Approach to the adult with acute diarrhea in resource-limited countries
- Regina LaRocque, MD, MPH
Regina LaRocque, MD, MPH
- Assistant Professor of Medicine
- Harvard Medical School
- Mark Pietroni, MA, MBBChir, FRCP, DTM&H
Mark Pietroni, MA, MBBChir, FRCP, DTM&H
- Medical Director
- International Centre for Diarrhoeal Disease Research, Bangladesh
The Global Burden of Disease study estimated that there were 1.4 million deaths due to diarrheal diseases in 2010 . According to this report, diarrheal diseases represent one of the five leading causes of death worldwide and are the second leading cause of death in children under five years of age (behind acute respiratory infections). Most cases of diarrhea are associated with contaminated food and water sources, and around 2.4 billion people globally have no access to basic sanitation .
The World Health Organization (WHO) provides guidelines for the management of diarrheal illness in resource-limited countries in "The Treatment of Diarrhea: A Manual for Physicians and Other Senior Health Workers" . Specific WHO guidelines for the management of epidemic shigellosis  and cholera  are also available. The recommendations in this topic are consistent with those guidelines.
This topic reviews the clinical assessment, treatment, and prevention of acute diarrhea, including watery diarrhea and dysentery, in adults in resource-limited countries.
The clinical assessment and management of children with acute diarrhea in resource-limited countries and of individuals with diarrhea in resource-rich settings are discussed elsewhere. (See "Approach to the child with acute diarrhea in resource-limited countries" and "Epidemiology and causes of acute diarrhea in resource-rich countries" and "Approach to the adult with acute diarrhea in resource-rich countries" and "Approach to the adult with chronic diarrhea in developed countries" and "Evaluation of diarrhea in children" and "Overview of the causes of chronic diarrhea in children".)
CLASSIFICATION OF DIARRHEA
Diarrhea is defined as the passage of loose or watery stools, typically at least three times in a 24-hour period . Acute diarrhea is defined as diarrhea of ≤14 days in duration, in contrast to persistent (>14 days and ≤30 days) or chronic (>30 days) diarrhea. Invasive diarrhea, or dysentery, is defined as diarrhea with visible blood, in contrast to watery diarrhea. Dysentery is commonly associated with fever and abdominal pain.
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- CLASSIFICATION OF DIARRHEA
- Worldwide incidence
- Risk factors
- - Crowding and poor sanitation
- - HIV infection
- Epidemic diarrhea
- Acute watery diarrhea
- Acute bloody diarrhea
- CLINICAL FEATURES
- Complications of acute diarrheal diseases in adults
- DIFFERENTIAL DIAGNOSIS
- CLINICAL ASSESSMENT
- - None to moderate hypovolemia
- - Severe hypovolemia
- Antibiotic therapy
- - Watery diarrhea
- - Dysentery
- - Antimicrobial resistance
- Dietary recommendations
- SUMMARY AND RECOMMENDATIONS