Wallach's Interpretation of Diagnostic Tests: Pathways to Arriving at a Clinical Diagnosis (148 page)

   Realize that many, but not all, foodborne illnesses present with prominent GI tract illness. Patients may present with predominant systemic, neurologic, or other signs and symptoms.

   Understand the testing required for likely pathogens. When specific diagnosis is required, ensure that appropriate specimens and cultures, or other tests, are submitted for testing.

   Obtain a clinical history that may provide clues regarding the source of the illness as well as assessing the possibility of a larger outbreak.

   Report suspect cases to public health officials, as appropriate. Be aware that a patient may be a part of a larger outbreak in the community.

   Instruct patients about how to prevent further transmission of illness to contacts.

Suggested Readings

Bresee JS, Marcus R, Venezia RA, et al. The etiology of severe gastroenteritis among adults visiting emergency departments in the United States.
J Infect Dis.
2012;205:1374–1381.

Centers for Disease Control and Prevention. Diagnosis and management of foodborne illnesses: a primer for physicians and other health care professionals.
MMWR.
2004;53(No. RR-4):1–33.

Centers for Disease Control and Prevention. Diagnosis and management of foodborne illnesses: a primer for physicians.
MMWR.
2001;50(No. RR-2):1–70.

Denno MD, Shaikh N, Stapp JR, et al. Diarrhea etiology in a pediatric emergency department: a case control Study.
Clin Infect Dis.
2012;55(7):897–904.

DuPont HL. Bacterial diarrhea.
N Engl J Med.
2009;361:1560–1569.

Payne DC, Vinjé J, Szilagyi PG, et al. Norovirus and medically attended gastroenteritis in U.S. children.
N Engl J Med.
2013;368:1121–1130.

Scallan E, Hoekstra RM, Anguolo FJ, et al. Foodborne illness acquired in the United States— major pathogens.
Emerg Infect Dis.
2011;17:7–15.

Steele JCH Jr, (ed). Food-borne diseases.
Clin Lab Med.
1999;19:469–703.

Thielman NM, Guerrant RL. Acute infectious diarrhea.
N Engl J Med.
2004;350:38–47.

DIARRHEA, CHRONIC

   Definition

Chronic diarrhea is diarrhea that lasts for more than 4 weeks.

   Causes

   Infectious agents (For a discussion of infectious causes of diarrhea, see the Infectious Gastrointestinal Diseases section in this Chapter and Chapter
11
)

   IBD (e.g., Crohn disease, UC, collagenous colitis)

   Carbohydrate malabsorption (e.g., lactase or sucrase deficiency)

   Foods (e.g., ethanol, caffeine, sweeteners such as sorbitol, fructose)