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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

  1. Allos BM. Clinical manifestations, diagnosis, and treatment of Campylobacter infection. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. http://www.uptodate.com/contents/clinical-manifestations-diagnosis-and-treatment-of-campylobacter-infection?source=search_result&search=Bacterial+gastroenteritis&selectedTitle=3~46.Last updated: September 9, 2016. Accessed: March 25, 2017.
  2. Campylobacter Fact sheet. http://www.who.int/mediacentre/factsheets/fs255/en/. Updated: December 1, 2016. Accessed: March 25, 2017.
  3. Javid MH. Campylobacter Infections. Campylobacter Infections. New York, NY: WebMD. http://emedicine.medscape.com/article/213720-overview#a4. Updated: May 20, 2016. Accessed: March 25, 2017.
  4. Bonheur JL. Bacterial Gastroenteritis. In: Anand BS, Bacterial Gastroenteritis. New York, NY: WebMD. http://emedicine.medscape.com/article/176400. Updated: January 8, 2017. Accessed: March 22, 2017.
  5. Jenkins B, McInnis M, Lewis C. Step-Up to USMLE Step 2 CK. Lippincott Williams & Wilkins ; 2015
  6. Shigella – Shigellosis - General Information. https://www.cdc.gov/shigella/general-information.html. Updated: August 3, 2016. Accessed: March 25, 2017.
  7. Agha R, Goldberg MB. Shigella infection: Treatment and prevention in adults. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/shigella-infection-treatment-and-prevention-in-adults?source=machineLearning&search=shigellosis+treatment&selectedTitle=1~133§ionRank=1&anchor=H1111772052#H1111772052.Last updated: September 9, 2016. Accessed: March 25, 2017.
  8. Goldberg MB. Shigella infection: Epidemiology, microbiology, and pathogenesis. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. http://www.uptodate.com/contents/shigella-infection-epidemiology-microbiology-and-pathogenesis?source=search_result&search=Shigellosis&selectedTitle=4~130.Last updated: September 9, 2016. Accessed: March 25, 2017.
  9. Agha R, Goldberg MB. Shigella infection: Clinical manifestations and diagnosis. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. http://www.uptodate.com/contents/shigella-infection-clinical-manifestations-and-diagnosis?source=search_result&search=Shigellosis&selectedTitle=1~130.Last updated: June 21, 2016. Accessed: March 25, 2017.
  10. Klochko A. Salmonellosis. Salmonellosis. New York, NY: WebMD. http://emedicine.medscape.com/article/228174-overview#showall. Updated: October 21, 2016. Accessed: March 25, 2017.
  11. Hohmann EL. Nontyphoidal Salmonella: Gastrointestinal infection and carriage. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/nontyphoidal-salmonella-gastrointestinal-infection-and-carriage?source=machineLearning&search=salmonellosis+treatment&selectedTitle=1~150§ionRank=1&anchor=H6#H6.Last updated: February 18, 2016. Accessed: March 25, 2017.
  12. Le T, Bhushan V, Skelley N. First Aid for the USMLE Step 2 CK. McGraw-Hill Education ; 2012
  13. Kotton CN, Hohmann EL. Pathogenesis of Salmonella gastroenteritis. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. http://www.uptodate.com/contents/pathogenesis-of-salmonella-gastroenteritis?source=search_result&search=Salmonellosis&selectedTitle=3~150#H5.Last updated: September 1, 2015. Accessed: March 25, 2017.
  14. Salmonella-Shigella Plates. http://iws2.collin.edu/dcain/CCCCD%20Micro/salmonellashigella_plates.htm. Updated: August 15, 2016. Accessed: November 16, 2018.
  15. Birdwood G. Antibiotics prolong salmonella excretion. Br Med J. 1969; 4 (5685): p.699-700.
  16. LaRocque R, Harris JB. Cholera: Clinical Features, Diagnosis, Treatment, and Prevention. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/cholera-clinical-features-diagnosis-treatment-and-prevention.Last updated: February 8, 2018. Accessed: April 26, 2018.
  17. Cholera - Vibrio cholerae infection - Antibiotic Treatment. https://www.cdc.gov/cholera/treatment/antibiotic-treatment.html. Updated: January 20, 2015. Accessed: March 25, 2017.
