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{{Acute diarrhea}}
{{Acute diarrhea}}
{{CMG}}; {{AE}} {{CK}}
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==Overview==
==Overview==
The risk factors of Acute diarrhea can be assessed based on the [[epidemiologic]] associations and the patient exposure histories. Some of theses factors can be classified based on travel history, epidemics and outbreaks, Food history, Animal contact, Hospitalization and immunosupression.
The [[risk factors]] of acute diarrhea may be assessed based on the [[epidemiologic]] associations and the patient exposure histories. [[Risk factors]] may be classified based on travel history, [[Epidemic|epidemics]], [[Outbreak|outbreaks]], food history, animal contact, [[Hospital|hospitalization]] and [[immunosupression]]. The 2017 Infectious Diseases Society of America Clinical Practice Guidelines for the Diagnosis and Management of Infectious Diarrhea lists the [[risk factors]] of diarrhea along with their causative [[Pathogen|pathogens]].


==Risk factors==  
==Risk factors==  
Most common risk factors for [[Acute diarrhea]] include:<ref name="pmid25928418">{{cite journal |vauthors=Heather CS |title=Travellers' diarrhoea |journal=BMJ Clin Evid |volume=2015 |issue= |pages= |year=2015 |pmid=25928418 |pmc=4415508 |doi= |url=}}</ref><ref name="pmid29083755">{{cite journal |vauthors=Dunn N, Gossman WG |title= |journal= |volume= |issue= |pages= |year= |pmid=29083755 |doi= |url=}}</ref><ref name="pmid9282385">{{cite journal |vauthors=Todd EC |title=Epidemiology of foodborne diseases: a worldwide review |journal=World Health Stat Q |volume=50 |issue=1-2 |pages=30–50 |year=1997 |pmid=9282385 |doi= |url=}}</ref><ref name="pmid23804024">{{cite journal |vauthors=Gould LH, Walsh KA, Vieira AR, Herman K, Williams IT, Hall AJ, Cole D |title=Surveillance for foodborne disease outbreaks - United States, 1998-2008 |journal=MMWR Surveill Summ |volume=62 |issue=2 |pages=1–34 |year=2013 |pmid=23804024 |doi= |url=}}</ref><ref name="pmid16319813">{{cite journal |vauthors= |title=Severe Clostridium difficile-associated disease in populations previously at low risk--four states, 2005 |journal=MMWR Morb. Mortal. Wkly. Rep. |volume=54 |issue=47 |pages=1201–5 |year=2005 |pmid=16319813 |doi= |url=}}</ref><ref name="pmid28214721">{{cite journal |vauthors=Efstratiou A, Ongerth JE, Karanis P |title=Waterborne transmission of protozoan parasites: Review of worldwide outbreaks - An update 2011-2016 |journal=Water Res. |volume=114 |issue= |pages=14–22 |year=2017 |pmid=28214721 |doi=10.1016/j.watres.2017.01.036 |url=}}</ref><ref name="pmid26111239">{{cite journal |vauthors=Guzman-Herrador B, Carlander A, Ethelberg S, Freiesleben de Blasio B, Kuusi M, Lund V, Löfdahl M, MacDonald E, Nichols G, Schönning C, Sudre B, Trönnberg L, Vold L, Semenza JC, Nygård K |title=Waterborne outbreaks in the Nordic countries, 1998 to 2012 |journal=Euro Surveill. |volume=20 |issue=24 |pages= |year=2015 |pmid=26111239 |doi= |url=}}</ref><ref name="pmid15880088">{{cite journal |vauthors=Niyogi SK |title=Shigellosis |journal=J. Microbiol. |volume=43 |issue=2 |pages=133–43 |year=2005 |pmid=15880088 |doi= |url=}}</ref><ref name="pmid29379258">{{cite journal |vauthors=Somboonwit C, Menezes LJ, Holt DA, Sinnott JT, Shapshak P |title=Current views and challenges on clinical cholera |journal=Bioinformation |volume=13 |issue=12 |pages=405–409 |year=2017 |pmid=29379258 |pmc=5767916 |doi=10.6026/97320630013405 |url=}}</ref>
