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Questions and Answers
What are the common presenting symptoms of viral acute infectious diarrhoea?
What are the common presenting symptoms of viral acute infectious diarrhoea?
Which of the following conditions can cause acute infectious diarrhoea?
Which of the following conditions can cause acute infectious diarrhoea?
Which of the following is NOT a marker of severity in acute infectious diarrhoea?
Which of the following is NOT a marker of severity in acute infectious diarrhoea?
Faecal testing in patients with acute diarrhoea is only appropriate when the results will inform management.
Faecal testing in patients with acute diarrhoea is only appropriate when the results will inform management.
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Traditional faecal microbiological testing has a higher yield than mPCR.
Traditional faecal microbiological testing has a higher yield than mPCR.
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MPCR presents some significant advantages over traditional faecal testing, but there are also disadvantages.
MPCR presents some significant advantages over traditional faecal testing, but there are also disadvantages.
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Which of the following conditions are NOT considered in the Empirical Antibiotic Therapy for acute infectious diarrhoea?
Which of the following conditions are NOT considered in the Empirical Antibiotic Therapy for acute infectious diarrhoea?
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Empirical antibiotics are indicated for patients with manifestations of severe disease.
Empirical antibiotics are indicated for patients with manifestations of severe disease.
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There is evidence that empirical antibiotic therapy shortens the duration of illness by 1 to 3 days in returned travellers with acute diarrhoea.
There is evidence that empirical antibiotic therapy shortens the duration of illness by 1 to 3 days in returned travellers with acute diarrhoea.
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What is the mainstay of therapy for acute infectious diarrhoea?
What is the mainstay of therapy for acute infectious diarrhoea?
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Empirical antibiotics are usually NOT indicated for community-acquired infectious diarrhoea.
Empirical antibiotics are usually NOT indicated for community-acquired infectious diarrhoea.
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Empirical antibiotic therapy is not recommended for children with bloody diarrhoea without fever or sepsis.
Empirical antibiotic therapy is not recommended for children with bloody diarrhoea without fever or sepsis.
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Empirical antibiotic therapy is indicated for patients with a history of recent antibiotic use or hospital admission.
Empirical antibiotic therapy is indicated for patients with a history of recent antibiotic use or hospital admission.
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Ciprofloxacin is not licensed for use in children because of the adverse effects on cartilage development.
Ciprofloxacin is not licensed for use in children because of the adverse effects on cartilage development.
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What is the mainstay of therapy for Campylobacter enteritis?
What is the mainstay of therapy for Campylobacter enteritis?
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Antibiotic therapy is always indicated in Campylobacter enteritis.
Antibiotic therapy is always indicated in Campylobacter enteritis.
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Asymptomatic contacts of an index case of Campylobacter enteritiis need faecal testing.
Asymptomatic contacts of an index case of Campylobacter enteritiis need faecal testing.
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The diagnosis of C. difficile infection is based on clinical features suggestive of C. difficile infection.
The diagnosis of C. difficile infection is based on clinical features suggestive of C. difficile infection.
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Testing for C. difficile should be performed on unformed stool only unless the patient has ileus.
Testing for C. difficile should be performed on unformed stool only unless the patient has ileus.
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What is the recommended treatment for the first episode of mild to moderate C. difficile disease?
What is the recommended treatment for the first episode of mild to moderate C. difficile disease?
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Injectable vancomycin can be given orally or enterally.
Injectable vancomycin can be given orally or enterally.
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Fidaxomicin is currently available on the PBS for the indication of C. difficile infection.
Fidaxomicin is currently available on the PBS for the indication of C. difficile infection.
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Faecal microbiota transplantation (FMT) is the preferred treatment for adults with C. difficile infection.
Faecal microbiota transplantation (FMT) is the preferred treatment for adults with C. difficile infection.
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Faecal microbiota transplantation is currently approved by TGA.
Faecal microbiota transplantation is currently approved by TGA.
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Intravenous vancomycin is effective against C. difficile infection.
