A. Infectious diarrhea is usually classified as noninflammatory or inflammatory, depending on whether the infectious organism has invaded the intestinal mucosa.
B. Noninflammatory infectious diarrhea is caused by organisms that produce a toxin (enterotoxigenic E coli strains, Vibrio cholerae). Noninflammatory, infectious diarrhea is usually self-limiting and lasts less than 3 days.
C. Blood or mucus in the stool suggests inflammatory disease, usually caused by bacterial invasion of the mucosa (enteroinvasive E coli, Shigella, Salmonella, Campylobacter). Patients usually have a septic appearance and fever; some have abdominal rigidity and severe abdominal pain.
D. Vomiting out of proportion to diarrhea is usually related to a neuroenterotoxin-mediated food poisoning from Staphylococcus aureus or Bacillus cereus, or from an enteric virus, such as rotavirus (in an infant), or a small round virus, such as Norwalk virus (in older children or adults). The incubation period for neuroenterotoxin food poisoning is less than 4 hours, while that of a viral agent is more than 8 hours.
E. Traveler's diarrhea is a common acute diarrhea. Three or four unformed stools are passed/24 hours, usually starting on the third day of travel and lasting 2-3 days. Anorexia, nausea, vomiting, abdominal cramps, abdominal bloating, and flatulence may also be present.
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