According to the '''2017 Infectious Diseases Society of America Clinical Practice Guidelines for the Diagnosis and Management of Infectious Diarrhea''', common [[risk factors]] along with causative [[Pathogen|pathogens]] of diarrhea include the following:<ref name="pmid29083755">{{cite journal |vauthors=Dunn N, Gossman WG |title= |journal= |volume= |issue= |pages= |year= |pmid=29083755 |doi= |url=}}</ref>
*Travel to endemic areas
{{Family tree/start}}
**Bacteria''':''' Enterotoxigenic E.coli ([[ETEC]]), Shigella, Salmonella, Campylobacter, Aeromonas, Plesiomonas
{{familytree |boxstyle=text-align: left; | | | | | | B01 | | | |B01='''Contamination''': <br> •Foodborne outbreaks in hotels, cruise ships, resorts, restaurants, catered events  <br> •Consumption of unpasteurized milk or dairy products <br> •Waterborne <br> •Animal exposure <br> •Consumption of raw or undercooked meat or poultry}}
**Virus: Rota virus, Noro virus (Cruise ship diarrhea), enteric Adenovirus
{{Family tree | | | | | | |!| | | | | }}
**Protozoans: Entamoeba histolytica, Cryptosporidium, Giardia
{{Family tree | | | | | | |!| | | | | }}
*Epidemics and Outbreaks:
{{familytree |boxstyle=text-align: left; | A01 |-|-| A02 |-|-|-| A03 | |A01= '''Exposure''': <br> •Child care facilities <br>•Long term care facilities <br>•[[Hospitalisation]] <br>•International travel| A02= '''RISK FACTORS FOR ACUTE DIARRHEA'''| A03='''Host factors''': <br>•[[Immunocompromised]] hosts <br>•Certain sexual practices <br>•Age group <br>•[[Hemochromatosis]] or [[hemoglobinopathy]]}} 
**Bacterial: Shigella, Vibrio cholerae
** Virus: Noro virus, Rotavirus
**Protozoan: Cryptosporidium
*Animal contact: Non typhoidal Salmonella, Campylobacter
*Day care: Common organisms include Noro virus, Rota virus, Calci virus, Campylobacter, Shigella, Cryptosporidium.
*Poor sanitation and crowding
*Water exposure''':''' Swimming pools and Marine environment (Shigella, Aeromonas, Giardia, Cryptosporidium)
*Food history: Consumption of raw or undercooked food is a common risk factor in the development of acute diarrhea.
**Raw eggs: Salmonella
**Diary food: Campylobacter, Salmonella
**Ground beef: EHEC
**Poultry: Campylobacter
**Oysters: Calci virus, Vibrio
*Antibiotic use and hospitalization:
** Clostridium difficle, Rota virus.
*Drug side effects: Broad spectrum antibiotics, Anti fungals, Immunosuppressants)
*Homosexual men
*Immunosupression: HIV, CMV, Cryptosporidia, [[Mycobacterium Avium complex]],
*Transplant recipients
*Old age
Foodborne
*Foodborne outbreaks in hotels, cruise ships, resorts,restaurants, catered events:Norovirus, nontyphoidal Salmonella, Clostridium perfringens, Bacillus cereus, Staphylococcus aureus, Campylobacter spp, ETEC, STEC, Listeria, Shigella, Cyclospora cayetanensis,Cryptosporidium spp
*Consumption of unpasteurized milk or dairy products:Salmonella, Campylobacter, Yersinia enterocolitica, S. aureus toxin, Cryptosporidium, and STEC. Listeria is infrequently associated with diarrhea, Brucella (goat milk cheese),Mycobacterium bovis, Coxiella burnetii
*Consumption of raw or undercooked meat or poultry:STEC (beef), C. perfringens (beef, poultry), Salmonella (poultry), Campylobacter (poultry),Yersinia (pork, chitterlings), S. aureus (poultry), and Trichinella spp (pork, wild game meat)
*Consumption of fruits or unpasteurized fruit juices, vegetables, leafy greens, and sprouts:STEC, nontyphoidal Salmonella, Cyclospora, Cryptosporidium, norovirus, hepatitis A, and Listeria monocytogenes
*Consumption of undercooked eggs: Salmonella, Shigella (egg salad)
*Consumption of raw shellfish:Vibrio species, norovirus, hepatitis A, Plesiomonas