Intravenous vancomycin is effective against C. difficile infection.
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Fidaxomicin is associated with lower rates of recurrence compared to vancomycin.
Fidaxomicin is associated with lower rates of recurrence compared to vancomycin.
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Repeat microbiological testing for C. difficile is indicated in asymptomatic patients.
Repeat microbiological testing for C. difficile is indicated in asymptomatic patients.
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Antibiotic therapy is indicated for all children with enterohaemorrhagic E. coli who do not have fever or sepsis.
Antibiotic therapy is indicated for all children with enterohaemorrhagic E. coli who do not have fever or sepsis.
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Antibiotic treatment is always indicated in patients with nontyphoidal Salmonella enteritis.
Antibiotic treatment is always indicated in patients with nontyphoidal Salmonella enteritis.
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What is the mainstay of therapy for Salmonella enteritis?
What is the mainstay of therapy for Salmonella enteritis?
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Antibiotics are not indicated for the asymptomatic short-term carrier state of Salmonella enteritis.
Antibiotics are not indicated for the asymptomatic short-term carrier state of Salmonella enteritis.
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Shigella is easily transmitted person-to-person.
Shigella is easily transmitted person-to-person.
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Antibiotic therapy is indicated for all patients with Shigella enteritis.
Antibiotic therapy is indicated for all patients with Shigella enteritis.
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Ceftriaxone is used in patients with Shigella who have severe disease and in immunocompromised patients when treatment is considered necessary.
Ceftriaxone is used in patients with Shigella who have severe disease and in immunocompromised patients when treatment is considered necessary.
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Antibiotic-resistant strains of V. cholerae are now common in some regions.
Antibiotic-resistant strains of V. cholerae are now common in some regions.
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Rehydration is the mainstay of therapy for Vibrio: noncholera species causing enteritis.
Rehydration is the mainstay of therapy for Vibrio: noncholera species causing enteritis.
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Yersinia enterocolitica infections are always foodborne.
Yersinia enterocolitica infections are always foodborne.
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Prophylactic probiotics are always effective in preventing antibiotic-associated diarrhoea.
Prophylactic probiotics are always effective in preventing antibiotic-associated diarrhoea.
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Enterotoxigenic Escherichia coli (ETEC) is the most common cause of travellers' diarrhoea.
Enterotoxigenic Escherichia coli (ETEC) is the most common cause of travellers' diarrhoea.
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Travellers' diarrhoea is usually self-limiting, and mild cases require symptomatic treatment only.
Travellers' diarrhoea is usually self-limiting, and mild cases require symptomatic treatment only.
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Antibiotics are effective for moderate to severe travellers' diarrhoea.
Antibiotics are effective for moderate to severe travellers' diarrhoea.
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Antimotility drugs can only be used in combination with antibiotics in adults who do not have fever or bloody stools.
Antimotility drugs can only be used in combination with antibiotics in adults who do not have fever or bloody stools.
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Prophylaxis for travellers' diarrhoea is always recommended.
Prophylaxis for travellers' diarrhoea is always recommended.
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The currently available cholera vaccine effectively protects against travellers' diarrhoea caused by enterotoxigenic E. coli (ETEC).
The currently available cholera vaccine effectively protects against travellers' diarrhoea caused by enterotoxigenic E. coli (ETEC).
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It is important to consider both infective and noninfective causes of persistent diarrhoea in a returned traveller.
It is important to consider both infective and noninfective causes of persistent diarrhoea in a returned traveller.
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Clinical management of acute infectious diarrhoea in patients in residential aged-care facilities is different than for other patients.
Clinical management of acute infectious diarrhoea in patients in residential aged-care facilities is different than for other patients.
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Study Notes
Acute Infectious Diarrhoea
- Acute diarrhoea is defined as an increase in stool frequency or a change in stool consistency lasting less than 14 days.
- Most cases are viral and self-limiting, resolving without specific treatment.
