Acute gastroenteritis

Background

Noninvasive AGE
Species	Onset	Symptoms	Transmission	Preformed Toxin
Viral (norovirus, adenovirus, rotavirus)	11-72 hrs	Nausea, vomiting, watery diarrhea Mild abdominal cramps, myalgia	Fecal-oral Contaminated food or water	No
Staph	1-6 hrs	Nausea, severe vomiting, diarrhea, Mild abdominal cramping	Previously cooked foods (mayonaise, ham, salads)	Yes
B. cereus	1-6 hrs	Abrupt onset of nausea, vomiting, mild diarrhea	Previously cooked foods (rice, vegetables, dried fruits, meat)	Yes
C. perfringens	8-24 hrs	Nausea, minimal vomiting, watery diarrhea Abd cramps	Previously cooked or reheated meats and poultry	Yes
V. cholerae	11-72 hrs	Explosive rice-water diarrhea Vomiting, abdominal cramps Fever	Fecal-oral Contaminated food or water	Yes
Giardia	1-4 wks	Flatus, bloating Foul-smelling and fatty stools (steatorrhea)	Fecal-oral Contaminated water	No

Invasive AGE
Species	Onset	Symptoms	Transmission
Salmonella	6-72 hours	Fever, relative bradycardia Abdominal pain Bloody diarrhea Headache Osteomyelitis in sickle cell	Eggs Poultry Water Reptiles
Shigella	1-3 days	Fever Abdominal pain Bloody diarrhea Headache 1-5 years old Seizures in children	Food Fecal-Oral
Yersinia	1-5 days	Appendicitis mimic, RLQ pain Fever Vomiting Kids and Young Adults	Water Milk Pork Wild Animals Fecal-Oral
Campylobacter	1-7 days	Low grade fever Abdominal pain Kids and Young Adults Guillain-Barre	Water Poultry Pets/Animals
C. Diff	1-11 Weeks	Copious FOUL diarrhea	Antibiotic use: PCN, Clinda, Cephalosporins
Entamoeba	1-11 weeks	Appendicitis Mimic Abdominal pain, nausea/vomiting, diarrhea	Water Sanitation Travel

Only consider in patients with invasive infection
- Shigella, campylobacter, E. coli, yersinia, vibrio
- Bloody stool with mucus and fever
NOT indicated for E. coli O157:H7
NOT routinely indicated for salmonella
- Exceptions: SCD, IBD, <3mo
Azithromycin (able to tolerate PO)
OR ciprofloxacin
OR TMP-SMX
Ceftriaxone (parenteral)