Acute diarrhea natural history, complications and prognosis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Chandrakala Yannam, MD [2]Sudarshana Datta, MD [3]
Overview
Untreated cases of acute diarrhea may progress to develop symptoms of fluid depletion including altered mental status, electrolyte imbalances, dehydration, metabolic acidosis and malnutrition. Common complications of acute diarrhea include confusion, convulsions, sepsis, and death. Prognosis is generally good, when the underlying cause is identified and treated early.
Natural History, Complications, and Prognosis
Natural history
If left untreated, patients with acute diarrhea may develop symptoms and signs of dehydration (dry mouth and tongue, sunken eyes, confusion, lethargy, poor skin turgor, delayed capillary refill), malnutrition, altered mental status, sepsis, electrolyte imbalance, metabolic acidosis and eventually develop hypovolemic shock, coma or death. Acute diarrhea may also progress to chronic diarrhea in a small fraction of cases.[1]
Complications
- Common complications of acute diarrhea include:[1][2]
- Examples of certain postinfectious manifestations associated with some enteric pathogens include:
- Erythema nodosum
- Aortitis, osteomyelitis, extravascular deep tissue focus
- Ekiri syndrome (lethal, toxic encephalopathy) and/or seizure
- Intestinal perforation
- Salmonella including Salmonella Typhi, Shigella, Campylobacter, Yersinia, Entamoeba histolytica
- Meningitis
- Listeria, Salmonella (infants ≤3 months of age are at high risk)
- Postinfectious irritable bowel syndrome
- Reactive arthritis
- Salmonella, Shigella, Campylobacter, Yersinia, rarely Giardia, and Cyclospora cayetanensis
- Immunoglobulin A nephropathy
- Hemolytic uremic syndrome
- Hemolytic anemia
- Guillain-Barré syndrome
- Glomerulonephritis
Prognosis
Acute diarrhea is usually self limiting and has good prognosis, when the underlying cause is identified and treated. The presence of the following features in a patient with acute diarrhea for over 4 weeks may indicate poor prognosis:[3][4][5][6][7]
- Weight loss
- Rectal bleeding
- Immunosupression
- Hemolytic uremic syndrome with EHEC infection
- Gullian barre syndrome with Campylobacter infection
- Toxic megacolon
- Tenesmus
- Associated psychological factors
- Somatization
- Dietary causes of diarrhea
- Age > 50 years
References
- ↑ 1.0 1.1 Riddle MS, DuPont HL, Connor BA (2016). "ACG Clinical Guideline: Diagnosis, Treatment, and Prevention of Acute Diarrheal Infections in Adults". Am. J. Gastroenterol. 111 (5): 602–22. doi:10.1038/ajg.2016.126. PMID 27068718.
- ↑ "Diarrhea - Symptoms and causes - Mayo Clinic".
- ↑ Karmali MA, Petric M, Lim C, Fleming PC, Arbus GS, Lior H (1985). "The association between idiopathic hemolytic uremic syndrome and infection by verotoxin-producing Escherichia coli". J. Infect. Dis. 151 (5): 775–82. PMID 3886804.
- ↑ Nylund CM, Denson LA, Noel JM (2010). "Bacterial enteritis as a risk factor for childhood intussusception: a retrospective cohort study". J. Pediatr. 156 (5): 761–5. doi:10.1016/j.jpeds.2009.11.026. PMID 20138300.
- ↑ Olesen M, Eriksson S, Bohr J, Järnerot G, Tysk C (2004). "Microscopic colitis: a common diarrhoeal disease. An epidemiological study in Orebro, Sweden, 1993-1998". Gut. 53 (3): 346–50. PMC 1773978. PMID 14960513.
- ↑ Tillisch K, Labus JS, Naliboff BD, Bolus R, Shetzline M, Mayer EA; et al. (2005). "Characterization of the alternating bowel habit subtype in patients with irritable bowel syndrome". Am J Gastroenterol. 100 (4): 896–904. doi:10.1111/j.1572-0241.2005.41211.x. PMID 15784038.
- ↑ Hammer HF, Fine KD, Santa Ana CA, Porter JL, Schiller LR, Fordtran JS (1990). "Carbohydrate malabsorption. Its measurement and its contribution to diarrhea". J Clin Invest. 86 (6): 1936–44. doi:10.1172/JCI114927. PMC 329829. PMID 2254453.