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Bacterial gastroenteritis

Last updated: October 26, 2020

Summary

Bacterial gastroenteritis is caused by a variety of organisms, including Campylobacter, Salmonella, Shigella, Yersinia, Vibrio cholerae, Staphylococcus aureus, diarrheagenic Escherichia coli, Clostridium difficile, Clostridium perfringens, and noncholera Vibrio species. Infection may be foodborne, fecal-oral, or involve direct or indirect animal transmission. Clinical features can be mild, manifesting as abdominal pain and diarrhea, or severe, including vomiting and watery or inflammatory diarrhea, fever, and hypotension. Stool analysis may reveal leukocytes or blood in certain cases. Stool cultures may be considered in severe gastroenteritis. Bacterial gastroenteritis is usually self-limiting and only requires supportive therapy. However, antibiotics are indicated when supportive therapy does not suffice or in immunosuppressed patients. Adequate food and water hygiene is crucial for preventing disease.

Overview

Overview of bacterial gastroenteritis
Pathogen Pathophysiology Associations Stool findings
Secretory diarrhea
Bacillus cereus
  • Rice, vomiting
  • WBC negative
  • No blood
ETEC
  • Recent travel (e.g., Asia, Africa, the Middle East, Mexico, Central, and South America)
Clostridium perfringens
  • Undercooked meat and raw legumes
Staphylococcus aureus
  • Inadequately refrigerated food
Vibrio cholerae
Invasive diarrhea
Yersinia
  • WBC positive (fecal mononuclear leukocytes)
  • Blood may be present
Salmonella typhi or paratyphi
Inflammatory diarrhea
Campylobacter
  • Most common bacterial organism pathogen responsible for foodborne gastroenteritis in the US
EHEC
  • Undercooked meat; most common association with hemolytic-uremic syndrome (HUS)
Clostridium difficile
Shigella
  • Second most common association with hemolytic-uremic syndrome (HUS)
Noncholera Vibrio species
  • Shellfish
Salmonella (non-typhoidal)
  • Poultry/eggs

References:[1][2][3][4][5][6][7][8][9][10][11][12][13][14][15]

Campylobacter enteritis (campylobacteriosis)

References:[5][16][17][18][19]

Salmonellosis (Salmonella gastroenteritis)

References:[5][16][20][21][22][23][24][25]

Shigellosis (bacillary dysentery)

[26][27][28][29]

Cholera

References:[5][15][30][31][32]

Yersiniosis

References:[33][34][35][36][37][38][39]

Clostridium perfringens enterocolitis

References:[1][5][30][40][41]

Noncholera Vibrio infection

References:[42][43][44]

Acute management checklist

Trimethoprim/sulfamethoxazole is not recommended as an empiric treatment for infectious gastroenteritis because of the high prevalence of resistant organisms.

References

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