Diarrhea: passage of abnormally liquid or unformed stools. Observed macroscopically.

Watery diarrhea: diarrhea that has little to no solid matter.

Gastroenteritis: inflammation of stomach and intestines, typically from infectious causes. Diarrhea and
vomiting that can lead to dehydration.
Enterocolitis: Enteritis of small intestine and colitis of the colon
Dysentery: inflammation of the intestine causing diarrhea with blood. Type of gastroenteritis. Diarrhea
and vomiting that can lead to dehydration. Caused by pathogens such as bacteria, viruses, parasitic
worms, or protozoa.

Hemorragic colitis: type of gastroenteritis where E.coli (typically O157:H7) infects the large intestine and
produces Shiga toxin that causes bloody diarrhea.
Enteric fever: aka typhoid fever. Ingestion of food/water contaminated with feces of someone infected
with salmonella typhi. 1st week: rising fever, cough. 2 week: distended abdomen, constipation, green
diarrhea. 3rd week: intestinal hemorrhage.
Incubation: amount of time post ingestion for signs and symptoms to occur

Preformed toxins: toxins that are preformed and ingested

Initial malaise
Cytotoxin: toxin that is toxic to cells
Enterotoxin: toxin that targets the intestines
Mucosal adherence: binding of a pathogen to the mucosal layer
adhere to intestinal mucosa without invading and produce enterotoxins. These toxins impair
intestinal absorption and cause secretion of electrolytes and water by stimulating adenylate
cyclase, resulting in watery diarrhea
Invasion: pathogen invades host cells or cell layers, establishing itself in the host
S&S: bleeding, pain, perforation
Viral causes
Rotavirus: 1-3 days incubation. Mostly young children. Diarrhea.
Norovirus: 1-2 day incubation. Cruise ships and nursing homes.
Astrovirus: 3-4 day incubation. Wintertime
Adenovirus: fecal oral. 3-10 day incubation.
Most viruses mostly affect children and infants. Fecal oral

Table 402 Association between Pathobiology of Causative Agents and Clinical Features in
Acute Infectious Diarrhea

Pathobiology/Agents

Incubation
Period

Vomiting

Abdominal
Pain

Fever Diarrhea

Toxin producers
Preformed toxin
Bacillus cereus, Staphylococcus aureus,

18 h 824 34+

12+

01+ 34+, watery

Clostridium perfringens

h
24+

12+

01+ 34+, watery

01+

13+

02+ 12+, watery,

Enterotoxin
Vibrio
872 h
cholerae, enterotoxigenic Escherichia coli,
Klebsiella pneumoniae,
Aeromonas species
Enteroadherent
Enteropathogenic and enteroadherent E.

18 d

coli, Giardia organisms, cryptosporidiosis,

helminths

mushy

Cytotoxin producers
C. difficile

13 d

01+

34+

12+ 13+, usually

watery,
occasionally
bloody

Hemorrhagic E. coli

1272 h

01+

34+

12+ 13+, initially

watery, quickly
bloody

13 d

13+

23+

34+ 13+, watery

12 h11 d

03+

24+

34+ 14+, watery

or bloody

12 h8 d

01+

34+

34+ 12+, bloody

Invasive organisms
Minimal inflammation
Rotavirus and norovirus
Variable inflammation
Salmonella, Campylobacter,
and Aeromonas species, Vibrio
parahaemolyticus, Yersinia
Severe inflammation
Shigella species, enteroinvasive E.
coli, Entamoeba histolytica