Management and prevention of bacterial diarrhea

The etiology, pathogenesis, transmission and communicability, diagnosis, and management of infectious diarrhea are reviewed. Infectious diarrhea is common in both industrialized and unindustrialized areas of the world. Better understanding of the etiology and pathogenesis and identification of "new" enteric pathogens has resulted in the use of a variety of drugs to relieve symptoms or to effect a clinical cure. Both host and microbial virulence factors are key in the acquisition of diarrheal illness. Host factors such as extreme age, a dysfunctional gastrointestinal tract, or underlying immunodeficiency enhance the risk of illness after ingestion of a pathogen or its toxins. Microbial virulence factors (the pathogen's ability to invade or produce enterotoxins, neurotoxins, or cytotoxins) characterize the type of illness manifested and the symptom complex (e.g., acute watery diarrhea versus chronic dysentery). Supportive care is indicated in the majority of cases of infectious enteritis, and rehydration is considered the mainstay of therapy in any diarrheal illness accompanied by dehydration. Antimicrobial therapy is beneficial in the treatment of severe diarrhea caused by Shigella, Campylobacter spp., Vibrio cholerae, Escherichia coli, and Clostridium difficile. Infectious diarrhea is common but is often self-limited and of short duration. Therapy frequently consists of symptomatic relief and fluid replacement.