Hong Kong Journal of Emergency Medicine

Volume 10 Number 3, July 2003

Acute infectious diarrhoea in adults: identifying clinical parameters associated with specific pathogens

SSW Chan, KC Ng, PKW Lam, DJ Lyon, WL Cheung, TH Rainer

Introduction: Infectious diarrhoea may be caused by viral, bacterial or protozoan agents. The objective of this study was to explore the possibility of correlating presenting clinical and demographic features with the specific types of stool pathogens subsequently identified. Materials & Methods: A retrospective study was performed in the setting of an Accident & Emergency (A&E) department of an urban acute-care hospital in Hong Kong. The inclusion criteria were adults (age>=16); presentation with features of acute infectious diarrhoea; treated as out-patients with or without observation; and with stool cultures requested from A&E. All consecutive culture-positive cases (n=130) satisfying the above criteria were included. The control-group (n=119) consisted of a random sample of culture-negative cases during the same study period. For each of the six pathogens identified, statistical analyses were performed to compare differences in clinical features amongst three groups: (i) cases positive for the specific pathogen; (ii) cases positive for other pathogens; and (iii) cases with negative culture. Results: Salmonella was associated with significantly higher body temperatures at presentation. Vibrio parahaemolyticus (VP) was associated with a significantly shorter duration of diarrhoea and of abdominal pain at presentation. Other variables were not helpful in predicting the type of stool pathogen. Conclusion: In patients presenting with acute infectious diarrhoea in an A&E setting in Hong Kong, Salmonella and VP may be suspected according to the clinical features identified in this study. (Hong Kong j.emerg.med. 2003;10:162-168)

Keywords : Emergency department, gastroenteritis, pathogens, predicting factors, stool culture

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