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KEY POINTS FOR ACUTE INFECTIOUS DIARRHEAL DISEASES

- Acute infectious diarrhea is a common complaint in the outpatient practice.
- Most cases of diarrhea are mild and self-limited, but severe and life-threatening illness can occur with certain pathogens and in certain demographic groups, most notably the immunosuppressed, the very old, and the very young.
- A detailed history may elicit clues to identify potential causative agents, and the decision to pursue laboratory testing, prescribe empiric antibiotics, or manage conservatively depends on both the suspected enteropathogen and the host.
- Because most death from diarrhea is secondary to dehydration, physicians must counsel patients to be diligent with oral replacement therapy and recognize individuals who are not maintaining adequate hydration so that intravenous therapy can be initiated.
- Physicians should encourage frequent hand washing to prevent the spread of disease, especially among day care workers, employees of nursing homes, and food handlers, who may need to abstain from their activities.
- When diarrhea persists and diagnostic testing fails to identify a pathogen, noninfectious or extra-intestinal causes of diarrhea should be considered, which may prompt further laboratory work, imaging, endoscopy, and referral to a gastroenterologist.
- Further research is needed to develop more concrete algorithms for the diagnosis and treatment of acute diarrhea. Primary care physicians must employ a sound knowledge of epidemiologic risk factors, potential etiologic agents, pathophysiology, and at-risk patients to provide cost-effective care to the many patients seen each year with acute infectious diarrhea.
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KEY POINTS FOR ACUTE INFECTIOUS DIARRHEAL DISEASES- Acute infectious diarrhea is a common complaint in the outpatient practice.- Most cases of diarrhea are mild and self-limited, but severe and life-threatening illness can occur with certain pathogens and in certain demographic groups, most notably the immunosuppressed, the very old, and the very young.- A detailed history may elicit clues to identify potential causative agents, and the decision to pursue laboratory testing, prescribe empiric antibiotics, or manage conservatively depends on both the suspected enteropathogen and the host.- Because most death from diarrhea is secondary to dehydration, physicians must counsel patients to be diligent with oral replacement therapy and recognize individuals who are not maintaining adequate hydration so that intravenous therapy can be initiated.- Physicians should encourage frequent hand washing to prevent the spread of disease, especially among day care workers, employees of nursing homes, and food handlers, who may need to abstain from their activities.- When diarrhea persists and diagnostic testing fails to identify a pathogen, noninfectious or extra-intestinal causes of diarrhea should be considered, which may prompt further laboratory work, imaging, endoscopy, and referral to a gastroenterologist.- Further research is needed to develop more concrete algorithms for the diagnosis and treatment of acute diarrhea. Primary care physicians must employ a sound knowledge of epidemiologic risk factors, potential etiologic agents, pathophysiology, and at-risk patients to provide cost-effective care to the many patients seen each year with acute infectious diarrhea.*76/348/5*

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