A Bayesian approach to acute infectious diarrhea in adults
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Published on: November 7, 2018
1Department of Medicine, Baylor College of Medicine, 1 Baylor Plaza, Room 525-D, Houston, TX 77030, USA. goodgame@bcm.tmc.edu
Abstract:
Acute infectious diarrhea is a yearly occurrence for most Americans, and is associated with 1 million hospitalizations and about 6000 deaths in the United States annually. Up to 80% of acute infectious diarrhea is caused by noroviruses, which produce a clinically mild illness with a predictable short course and good outcome that make laboratory testing and antimicrobial treatment unnecessary. Most diarrhea-causing bacteria and protozoa can cause a clinical illness "like norovirus"; when they do so in healthy adults neither specialized testing nor antimicrobials is required. The presence or absence of epidemiologic evidence (such as travel, hospitalization, antibiotic use, other exposures)and clinical evidence (such as diarrhea frequency and duration, severity of abdominal pain and fever, character of stool, presence of chronic illness or immune deficiency) can change the probability of "not norovirus" from as low as 8% to as high as 100%. Such probabilities guide the use of laboratory testing and antimicrobial therapy in patients who have acute infectious diarrhea.
Insights
Most acute infectious diarrhea in the US is caused by noroviruses and typically does not require testing or antibiotics. Clinical and epidemiological factors help determine when further evaluation for other causes of diarrhea is needed.
Area of Science:
- Infectious Diseases
- Gastroenterology
- Public Health
Background:
- Acute infectious diarrhea affects millions annually in the US, leading to significant hospitalizations and deaths.
- Noroviruses are the primary cause of acute infectious diarrhea, accounting for up to 80% of cases.
- Many bacterial and protozoal pathogens can mimic norovirus symptoms.
Purpose of the Study:
- To evaluate the necessity of laboratory testing and antimicrobial treatment for acute infectious diarrhea.
- To determine the role of clinical and epidemiological factors in guiding diagnostic and therapeutic decisions.
- To differentiate norovirus infections from other causes of diarrhea.
Main Methods:
- Review of clinical presentations and epidemiological data associated with acute infectious diarrhea.
- Analysis of factors influencing the probability of non-noroviral causes.
- Assessment of the clinical course and outcomes of infectious diarrhea.
Main Results:
- Norovirus infections typically present as mild illnesses with good outcomes, not requiring laboratory testing or antimicrobial therapy.
- Bacterial and protozoal infections can present similarly to norovirus but may warrant different management.
- Epidemiological and clinical evidence significantly alters the likelihood of non-noroviral causes, ranging from 8% to 100%.
Conclusions:
- Laboratory testing and antimicrobial treatment are generally unnecessary for most cases of acute infectious diarrhea, particularly those suspected to be noroviral.
- Careful consideration of patient history and clinical signs is crucial for identifying cases that may require further investigation.
- Risk stratification using clinical and epidemiological data guides appropriate management of infectious diarrhea.
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