Contact or exposure
{{Family tree | | | | | | |!| | | | | }}
*Swimming in or drinking untreated fresh water:Campylobacter, Cryptosporidium, Giardia, Shigella, Salmonella, STEC, Plesiomonas shigelloides
{{Family tree | | | | | | |!| | | | | }}
*Swimming in recreational water facility with treated water:Cryptosporidium and other potentially waterborne pathogens when disinfectant concentrations are inadequately maintained
{{familytree |boxstyle=text-align: left; | | | | | | B01 | | | |B01= '''Side effects of pharmacotherapy''': <br>•[[Antimicrobial]] therapy <br>•Drug side effects}}
*Healthcare, long-term care, prison exposure, or employment:Norovirus, Clostridium difficile, Shigella, Cryptosporidium, Giardia, STEC, rotavirus
{{Family tree/end}}
*Child care center attendance or employment:Rotavirus, Cryptosporidium, Giardia, Shigella, STEC
*Recent antimicrobial therapy:C. difficile, multidrug-resistant Salmonella
*Travel to resource-challenged countries:Escherichia coli (enteroaggregative, enterotoxigenic, enteroinvasive), Shigella, Typhi and
nontyphoidal Salmonella, Campylobacter, Vibrio cholerae, Entamoeba histolytica, Giardia,
Blastocystis, Cyclospora, Cystoisospora, Cryptosporidium
*Exposure to house pets with diarrhea:Campylobacter, Yersinia
*Exposure to pig feces in certain parts of the world:Balantidium coli
*Contact with young poultry or reptiles: Nontyphoidal Salmonella
*Visiting a farm or petting zoo:STEC, Cryptosporidium, Campylobacter


