Epidemiology and causes of acute diarrhea in resource-rich countries
- Christine A Wanke, MD
Christine A Wanke, MD
- Professor of Medicine and Public Health
- Tufts University School of Medicine
Morbidity and mortality due to acute diarrhea is significant even in the United States where diarrhea is more often than not a "nuisance disease" in the normally healthy individual [1,2].
Most cases of acute diarrhea are self-limited, whether the cause is an infection, including viruses, or non-infectious. Definitions, epidemiology, and etiologies of acute diarrhea in the United States and other resource-rich countries will be reviewed here. A diagnostic and treatment approach to acute diarrhea, more details on the responsible pathogens, and chronic diarrhea are discussed separately. (See "Approach to the adult with acute diarrhea in resource-rich settings".)
Diarrhea is defined as stool weight in excess of 200 grams per day. However, this definition is of little clinical value, since collecting and weighing stools is neither practical nor required except in a clinical research setting. A good working definition is three or more loose or watery stools per day or a definite decrease in consistency and increase in frequency based upon an individual baseline.
Diarrhea reflects increased water content of the stool, whether due to impaired water absorption and/or active water secretion by the bowel. In severe infectious diarrhea, the number of stools may reach 20 or more per day, with defecation occurring every 20 or 30 minutes. In this situation, the total daily volume of stool may exceed two liters, with resultant volume depletion and hypokalemia. Most patients with acute diarrhea have three to seven movements per day with total stool volume less than one liter per day. When diarrhea lasts for 14 days it can be considered persistent; the term chronic generally refers to diarrhea that lasts for at least one month .
The overall burden of acute infectious diarrhea in the United States and other resource-rich countries has not been well-studied in contrast to this entity in the resource-limited settings. Most series have focused on specific groups of patients or specific pathogens.
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- Limitations of the data
- Frequency of isolating an organism
- Frequency of bacterial or protozoal pathogens
- - Bloody diarrhea
- Bacterial pathogens
- - Salmonella
- - Campylobacter
- - Shigella
- - Enterohemorrhagic E. coli
- - Vibrio
- - Yersinia
- - Clostridium perfringens
- - Enterotoxigenic E. coli
- - Clostridium difficile
- - Bacteroides fragilis
- - Other bacteria
- - Norovirus
- - Rotavirus
- - Adenovirus
- - Astrovirus
- - Other viruses
- - Cryptosporidium
- - Giardia
- - Cyclospora
- - Entamoeba histolytica
- APPROACH TO THE PATIENT
- INFORMATION FOR PATIENTS