0071643192.pdf

ABDOMINAL AND GASTROINTESTINAL

EMERGENCIES

TABLE 11.7. Common Causes of Invasive Gastroenteritis

CAUSATIVEAGENT INCUBATION ANDTRANSMISSION DESCRIPTION TREATMENT

Salmonellasp. 8–72 hr; contaminated Fever, abdominal pain, Ciprofloxacin if severe illness, sepsis,

food (eggs or poultry) or water, myalgia, headache; or immunocompromise; alternatives:

pet turtles, chicks, or lizards risk of sepsis in very Ceftriaxone or Azithromycin

young, elderly,

immunocompromised;

many fecal WBCs and

few RBCs

Shigellasp. 1–3 days; fecal-oral, Fever, headache, myalgia, Ciprofloxacin if severe illness, sepsis, or

person-to-person, contaminated diarrhea, little vomiting; immunocompromise; alternatives:

food common in kids 1–5 yr; Ceftriaxone or Azithromycin

many fecal WBCs and RBCs

Campylobactersp. 1–7 days; contaminated Common in children and Ciprofloxacin if severely ill or septic;

water, food (poultry, eggs), young adults; low-grade alternative: Azithromycin

animals or pets fever, abdominal pain, and

vomiting may precede

diarrhea; fecal RBCs and

WBCs common

Yersinia enterolitica 1–5 days; contaminated Children and young adults; Usually self-limiting; treat with

food or water (milk, pork), may mimic appendicitis; Ciprofloxacin; Alternative: Bactrim

fecal-oral, person-to-person, anorexia, fever, RLQ

pets or wild animals abdominal pain, and

vomiting precede diarrhea;

many fecal WBCs and RBCs

C. difficile 1–11 wk; recent antibiotic Fever, abdominal pain, Metronidazole orally preferred;

use; PCN, clindamycin, copious foul-smelling vancomycin orally; IV vancomycin

cephalosporins most diarrhea, rarely vomiting; ineffective; IV metronizadole may

commonly implicated fecal WBCs and RBCs; be beneficial

stoolC. difficiletoxin

confirms diagnosis

Entamoeba 1–11 wk; contaminated food Acute amebic dysentery: Metronidazole then Iodoquinol;

histolytica or water, poor sanitation, abrupt onset of fever, chloroquine may be added; antibiotics

travel to developing countries abdominal pain, tenesmus, will usually sufficiently treat abscess

and bloody diarrhea; chronic as well

dysentery: malaise, weight

loss, bloating, and bloody

diarrhea;

may develop hepatic

abscess;

fecal RBCs, WBCs common

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