Exposure or condition
==== Contamination ====
*Age group: Rotavirus (6–18 months of age), nontyphoidal Salmonella (infants from birth to 3 months of
*Foodborne outbreaks in hotels, cruise ships, resorts, restaurants, catered events<ref name="pmid9282385">{{cite journal |vauthors=Todd EC |title=Epidemiology of foodborne diseases: a worldwide review |journal=World Health Stat Q |volume=50 |issue=1-2 |pages=30–50 |year=1997 |pmid=9282385 |doi= |url=}}</ref>
age and adults >50 years with a history of atherosclerosis), Shigella (1–7 years of age),
**[[Shigella]], [[Vibrio cholerae]], [[Bacillus cereus]], [[Staphylococcus aureus]], [[Salmonella|nontyphoidal Salmonella]], [[Clostridium perfringens]], [[Campylobacter]], [[ETEC]], [[Listeria monocytogenes|Listeria]], [[Norovirus]], [[Rotavirus]], [[Cryptosporidium]], [[Cyclospora cayetanensis]]
Campylobacter (young adults)
*Consumption of unpasteurized milk or dairy products<ref name="pmid23804024">{{cite journal |vauthors=Gould LH, Walsh KA, Vieira AR, Herman K, Williams IT, Hall AJ, Cole D |title=Surveillance for foodborne disease outbreaks - United States, 1998-2008 |journal=MMWR Surveill Summ |volume=62 |issue=2 |pages=1–34 |year=2013 |pmid=23804024 |doi= |url=}}</ref>
*Underlying immunocompromising condition:Nontyphoidal Salmonella, Cryptosporidium, Campylobacter, Shigella, Yersinia
**[[Salmonella]], [[Campylobacter]], [[Brucella]] (goat milk cheese), [[Coxiella burnetii]], [[Yersinia enterocolitica]], [[Staphylococcus aureus infections|S. aureus toxin]], [[Cryptosporidium]], [[Listeria monocytogenes|Listeria]], [[Mycobacterium bovis]]
*Hemochromatosis or hemoglobinopathy:Y. enterocolitica, Salmonella
*Consumption of raw or undercooked meat or poultry<ref name="pmid29379258">{{cite journal |vauthors=Somboonwit C, Menezes LJ, Holt DA, Sinnott JT, Shapshak P |title=Current views and challenges on clinical cholera |journal=Bioinformation |volume=13 |issue=12 |pages=405–409 |year=2017 |pmid=29379258 |pmc=5767916 |doi=10.6026/97320630013405 |url=}}</ref>
*AIDS, immunosuppressive therapies:Cryptosporidium, Cyclospora, Cystoisospora, microsporidia, Mycobacterium avium–intercellulare
**[[Clostridium perfringens|C. perfringens]] (beef, poultry), [[EHEC]] (ground beef), [[Salmonella]] (poultry), Calcivirus (oysters), [[Campylobacter]] (poultry), [[Vibrio]] (oysters),[[Yersinia]] (pork, chitterlings), [[Staphylococcus aureus|S. aureus]] (poultry), and [[Trichinella]] (pork, wild game meat)
complex, cytomegalovirus
*Consumption of fruits or unpasteurized fruit juices, vegetables, leafy greens, and sprouts
*Anal-genital, oral-anal, or digital-anal contact:Shigella, Salmonella, Campylobacter, E. histolytica, Giardia lamblia, Cryptosporidium as well as
**[[Hepatitis A]], [[Listeria monocytogenes]], [[Salmonella|Nontyphoidal Salmonella]], [[Cyclospora cayetanensis|Cyclospora]], [[Cryptosporidium]], [[Norovirus]]
sexually transmitted infections
*Consumption of undercooked eggs
**[[Salmonella]], [[Shigella]] (egg salad)
*Consumption of raw shellfish
**[[Hepatitis A]], [[Vibrio]] species, [[Plesiomonas shigelloides|Plesiomonas]], [[Norovirus]]


