Chapter 040. Diarrhea and Constipation (Part 5)

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Table 40-2 Association between Pathobiology of Causative Agents and Clinical Features in Acute Infectious Diarrhea Pathobiolo gy/Agents bation Incu miting Vo Abd ominal Pain ever F rrhea Dia Period Toxin producers Preforme d toxin Bacillus cereus, Staphylococcus aureus, h 1–8 4+ 3– 1–2+ –1+ 0 4+, watery 3– Clostridi um perfringens h 8–24 Enterotox in Vibrio cholerae, enterotoxigenic Escherichia coli, Klebsiella pneumoniae, Aeromonas h 8–72 4+ 2– 1–2+ –1+ 0 4+, watery 3– species Enteroadhe rent Enteropat hogenic and d 1–8 1+ 0– 1–3+ –2+ 0 2+, 1– enteroadherent E. coli, Giardia watery, mushy organisms, cryptosporidiosis, helminths Cytotoxinproducers Clostridiu m difficile d 1–3 1+ 0– 3–4+ –2+ 1 3+, 1– usually watery, occasional ly bloody ...

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Chapter 040. Diarrhea and Constipation (Part 5) Table 40-2 Association between Pathobiology of Causative Agents and Clinical Features in Acute Infectious Diarrhea Pathobiolo gy/Agents Incu bation Period Vo miting Abd ominal Pain F ever Dia rrhea Toxin producers Preforme d toxin Bacillus cereus, Staphylococcus aureus, 1–8 h 3– 4+ 1–2+ 0 –1+ 3– 4+, watery Clostridi um perfringens 8–24 h Enterotox in Vibrio cholerae, enterotoxigenic Escherichia coli, Klebsiella pneumoniae, Aeromonas 8–72 h 2– 4+ 1–2+ 0 –1+ 3– 4+, watery species Enteroadhe rent Enteropat hogenic and enteroadherent E. coli, Giardia organisms, cryptosporidiosis, helminths 1–8 d 0– 1+ 1–3+ 0 –2+ 1– 2+, watery, mushy Cytotoxin- producers Clostridiu m difficile 1–3 d 0– 1+ 3–4+ 1 –2+ 1– 3+, usually watery, occasional ly bloody Hemorrha gic E. coli 12– 72 h 0– 1+ 3–4+ 1 –2+ 1– 3+, initially watery, quickly bloody Invasive organisms Minimal inflammation Rotaviru s and Norwalk agent 1–3 d 1– 3+ 2–3+ 3 –4+ 1– 3+, watery Variable inflammation Salmone lla, Campylobacter, and Aeromonas species, Vibrio parahaemolyticus, Yersinia 12 h–11 d 0– 3+ 2–4+ 3 –4+ 1– 4+, watery or bloody Severe inflammation Shigella species, enteroinvasive E. coli, Entamoeba histolytica 12 h–8 d 0– 1+ 3–4+ 3 –4+ 1– 2+, bloody Source: Adapted from DW Powell, in T Yamada (ed): Textbook of Gastroenterology and Hepatology, 4th ed. Philadelphia, Lippincott Williams & Wilkins, 2003; and DR Syndman, in SL Gorbach (ed): Infectious Diarrhea. London, Blackwell, 1986. Finally, infectious diarrhea may be associated with systemic manifestations. Reiter's syndrome (arthritis, urethritis, and conjunctivitis) may accompany or follow infections by Salmonella, Campylobacter, Shigella, and Yersinia. Yersiniosis may also lead to an autoimmune-type thyroiditis, pericarditis, and glomerulonephritis. Both enterohemorrhagic E. coli (O157:H7) and Shigella can lead to the hemolytic-uremic syndrome with an attendant high mortality rate. The syndrome of postinfectious IBS has now been recognized as a complication of infectious diarrhea. Acute diarrhea can also be a major symptom of several systemic infections including viral hepatitis, listeriosis, legionellosis, and toxic shock syndrome.