- Clinical clues for differentiating between viral, bacterial, and toxin-mediated diarrhoea are summarised in Table 2.4.
- Viral causes (e.g., rotavirus, norovirus) are often associated with a history of contact with a person with diarrhoea, outbreaks, and prominent upper gastrointestinal symptoms (vomiting, nausea).
- Bacterial causes (e.g., Campylobacter enteritis, Clostridioides difficile) are more likely with fever, tenesmus (straining to defecate), and bloody stool. Travellers with diarrhoea frequently have a bacterial aetiology.
- Toxin-mediated cases (e.g., Staphylococcus aureus, Bacillus cereus) present with a short incubation period (typically several hours), vomiting, nausea, and abdominal pain, with diarrhoea occurring later.
- Immunocompromised individuals are susceptible to a wider range of pathogens (bacteria, viruses, parasites).
Faecal Testing
- Faecal testing is only appropriate if results will aid management.
- It's recommended in patients with bloody stools, moderate to severe disease, prolonged symptoms, and immunocompromised individuals.
- Traditional faecal testing (culture, microscopy, antigen testing) still plays a role but is less sensitive compared to multiplex PCR. The positive results from bacterial cultures can be used for susceptibility testing and epidemiological assessment.
- Multiplex PCR tests are widely available as a culture-independent method. They screen for a broad range of pathogens, provide rapid results, and have improved sensitivity over traditional methods. Although positive results do not always indicate disease, useful information about the causative bacteria, and antimicrobial susceptibility testing is possible.
- Microbiological tests performed on faecal samples vary between laboratories and each uses its own algorithms.
Severity of Acute Infectious Diarrhoea
- Severity relates to the degree of functional incapacity. Mild cases allow for normal activity, moderate cases require adjustments to activities, and severe cases lead to incapacity and may require hospitalisation.
- Specific clinical features suggestive of severity include high fever, tachycardia, leucocytosis, abdominal tenderness, severe abdominal pain, high volume diarrhoea with hypovolaemia, bloody stool, or prolonged symptoms.
Empirical Antibiotic Therapy
- Empirical antibiotics are generally not indicated for community-acquired infectious diarrhoea.
- An exception is for patients with severe disease (see specifics related to severity) or immunocompromised patients.
- Patients with bloody diarrhoea without fever or sepsis, or are immunocompromised are not always given empirical antibiotics.
Specific Infectious Pathogens
- Individual pathogens like Campylobacter, Clostridioides difficile, Enterohaemorrhagic Escherichia coli, Salmonella, Shigella, Vibrio cholerae, Vibrio non-cholera species, Cytomegalovirus, Cryptosporidium, Cyclospora, Cystoisospora (Isospora) belli, Microsporidia are mentioned with diagnostic criteria.
Treatment and Rehydration
- Rehydration is the primary treatment goal. Oral rehydration is generally sufficient unless severe dehydration is present.
- Details of rehydration, probiotics, antiemetics, antidiarrhoeal, and zinc supplementation are found in corresponding guidelines.
- Indications for empirical antibiotic therapy, regimen, and duration vary based on the severity of disease and causative pathogen. Clostridioides difficile has specific treatment protocols.
- Treatment for recurrence may differ in approach.
- Consider faecal microbiota transplantation when indicated in specific patient groups; for example, cases of recurrence, or ongoing refractory disease.
Other Key Information
- Patients with suspected cases of infectious diarrhoea should have faecal specimens analyzed as appropriate.
- There is a risk for antimicrobial resistance in some pathogens, and clinicians should note local resistance levels when choosing treatments in specific pathogens.
- Severity guidelines can aid in determining appropriate interventions.
- Certain situations warrant expert advice (severe disease, immunocompromised patients, or those lacking responses to treatment).
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Description
This quiz covers the key aspects of acute infectious diarrhoea, including its definition, causes, and clinical clues for differentiation among viral, bacterial, and toxin-mediated diarrhoea. It highlights common pathogens and their associated symptoms. Test your knowledge on this important medical condition.