*Swimming in or drinking untreated fresh water<ref name="pmid26111239">{{cite journal |vauthors=Guzman-Herrador B, Carlander A, Ethelberg S, Freiesleben de Blasio B, Kuusi M, Lund V, Löfdahl M, MacDonald E, Nichols G, Schönning C, Sudre B, Trönnberg L, Vold L, Semenza JC, Nygård K |title=Waterborne outbreaks in the Nordic countries, 1998 to 2012 |journal=Euro Surveill. |volume=20 |issue=24 |pages= |year=2015 |pmid=26111239 |doi= |url=}}</ref>
**[[Giardia lamblia|Giardia]], [[Campylobacter]], [[Cryptosporidium]], [[Salmonella]], [[Shigella]], [[Plesiomonas shigelloides]], [[Aeromonas]]
*Swimming in recreational water facility with treated water<ref name="pmid26111239" /><ref name="pmid28214721">{{cite journal |vauthors=Efstratiou A, Ongerth JE, Karanis P |title=Waterborne transmission of protozoan parasites: Review of worldwide outbreaks - An update 2011-2016 |journal=Water Res. |volume=114 |issue= |pages=14–22 |year=2017 |pmid=28214721 |doi=10.1016/j.watres.2017.01.036 |url=}}</ref> 
**[[Cryptosporidium]]
*Exposure to house pets with diarrhea
**[[Campylobacter]], [[Yersinia]]
*Exposure to pig feces in certain parts of the world
**[[Balantidium coli]]
*Contact with young poultry or reptiles
**[[Salmonella|Nontyphoidal Salmonella]]
*Visiting a farm or petting zoo
**[[Cryptosporidium]], [[Campylobacter]]
==== Host factors ====
*Age group
**Birth- 3 months: [[Salmonella|Nontyphoidal Salmonella]]
**6–18 months: [[Rotavirus]]
**1–7 years: [[Shigella]]
**Young adults: [[Campylobacter]]
**Adults >50 years with a history of [[atherosclerosis]]: [[Salmonella|Nontyphoidal Salmonella]]
*[[Immunocompromised|Immunocompromised individuals]]
**[[Salmonella|Nontyphoidal Salmonella]], [[Yersinia]], [[Shigella]], [[Cryptosporidium]], [[Campylobacter]]
*[[Hemochromatosis]] or [[hemoglobinopathy]]
**[[Salmonella]], [[Yersinia Enterocolitica Infection|Y. enterocolitica]]
*[[HIV AIDS|AIDS]], [[Immunosuppression|immunosuppressive therapies]], [[homosexual men]], [[Transplant|transplant recipients]]
**[[Cytomegalovirus]], [[Mycobacterium avium intracellulare|Mycobacterium avium–intercellulare complex]], [[Cryptosporidium]], [[Cyclospora cayetanensis|Cyclospora]], [[Cystoisospora belli|Cystoisospora]], [[Microsporidia]], [[Human Immunodeficiency Virus (HIV)|HIV]]
==== Side effects of pharmacotherapy ====
*Drug side effects<ref name="pmid16319813">{{cite journal |vauthors= |title=Severe Clostridium difficile-associated disease in populations previously at low risk--four states, 2005 |journal=MMWR Morb. Mortal. Wkly. Rep. |volume=54 |issue=47 |pages=1201–5 |year=2005 |pmid=16319813 |doi= |url=}}</ref>
**[[Antibiotic|Broad spectrum antibiotics]]
**[[Immunosuppressive drug|Immunosuppressants]]
**[[Antifungal drug|Antifungals]]
*Recent [[Antimicrobial|antimicrobial therapy]] and [[Hospital|hospitalization]]<ref name="pmid16319813" />
**[[Clostridium difficile infection|C. difficile]]
**Multidrug-resistant [[Salmonella]]
**[[Rotavirus]]
==== Exposure ====
*[[Anal]]-[[Sex organ|genital]], oral-anal, or digital-anal contact
**[[Shigella]], [[Giardia lamblia]], [[Campylobacter]], [[Entamoeba histolytica|E. histolytica]], [[Cryptosporidium]] and [[Sexually transmitted disease|sexually transmitted infections]], [[Salmonella]]
*Healthcare, long-term care, prison exposure, or employment
**[[Norovirus]], [[Clostridium difficile]], [[Shigella]], [[Cryptosporidium]], [[Giardia lamblia|Giardia]], [[Rotavirus]]
*Day care
**[[Rotavirus]], [[Cryptosporidium]], [[Giardia lamblia|Giardia]], [[Shigella]], [[Norovirus]], Calcivirus, [[Campylobacter]]
*Travel to endemic areas, poor [[sanitation]] and crowding<ref name="pmid25928418">{{cite journal |vauthors=Heather CS |title=Travellers' diarrhoea |journal=BMJ Clin Evid |volume=2015 |issue= |pages= |year=2015 |pmid=25928418 |pmc=4415508 |doi= |url=}}</ref>
**[[Escherichia coli]] ([[EAEC|enteroaggregative]], [[Enterotoxigenic Escherichia coli|enterotoxigenic]], [[Enteroinvasive Escherichia coli infection|enteroinvasive]]), [[Shigella]], [[Salmonella|Typhi and nontyphoidal Salmonella]], [[Campylobacter]], [[Vibrio cholerae]], [[Aeromonas]], [[Plesiomonas shigelloides|Plesiomonas]], [[Rotavirus]], [[Norovirus]] (Cruise ship diarrhea), [[Adenoviridae|enteric Adenovirus]], [[Entamoeba histolytica]], [[Cryptosporidium]], [[Blastocystis]], [[Giardia lamblia|Giardia]], [[Cyclospora cayetanensis|Cyclospora]], [[Cystoisospora belli|Cystoisospora]]


