Acute diarrhea natural history, complications and prognosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Chandrakala Yannam, MD [2]Sudarshana Datta, MD [3]

Overview

Untreated cases of acute diarrhea may progress to develop symptoms of fluid depletion including altered mental status, electrolyte imbalances, dehydration, metabolic acidosis and malnutrition. Common complications of acute diarrhea include confusion, convulsions, sepsis, and death. Prognosis is generally good, when the underlying cause is identified and treated early.

Natural History, Complications, and Prognosis

Natural history

If left untreated, patients with acute diarrhea may develop symptoms and signs of dehydration (dry mouth and tongue, sunken eyes, confusion, lethargy, poor skin turgor, delayed capillary refill), malnutrition, altered mental status, sepsis, electrolyte imbalance, metabolic acidosis and eventually develop hypovolemic shock, coma or death. Acute diarrhea may also progress to chronic diarrhea in a small fraction of cases.^[1]

Complications

Common complications of acute diarrhea include:^[1]^[2]
Examples of certain postinfectious manifestations associated with some enteric pathogens include:
- Erythema nodosum
  - Yersinia, Campylobacter, Salmonella, Shigella
- Aortitis, osteomyelitis, extravascular deep tissue focus
  - Salmonella, Yersinia
- Ekiri syndrome (lethal, toxic encephalopathy) and/or seizure
  - Shigella
- Intestinal perforation
  - Salmonella including Salmonella Typhi, Shigella, Campylobacter, Yersinia, Entamoeba histolytica
- Meningitis
  - Listeria, Salmonella (infants ≤3 months of age are at high risk)
- Postinfectious irritable bowel syndrome
  - Campylobacter, Salmonella, Shigella, Giardia
- Reactive arthritis
  - Salmonella, Shigella, Campylobacter, Yersinia, rarely Giardia, and Cyclospora cayetanensis
- Immunoglobulin A nephropathy
  - Campylobacter
- Hemolytic uremic syndrome
  - Shigella dysenteriae serotype 1
- Hemolytic anemia
  - Campylobacter, Yersinia
- Guillain-Barré syndrome
  - Campylobacter
- Glomerulonephritis
  - Shigella, Campylobacter, Yersinia

Prognosis

Acute diarrhea is usually self limiting and has good prognosis, when the underlying cause is identified and treated. The presence of the following features in a patient with acute diarrhea for over 4 weeks may indicate poor prognosis:^[3]^[4]^[5]^[6]^[7]

Weight loss
Rectal bleeding
Immunosupression
Hemolytic uremic syndrome with EHEC infection
Gullian barre syndrome with Campylobacter infection
Toxic megacolon
Tenesmus
Associated psychological factors
Somatization
Dietary causes of diarrhea
Age > 50 years

References

↑ ^1.0 ^1.1 Riddle MS, DuPont HL, Connor BA (2016). “ACG Clinical Guideline: Diagnosis, Treatment, and Prevention of Acute Diarrheal Infections in Adults”. Am. J. Gastroenterol. 111 (5): 602–22. doi:10.1038/ajg.2016.126. PMID 27068718.
↑ “Diarrhea – Symptoms and causes – Mayo Clinic”.
↑ Karmali MA, Petric M, Lim C, Fleming PC, Arbus GS, Lior H (1985). “The association between idiopathic hemolytic uremic syndrome and infection by verotoxin-producing Escherichia coli”. J. Infect. Dis. 151 (5): 775–82. PMID 3886804.
↑ Nylund CM, Denson LA, Noel JM (2010). “Bacterial enteritis as a risk factor for childhood intussusception: a retrospective cohort study”. J. Pediatr. 156 (5): 761–5. doi:10.1016/j.jpeds.2009.11.026. PMID 20138300.
↑ Olesen M, Eriksson S, Bohr J, Järnerot G, Tysk C (2004). “Microscopic colitis: a common diarrhoeal disease. An epidemiological study in Orebro, Sweden, 1993-1998”. Gut. 53 (3): 346–50. PMC 1773978. PMID 14960513.
↑ Tillisch K, Labus JS, Naliboff BD, Bolus R, Shetzline M, Mayer EA; et al. (2005). “Characterization of the alternating bowel habit subtype in patients with irritable bowel syndrome”. Am J Gastroenterol. 100 (4): 896–904. doi:10.1111/j.1572-0241.2005.41211.x. PMID 15784038.
↑ Hammer HF, Fine KD, Santa Ana CA, Porter JL, Schiller LR, Fordtran JS (1990). “Carbohydrate malabsorption. Its measurement and its contribution to diarrhea”. J Clin Invest. 86 (6): 1936–44. doi:10.1172/JCI114927. PMC 329829. PMID 2254453.

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[pmid27068718-1] 1.0 ^1.1 Riddle MS, DuPont HL, Connor BA (2016). “ACG Clinical Guideline: Diagnosis, Treatment, and Prevention of Acute Diarrheal Infections in Adults”. Am. J. Gastroenterol. 111 (5): 602–22. doi:10.1038/ajg.2016.126. PMID 27068718.

[urlDiarrhea_-_Symptoms_and_causes_-_Mayo_Clinic-2] “Diarrhea – Symptoms and causes – Mayo Clinic”.

[pmid3886804-3] Karmali MA, Petric M, Lim C, Fleming PC, Arbus GS, Lior H (1985). “The association between idiopathic hemolytic uremic syndrome and infection by verotoxin-producing Escherichia coli”. J. Infect. Dis. 151 (5): 775–82. PMID 3886804.

[pmid20138300-4] Nylund CM, Denson LA, Noel JM (2010). “Bacterial enteritis as a risk factor for childhood intussusception: a retrospective cohort study”. J. Pediatr. 156 (5): 761–5. doi:10.1016/j.jpeds.2009.11.026. PMID 20138300.

[pmid14960513-5] Olesen M, Eriksson S, Bohr J, Järnerot G, Tysk C (2004). “Microscopic colitis: a common diarrhoeal disease. An epidemiological study in Orebro, Sweden, 1993-1998”. Gut. 53 (3): 346–50. PMC 1773978. PMID 14960513.

[pmid15784038-6] Tillisch K, Labus JS, Naliboff BD, Bolus R, Shetzline M, Mayer EA; et al. (2005). “Characterization of the alternating bowel habit subtype in patients with irritable bowel syndrome”. Am J Gastroenterol. 100 (4): 896–904. doi:10.1111/j.1572-0241.2005.41211.x. PMID 15784038.

[pmid2254453-7] Hammer HF, Fine KD, Santa Ana CA, Porter JL, Schiller LR, Fordtran JS (1990). “Carbohydrate malabsorption. Its measurement and its contribution to diarrhea”. J Clin Invest. 86 (6): 1936–44. doi:10.1172/JCI114927. PMC 329829. PMID 2254453.

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