Ver el código de «Bacterial gastroenteritis»

''See [[Acute gastroenteritis (peds)]] for pediatric patients''
==Background==
*Most acute gastroenteritis (AGE) is viral, not bacterial
*[[rectal bleeding|Bloody diarrhea]] suggests bacterial etiology
*Do NOT diagnose isolated vomiting as AGE

===Clinical Features and Causes===
{| class="wikitable"
|+ Noninvasive AGE
|-
! Species!! Onset !! Symptoms !! Transmission !! Preformed Toxin
|-
| Viral ([[norovirus]], [[adenovirus]], [[rotavirus]])
|| 11-72 hrs
|| 
*Nausea, vomiting, watery diarrhea
*Mild abdominal cramps, myalgia
|| 
*Fecal-oral 
*Contaminated food or water
|| No
|-
| [[S. aureus|Staph]]
|| 1-6 hrs
|| 
*Nausea, severe vomiting, diarrhea, 
*Mild abdominal cramping
|| 
*Previously cooked foods (mayonaise, ham, salads)
|| Yes
|-
| [[Bacillus cereus|B. cereus]]
|| 1-6 hrs
|| 
*Abrupt onset of nausea, vomiting, mild diarrhea
|| 
*Previously cooked foods (rice, vegetables, dried fruits, meat)
|| Yes
|-
| [[Clostridium (not difficile)|C. perfringens]]
|| 8-24 hrs
|| 
*Nausea, minimal vomiting, watery diarrhea
*Abd cramps
|| 
*Previously cooked or reheated meats and poultry
|| Yes
|-
| [[Vibrio cholera|V. cholerae]]|| 11-72 hrs || 
*Explosive rice-water diarrhea
*Vomiting, abdominal cramps
*Fever
|| 
*Fecal-oral 
*Contaminated food or water 
|| No
|-
| [[Giardia]]
|| 1-4 wks
|| 
*Flatus, bloating
*Foul-smelling and fatty stools (steatorrhea)
|| 
*Fecal-oral
*Contaminated water
|| No
|}

{| class="wikitable sortable"
|+ Invasive AGE
|-
! scope="col" | '''Species'''
! scope="col" | '''Onset'''
! scope="col" | '''Symptoms'''
! scope="col" | '''Transmission'''
|-
| [[Salmonella]]||6-72 hours||
*[[Fever]], relative bradycardia
*[[Abdominal pain]]
*Bloody diarrhea
*[[Headache]]
*Osteomyelitis in sickle cell
||
*Eggs
*Poultry
*Water
*Reptiles
|-
| [[Shigella]]||1-3 days||
*[[Fever]]
*[[Abdominal pain]]
*Bloody diarrhea
*[[Headache]]
*1-5 years old
*Seizures in children
||
*Food
*Fecal-Oral
|-
| [[Yersinia]]||1-5 days||
*[[Appendicitis]] mimic, [[RLQ pain]]
*[[Fever]]
*[[Vomiting]]
*Kids and Young Adults
||
*Water
*Milk
*Pork
*Wild Animals
*Fecal-Oral
|-
| [[Campylobacter]]||1-7 days||
*Low grade [[fever]]
*[[Abdominal pain]]
*Kids and Young Adults
*Guillain-Barre
||
*Water
*Poultry
*Pets/Animals
|-
| [[C. Diff]]||1-11 Weeks||
*Copious FOUL diarrhea
||
*Antibiotic use: [[PCN]], [[Clinda]], [[Cephalosporins]]
|-
| [[Entamoeba]]||1-11 weeks||
*[[Appendicitis]] Mimic
*[[Abdominal pain]], [[nausea/vomiting]], [[diarrhea]]
||
*Water
*Sanitation
*Travel
|}
==Differential Diagnosis==
{{Abdominal Pain DDX Diffuse}}
{{Nausea and vomiting DDX}}

==Evaluation==
*Assess hydration status
**Cap refill, skin turgor, respiratory rate
*Consider stool studies if:
**>10 stools in previous 24hr
**[[Traveler's diarrhea|Travel to high-risk country]]
**Fever
**Bloody stool
**Persistent diarrhea

==Management==
#[[oral rehydration therapy|Rehydration]] (PO preferred)
#*30mL(1oz)/kg/hr
#*[[Reduced-osmolarity oral rehydration solution]]
#Antiemetic
#*[[Ondansetron]] 0.15mg/kg/dose IV/PO
#[[Antibiotics]]
#*Only consider in patients with invasive infection
#**[[Shigella]], [[campylobacter]], [[E. coli]], [[yersinia]], [[vibrio]]
#**Bloody stool with mucus and fever
#*NOT indicated for [[E. coli]] O157:H7
#*NOT routinely indicated for salmonella
#**Exceptions: [[sickle cell|SCD]], [[IBD]], <3mo
#*[[Azithromycin]] (able to tolerate PO)
#*'''OR''' [[ciprofloxacin]]
#*'''OR''' [[TMP-SMX]]
#*[[Ceftriaxone]] (parenteral)

==Disposition==
*Most can be discharged
*Admit
**Unable to tolerate PO
**Hemodynamic instability
**Significant comorbidities

==See Also==
*[[Acute gastroenteritis]]
*[[Nausea and Vomiting]]
*[[Acute gastroenteritis (peds)]]
*[[Dehydration]]
*[[Acute diarrhea]]

==External Links==

==References==
<references/>

[[Category:ID]] [[Category:GI]]