Which epidemiologic factors should be assessed in the evaluation of gastroenteritis?

Updated: Feb 10, 2017
  • Author: Arthur Diskin, MD; Chief Editor: Steven C Dronen, MD, FAAEM  more...
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Answer

Note the following:

  • A number of historical questions may provide clues to the etiology of the illness, including foreign travel, recent camping, recent antibiotic use, daycare attendance, and/or ingestion of raw, possibly spoiled, or new marine products, as well as similar illnesses in family, friends, or close contacts.

  • An epidemiologic factor may be travel to developing countries where bacterial or parasitic agents are endemic and can cause infection or to campgrounds in developed regions, where agents such as Giardia lamblia, Aeromonas, and Cryptosporidium can contaminate untreated water.

  • Enterotoxigenic E coli is the most frequent cause of traveler's diarrhea. Symptoms usually begin within days of arrival in the region and can last from 5 days to 2 weeks.

  • Vibrio species are more common in Asia, although epidemics have occurred in Central America within the last 10 years.

  • As many as 12% of diarrheal illness cases may be caused by rotavirus in travelers to Asia, Africa, and South America.

  • Men who are homosexual are more prone to infection by the usual pathogens (ie, Shigella, Campylobacter jejuni, Salmonella, protozoalike Entamoeba) via the fecal-oral route. Anal receptive intercourse may result in the direct inoculation of Neisseria gonorrhoeae, Chlamydia trachomatis, Treponema pallidum, and herpes simplex virus. Severely immunocompromised states (CD4 cell count < 200) increase the risk of infection by agents such as Mycobacterium avium complex, microsporidia, cytomegalovirus (CMV), and Isospora belli.

  • Recent use of antimicrobial drugs increases the risk of C difficile infection.

  • A common source outbreak from contaminated water and food may cause gastroenteritis either by infection (eg, C jejuni, G lamblia) or by ingestion of a preformed toxin (eg, E coli O157:H7, scombroid, ciguatera).

  • Infections via the fecal-oral route are prevalent in children who attend daycare centers. Rotavirus has an infection rate of nearly 100% in exposed children younger than 2 years. Other family members are also at risk for infection.

  • Exposure to a public vomiting episode in a public location such as cruise ship or casino can lead to exposure to aerosolized norovirus infection.


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