History towards potential exposure(eg: food history,travel history, exposure to pets)
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| ***Travel history:
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| ****Travel history may be helpful in identifying a cause for diarrhea.
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| ****The risk of traveler"s diarrhea is high in regions where hygienic practices and sanitation are poor.
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| ****Traveler's diarrhea risk also varies with season of the year, higher risk during warmer months and rainy seasons.
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| ****Risk by geographic regions:
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| *****High risk: South and Southeast Asia, Central and western Africa, South and Central America, and Mexico.
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| *****Moderate risk: Caribbean Islands, South Africa, Central and East Asia, Eastern Europe, and the Middle East. | |
| *****Low risk: the United States, Canada, Singapore, Japan,Northern and Western Europe, Australia and New Zealand.
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| ***Common organisms that cause diarrhea among traveler's include:
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| ****Enterotoxigenic E.coli [[ETEC]] is the leading cause
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| ****Shigella
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| ****Salmonella | |
| ****Campylobacter
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| ****Rota virus.
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| ***Other organisms that are prevalent in particular parts of the world include the following:
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| ****Nonspecific foreign travel history: Consider Enterotoxigenic E coli [[ETEC]], Aeromonas, Giardia, Plesiomonas, Salmonella, and Shigella species
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| ****Travel to Africa: Entamoeba species, Vibrio cholerae
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| ****Travel to South America and Central America: Entamoeba species, V cholerae, enterotoxigenic E coli
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| ****Travel to Asia: V cholerae
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| ****Travel to Australia: Yersinia species
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| ****Travel to Canada: Yersinia species
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| ****Travel to Europe: Yersinia species
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| ****Travel to India: Entamoeba species, V cholerae
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| ****Travel to Japan: Vibrio parahaemolyticus
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| ****Travel to Mexico: Aeromonas, Entamoeba, Plesiomonas, and Yersinia species
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| ****New Guinea: Clostridium species.
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| *Day care history: Certain pathogens are spread very quickly in daycare.
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| **Virus:
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| ***Rota virus
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| ***Astro virus
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| ***Calcivirus
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| **Bacteria:
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| ***Campylobacter
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| ***Shigela
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| **Protozoa:
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| ***Giardia
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| ***Cryptosporidium species.
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| *Food history:
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| **Intake of raw or uncooked food is a common cause of infectious diarrhea. Consumption of undercooked or raw meat or fish, unpasteurized dairy products, or certain organic vitamin preperations may suggest certain pathogens.
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| ***Meats: C perfringens and Aeromonas, Campylobacter, and Salmonella species
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| ***Dairy food: Campylobacter and Salmonella species,Listeria esp in pregnant woman.
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| ***Eggs: Salmonella species
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| ***Seafood: Astrovirus and Aeromonas, Plesiomonas, and Vibrio species
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| ***Poultry: Campylobacter species
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| ***Oysters: Calicivirus and Plesiomonas and Vibrio species | |
| ***Vegetables: Aeromonas species and C perfringens
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| ***Ground beef: Enterohemorrhagic E coli
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| ***Pork: C perfringens, Y enterocolitica
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| ***
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| **Although it is often difficult to know which food exposure was the potential cause, the timing of onset of symptoms following exposure to the suspected food can be an important clue to find the diagnosis.
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| ***Up to 6 hrs: Ingestion of a preformed toxin produced by Staphylococcus aureus or Bacillus cereus,if nausea and vomiting were the initial symptoms.
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| ***Between 8 to 16 hours: suggests infection with Clostridium perfringens
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| ***After 16 hours: Most commonly either viral or other bacterial infection (eg, contamination of food with enterotoxigenic E.coli [[EHEC]] or other pathogens.
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| *Water exposure: Water is the main source for organisms that cause diarrhea.
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| **Swimming pools have been associated with outbreaks of infection with Shigella species.
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| **Aeromonas organisms are associated with exposure to the marine environment
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| **Certain organisms are resistant to chlorination(eg: Giardia, Cryptosporidium, and Entamoeba), so,exposure to contaminated water should raise the suspicion of infection with these pathogens.
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| **Camping history with exposure to water sources may also suggest infection with Giardia.
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| *Exposure to animals:
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| **poultry, petting zoos has been associated with Salmonella and Campylobacter infections.
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| *Medical history:
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| **Various medical conditions can make patients prone to infections.
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| ***C difficile: Hospitalization, antibiotic administration
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| ***Plesiomonas species: Liver diseases or malignancy
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| ***Salmonella species: Intestinal dysmotility, malnutrition, achlorhydria, hemolytic anemia (especially sickle cell disease), immunosuppression, malaria
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| ***Rotavirus: Hospitalization
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| ***Giardia species: Agammaglobulinemia, chronic pancreatitis, achlorhydria, cystic fibrosis
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| ***Cryptosporidia species:Immunocompromised or immunosuppressed state
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| ***Vibrio: Cirrhosis
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| ***Yersinia: Hemochromatosis.
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| ===Common Symptoms=== | | ===Common Symptoms=== |