==References==
==References==
{{Reflist|2}}
{{Reflist|2}}
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Latest revision as of 20:16, 29 July 2020

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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

The risk factors of acute diarrhea may be assessed based on the epidemiologic associations and the patient exposure histories. Risk factors may be classified based on travel history, epidemics, outbreaks, food history, animal contact, hospitalization and immunosupression. The 2017 Infectious Diseases Society of America Clinical Practice Guidelines for the Diagnosis and Management of Infectious Diarrhea lists the risk factors of diarrhea along with their causative pathogens.

Risk factors

According to the 2017 Infectious Diseases Society of America Clinical Practice Guidelines for the Diagnosis and Management of Infectious Diarrhea, common risk factors along with causative pathogens of diarrhea include the following:[1]

 
 
 
 
 
Contamination:
•Foodborne outbreaks in hotels, cruise ships, resorts, restaurants, catered events
•Consumption of unpasteurized milk or dairy products
•Waterborne
•Animal exposure
•Consumption of raw or undercooked meat or poultry
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Exposure:
•Child care facilities
•Long term care facilities
•Hospitalisation
•International travel
 
 
RISK FACTORS FOR ACUTE DIARRHEA
 
 
 
Host factors:
•Immunocompromised hosts
•Certain sexual practices
•Age group
•Hemochromatosis or hemoglobinopathy
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Side effects of pharmacotherapy:
•Antimicrobial therapy
•Drug side effects
 
 
 

Contamination

Host factors

Side effects of pharmacotherapy

Exposure

References

  1. ↑ Dunn N, Gossman WG. PMID 29083755. Missing or empty |title= (help)
  2. ↑ Todd EC (1997). "Epidemiology of foodborne diseases: a worldwide review". World Health Stat Q. 50 (1–2): 30–50. PMID 9282385.
  3. ↑ Gould LH, Walsh KA, Vieira AR, Herman K, Williams IT, Hall AJ, Cole D (2013). "Surveillance for foodborne disease outbreaks - United States, 1998-2008". MMWR Surveill Summ. 62 (2): 1–34. PMID 23804024.
  4. ↑ Somboonwit C, Menezes LJ, Holt DA, Sinnott JT, Shapshak P (2017). "Current views and challenges on clinical cholera". Bioinformation. 13 (12): 405–409. doi:10.6026/97320630013405. PMC 5767916. PMID 29379258.
  5. ↑ 5.0 5.1 Guzman-Herrador B, Carlander A, Ethelberg S, Freiesleben de Blasio B, Kuusi M, Lund V, Löfdahl M, MacDonald E, Nichols G, Schönning C, Sudre B, Trönnberg L, Vold L, Semenza JC, Nygård K (2015). "Waterborne outbreaks in the Nordic countries, 1998 to 2012". Euro Surveill. 20 (24). PMID 26111239.
  6. ↑ Efstratiou A, Ongerth JE, Karanis P (2017). "Waterborne transmission of protozoan parasites: Review of worldwide outbreaks - An update 2011-2016". Water Res. 114: 14–22. doi:10.1016/j.watres.2017.01.036. PMID 28214721.
  7. ↑ 7.0 7.1 "Severe Clostridium difficile-associated disease in populations previously at low risk--four states, 2005". MMWR Morb. Mortal. Wkly. Rep. 54 (47): 1201–5. 2005. PMID 16319813.
  8. ↑ Heather CS (2015). "Travellers' diarrhoea". BMJ Clin Evid. 2015. PMC 4415508. PMID 25928418.
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