Editing Infective diarrhoea (section)

== '''Workup of acute diarrhoea in resource-rich settings''' ==

* Consider admission if:
** Persistent fever
** Dysentery
** Severe abdominal pain
** Symptoms of volume depletion
** History IBD
** Immunosuppression
** Significant vascular/cardiovascular disease
* History
** Exposures - food history, residence, occupational exposure, recent and remote travel, pets, hobbies
** Recent Abx
** Cirrhosis - vibrio infection
** Haemochromatosis - Yersinia
* Investigations
** Low platelets - concern for development of haemolytic-uraemic syndrome
** Leukemoid reaction - occurs with C. dif
** Indications for stool tests (test those who probably have bacterial infection, since viral will be self-limiting)
*** Severe illness (need for hospitalisation)
*** Inflammatory diarrhoea (blood, fever)
*** High-risk host features
*** Symptoms persisting for more than a week
*** Public health concerns
** Indications for imaging:
*** Abdominal signs
*** Unwell patient
*** Consider typhlitis or ischaemic colitis
** Choice of test
*** Bloody diarrhoea - shiga toxin
*** Stool culture is the main one in acute presentations to ED
*** Stool culture not very useful for diarrhoea that starts as an inpatient - need CDT
*** Ova and parasite testing is only worthwhile for persistent/chronic diarrhoea
*** Immunocompromised - CMV (may need endoscopy and biopsy), consider parasites in immunocompromised patients. CMV quantitative serology seems to be recommended.
*** MSM - consider proctitis (gonorrhoea, chlamydia, syphilis, HSV)