Persistent Diarrhea: A Clinical Review
1University of Texas School of Public Health and Medical School, Houston2Kelsey Research Foundation, Houston, Texas3Baylor College of Medicine, Houston, Texas.
Importance:
Diarrheal disease is commonly encountered in clinical practice. Persistent diarrhea (≥14 days) can be caused by pathogens that differ from those commonly seen in acute illness; proper etiologic diagnosis is important for appropriate therapeutic management. This review provides an overview of the epidemiology, etiology, diagnosis, and management of persistent diarrhea caused by infectious agents in immunocompetent individuals worldwide.
Observations:
Much of the data on persistent diarrhea comes from studies of residents in or expatriates of developing countries and travelers to these regions where follow-up studies have been performed. Persistent diarrhea occurs in approximately 3% of individuals traveling to developing countries. Schistosoma mansoni (and rarely Schistosoma haematobium) intestinal infection is also not very common and is found only in endemic areas. The microbiologic causes of protracted diarrhea include detectable parasitic (eg, Giardia, Cryptosporidium) and bacterial (eg, enteroaggregative Escherichia coli, Shigella) pathogens. Available diagnostic tests include culture-dependent for bacterial pathogens and culture-independent methods for bacterial, viral, and protozoal infections (eg, polymerase chain reaction [PCR]), including multiplex PCR, as well as and microscopy for protozoal infections. Antimicrobial therapy can be given empirically to patients returning from the undeveloped to the developed world. Otherwise, antibiotics should be given based on the results of laboratory testing.
Conclusions And Relevance:
Persistent diarrhea is a poorly recognized syndrome in all populations that requires proper assessment and diagnosis to ensure that affected individuals receive the treatment needed to experience improvement of clinical symptoms.
Insights
Persistent diarrhea, lasting over 14 days, often stems from different infectious agents than acute cases. Accurate diagnosis is crucial for effective treatment of this underrecognized condition.
Area of Science:
- Medical Microbiology
- Infectious Diseases
- Gastroenterology
Background:
- Diarrheal diseases are common, but persistent diarrhea (≥14 days) involves distinct etiologies.
- Understanding these causes is vital for appropriate clinical management and patient outcomes.
Purpose of the Study:
- To review the epidemiology, etiology, diagnosis, and management of persistent diarrhea caused by infectious agents.
- To highlight the importance of accurate diagnosis for effective treatment in immunocompetent individuals worldwide.
Main Methods:
- Review of data from studies in developing countries and on travelers.
- Identification of common and uncommon parasitic and bacterial pathogens.
- Discussion of diagnostic methods including culture-dependent, culture-independent (PCR), and microscopy.
Main Results:
- Persistent diarrhea affects approximately 3% of travelers to developing countries.
- Key pathogens include Giardia, Cryptosporidium, enteroaggregative E. coli, and Shigella.
- Schistosoma species are rare causes found in endemic areas.
Conclusions:
- Persistent diarrhea is an underrecognized syndrome requiring thorough assessment.
- Accurate etiologic diagnosis is essential for successful therapeutic intervention and symptom improvement.
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