  18. Kasper DL, Fauci AS, Hauser SL, Longo DL, Lameson JL, Loscalzo J. Harrison's Principles of Internal Medicine. McGraw-Hill Education ; 2015
  19. Cholera. http://www.austincc.edu/microbio/2421a/vc.htm. Updated: February 1, 2010. Accessed: November 16, 2018.
  20. Yersinia enterocolitica (Yersiniosis). https://www.cdc.gov/yersinia/healthcare.html. Updated: October 24, 2016. Accessed: April 26, 2018.
  21. Tauxe RV. Epidemiology of yersiniosis. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. http://www.uptodate.com/contents/epidemiology-of-yersiniosis?source=search_result&search=yersiniosis&selectedTitle=3~41.Last updated: September 11, 2015. Accessed: March 25, 2017.
  22. Tauxe RV. Clinical Manifestations and Diagnosis of Yersinia Infections. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/clinical-manifestations-and-diagnosis-of-yersinia-infections.Last updated: June 12, 2017. Accessed: April 26, 2018.
  23. Khan ZZ. Yersinia Enterocolitica. Yersinia Enterocolitica. New York, NY: WebMD. http://emedicine.medscape.com/article/232343-overview. Updated: October 20, 2015. Accessed: March 25, 2017.
  24. Tauxe RV. Treatment and prevention of Yersinia enterocolitica and Yersinia pseudotuberculosis infection. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. http://www.uptodate.com/contents/treatment-and-prevention-of-yersinia-enterocolitica-and-yersinia-pseudotuberculosis-infection?source=search_result&search=yersiniosis&selectedTitle=1~41#H8.Last updated: July 14, 2015. Accessed: March 25, 2017.
  25. Plague - Ecology and Transmission. https://www.cdc.gov/plague/transmission/. Updated: September 14, 2015. Accessed: March 25, 2017.
  26. Travelers' Health - Yersiniosis. https://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseases-related-to-travel/yersiniosis. Updated: July 10, 2015. Accessed: March 25, 2017.
  27. Humphries RM, Linscott AJ. Laboratory Diagnosis of Bacterial Gastroenteritis. Clin Microbiol Rev. 2015; 28 (1): p.3-31. doi: 10.1128/CMR.00073-14 . | Open in Read by QxMD
  28. Travelers' Health - Travelers' Diarrhea. https://wwwnc.cdc.gov/travel/yellowbook/2016/the-pre-travel-consultation/travelers-diarrhea. Updated: July 10, 2015. Accessed: March 22, 2017.
  29. Wanke CA. Approach to the adult with acute diarrhea in resource-rich settings. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/approach-to-the-adult-with-acute-diarrhea-in-resource-rich-settings.Last updated: June 30, 2016. Accessed: February 20, 2017.
  30. Adams D, Fullerton K, Jajosky R et al. Summary of Notifiable Infectious Diseases and Conditions — United States, 2013. Morbidity and Mortality Weekly Report. 2015; 62 (53): p.1-119.
  31. Division of Foodborne, Waterborne, and Environmental Diseases (DFWED) - Surveillance & Data Systems. https://www.cdc.gov/ncezid/dfwed/keyprograms/surveillance.html. Updated: September 29, 2016. Accessed: March 24, 2017.
  32. Agabegi SS, Agabegi ED. Step-Up To Medicine. Lippincott Williams & Wilkins ; 2013
  33. Le T, Bhushan V, Chen V, King M. First Aid for the USMLE Step 2 CK. McGraw-Hill Education ; 2015
  34. Fischer C. Master the Boards USMLE Step 2 CK. Kaplan Publishing ; 2015
  35. LaRocque R, Harris JB. Causes of Acute Infectious Diarrhea and Other Foodborne Illnesses in Resource-rich Settings. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/causes-of-acute-infectious-diarrhea-and-other-foodborne-illnesses-in-resource-rich-settings.Last updated: January 10, 2018. Accessed: April 26, 2018.
