Treatment Guideline Chart
Diarrhea is a change in normal bowel movements characterized by increase in frequency, water content or volume of stools. The usual stool output is 10 g/kg/day.
Acute diarrhea lasts ≤14 days while chronic diarrhea lasts >14 days.
Infectious diarrhea is usually associated with symptoms of nausea and vomiting and abdominal cramps.

Gastroenteritis%20-%20bacterial Signs and Symptoms


Watery Diarrhea

  • Semi-formed to loose-watery stools without the presence of blood
  • Often clinical presentation of enterotoxin-induced diarrhea

Bloody Diarrhea

  • Bloody diarrhea is considered if macroscopic exam of stools contains blood


  • Diarrhea: Change in normal bowel movements characterized by increase in frequency, water content or volume of stools or with bloody stools
    • Usual stool output is 10 g/kg/day
  • Acute diarrhea: Diarrhea lasting ≤14 days duration
    • Chronic diarrhea is a diarrhea lasting >14 days
  • Infectious diarrhea: Diarrhea of infectious origin and is usually associated with symptoms of nausea, vomiting and abdominal cramps


Traveler's Diarrhea 

  • Causes of acute traveler’s diarrhea will vary from one geographical area to another
  • Enterotoxigenic E coli is one of the most frequently identified organisms
  • Campylobacter infections seem to predominate as the cause of traveler’s diarrhea in North Africa and Southeast Asia
  • Other common bacterial causes:
    • Enteroaggregative E coli (EAEC), Salmonella, Shigella sp, Campylobacter jejuni

Watery Diarrhea

  • Severe dehydration with severe watery diarrhea is most likely caused by Vibrio cholerae subgroup O1 
  • Vibrio O139, other non-O1 vibrios and occasionally Vibrio parahaemolyticusAeromonas sp and enteropathogenic Escherichia coli can cause a similar clinical picture (though diarrhea by these organisms usually causes milder forms of diarrheal illness)
  • Cholera
    • Cholera is highly suggested by severe profuse watery diarrhea and dehydration
    • Other clinical features: Very abrupt onset of acute diarrhea with rapid progression to severe dehydration, the presence of muscle cramps but no fever or abdominal pain
    • Stools are usually greenish-yellow, clear, watery with little food residue
    • Dark-field microscopy (DFM) and stool culture should be done in all cases
    • Microscopic exam of stool may also reveal shooting bacteria, but not white blood cell (WBC) or red blood cell (RBC)
    • If cholera is confirmed in nonendemic areas, it should be reported to health authorities
    • Any case of watery diarrhea in endemic areas during outbreaks or seasonal epidemics should be treated as cholera and stool cultures should be done in all cases to confirm

Bloody Diarrhea 

  • Shigella sp and Campylobacter jejuni
    • Shigella dysenteriae and Shigella flexneri may cause a more severe disease with high fever
    • Shigella boydii and Shigella sonnei cause a milder disease
  • Salmonella enteritidis, Yersinia enterocolitica, C difficile, Balantidium coli, Plesiomonas, enterohemorrhagic E coli (EHEC) and enteroinvasive E coli (EIEC) can produce bloody diarrhea

Signs and Symptoms

Associated Symptoms  

  • Frequency and intensity of nausea and vomiting, abdominal pain, cramps, myalgia, headache, altered sensorium

Symptoms of Volume Depletion

  • Thirst
  • Tachycardia
  • Orthostasis
  • Decreased urination
  • Decrease in skin turgor
  • Lethargy

Bloody Diarrhea

  • Patients often have fever that may last >2 days and might be high (>38.5°C)
  • May initially suffer with watery diarrhea that rapidly changes to bloody diarrhea and dysentery
  • Mild dehydration
  • Red blood cell (RBC) and white blood cell (WBC) are found on microscopic exam of the stools
  • Dysentery
    • Suggested by frequent passage (10-30x/day) of small-volume stools that consist of blood, mucus and pus
    • Patient usually suffers abdominal cramps and tenesmus

Risk Factors

  • Travel to developing/underdeveloped areas
  • Daycare attendance
  • Ingestion of unsafe foods (eg unpasteurized dairy products, undercooked meats, seafood)
  • Swimming/drinking untreated fresh water
  • Poor personal and public hygiene (eg seldom practice of handwashing)
  • Visit to farm or contact with pets with diarrhea
  • Knowledge of other ill persons
  • Recent or regular medications (eg antibiotics)
  • Underlying medical conditions (eg AIDS, immunosuppressants)
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