Diarrhea, Acute (Community-Acquired)

Valeria Fabre, M.D.

Diarrhea, Acute (Community-Acquired) is a topic covered in the Johns Hopkins ABX Guide.

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PATHOGENS

Common pathogens and causes: the list is by no means exhaustive
- Bacterial
  - Campylobacter jejuni
  - Salmonella species
  - Shigella species
  - Yersinia spp. (non-plague)
  - Plesiomonas shigelloides(controversial)
  - Vibrio spp.
  - E. coli: multiple classified by mechanism
    - Most important are enterotoxigenic (ETEC), enterohemorrhagic (EHEC) or Shiga toxin E. coli (STEC).
      - The most common STEC is E. coli 0157:H7
  - Cryptosporidia and Isospora
  - Giardia lamblia
  - E. histolytica
  - C. difficile (increasing descriptions as community-acquired without obvious risk factors such as prior antibiotic exposure)
  - Aeromonas species (2% of traveler’s diarrhea, usually watery diarrhea with fever and abdominal cramps)
- Parasites: more typical to consider with diarrhea lasting > 14d (sub-acute or chronic).
- Viral:
  - Norovirus (a leading cause)
  - Adenovirus
  - Astrovirus
  - Coronavirus
  - Enterovirus
  - Calicivirus
  - Rotavirus
Non-infectious causes: adverse drug reactions, irritable bowel syndrome, inflammatory bowel disease (ulcerative colitis or Crohn’s disease), radiation or ischemic bowel disease, partial bowel obstruction, small bowel overgrowth, laxative abuse, collagen colitis, tube feeding and endocrine disorders among others.

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PATHOGENS

Common pathogens and causes: the list is by no means exhaustive
- Bacterial
  - Campylobacter jejuni
  - Salmonella species
  - Shigella species
  - Yersinia spp. (non-plague)
  - Plesiomonas shigelloides(controversial)
  - Vibrio spp.
  - E. coli: multiple classified by mechanism
    - Most important are enterotoxigenic (ETEC), enterohemorrhagic (EHEC) or Shiga toxin E. coli (STEC).
      - The most common STEC is E. coli 0157:H7
  - Cryptosporidia and Isospora
  - Giardia lamblia
  - E. histolytica
  - C. difficile (increasing descriptions as community-acquired without obvious risk factors such as prior antibiotic exposure)
  - Aeromonas species (2% of traveler’s diarrhea, usually watery diarrhea with fever and abdominal cramps)
- Parasites: more typical to consider with diarrhea lasting > 14d (sub-acute or chronic).
- Viral:
  - Norovirus (a leading cause)
  - Adenovirus
  - Astrovirus
  - Coronavirus
  - Enterovirus
  - Calicivirus
  - Rotavirus
Non-infectious causes: adverse drug reactions, irritable bowel syndrome, inflammatory bowel disease (ulcerative colitis or Crohn’s disease), radiation or ischemic bowel disease, partial bowel obstruction, small bowel overgrowth, laxative abuse, collagen colitis, tube feeding and endocrine disorders among others.

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