  36. Freedman D, Leder K. Immunizations for travel. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. http://www.uptodate.com/contents/immunizations-for-travel?source=machineLearning&search=cholera+vaccine&selectedTitle=1~16§ionRank=1&anchor=H3180683#H3180683.Last updated: August 25, 2016. Accessed: March 24, 2017.
  37. Nickonchuk T, Lindblad AJ, Kolber MR. Oral cholera vaccine for traveler's diarrhea prophylaxis. Can Fam Physician. 2014; 60 (5): p.451.
  38. Cholera Fact sheet. http://www.who.int/mediacentre/factsheets/fs107/en/. Updated: October 1, 2016. Accessed: March 24, 2017.
  39. Brown T. FDA Approves First Cholera Vaccine in the US. FDA Approves First Cholera Vaccine in the US. New York, NY: WebMD. http://www.medscape.com/viewarticle/864673. Updated: June 10, 2016. Accessed: March 24, 2017.
  40. Food safety - Clostridium perfringens. https://www.cdc.gov/foodsafety/diseases/clostridium-perfringens.html. Updated: January 10, 2017. Accessed: March 25, 2017.
  41. Sobel J, Mixter CG, Kolhe P, et al. Necrotizing enterocolitis associated with Clostridium perfringens type A in previously healthy North American adults. J Am Coll Surg. 2005; 201 (1): p.48-56. doi: 10.1016/j.jamcollsurg.2005.02.029 . | Open in Read by QxMD
  42. Ho H. Vibrio Infections. Vibrio Infections. New York, NY: WebMD. http://emedicine.medscape.com/article/232038-overview. Updated: September 25, 2014. Accessed: March 25, 2017.
  43. Schwartz RA. Vibrio Vulnificus Infection. Vibrio Vulnificus Infection. New York, NY: WebMD. http://emedicine.medscape.com/article/1055523-overview. Updated: June 6, 2016. Accessed: March 25, 2017.
  44. Morris JG Jr. Vibrio Vulnificus Infections. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/vibrio-vulnificus-infections.Last updated: March 10, 2017. Accessed: April 26, 2018.
  45. Shane AL, Mody RK, Crump JA, et al. 2017 Infectious Diseases Society of America Clinical Practice Guidelines for the Diagnosis and Management of Infectious Diarrhea. Clin Infect Dis. 2017; 65 (12): p.e45-e80. doi: 10.1093/cid/cix669 . | Open in Read by QxMD
  46. Zollner-Schwetz I, Krause R. Therapy of acute gastroenteritis: role of antibiotics. Clinical Microbiology and Infection. 2015; 21 (8): p.744-749. doi: 10.1016/j.cmi.2015.03.002 . | Open in Read by QxMD
  47. Barr W, Smith A. Acute Diarrhea in Adults. Am Fam Physician. 2014 .
  48. McDonald LC, Gerding DN, Johnson S, et al. Clinical practice guidelines for clostridium difficile infection in adults and children: 2017 update by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA). Clin Infect Dis. 2018; 66 (7): p.e1-e48. doi: 10.1093/cid/cix1085 . | Open in Read by QxMD
  49. Switaj T, Winter K, Christensen S. Diagnosis and Management of Foodborne Illness. Am Fam Physician. undefined .
  50. Bányai K, Estes MK, Martella V, Parashar UD. Viral gastroenteritis. The Lancet. 2018; 392 (10142): p.175-186. doi: 10.1016/s0140-6736(18)31128-0 . | Open in Read by QxMD
  51. Wanke CA. Epidemiology and causes of acute diarrhea in resource-rich countries. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/epidemiology-and-causes-of-acute-diarrhea-in-resource-rich-countries?source=machineLearning&search=bacterial+gastroenteritis+prevention&selectedTitle=1~46§ionRank=1&anchor=H34#H4.Last updated: February 10, 2016. Accessed: March 24, 2017.
  52. CDC Features - Salmonella and Chicken: What You Should Know and What You Can Do. https://www.cdc.gov/features/SalmonellaChicken/. Updated: October 28, 2013. Accessed: March 25, 2017.
  53. Yersinia enterocolitica (Yersiniosis) - Information for Health & Lab Professionals. https://www.cdc.gov/yersinia/healthcare.html. Updated: May 25, 2016. Accessed: March 25, 2017.