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Bacterial Gastroenteritis - Causes, Symptoms, Diagnosis, and Treatment

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Bacterial gastroenteritis is diarrhea due to excessive bowel movement caused by inflammation. A description of the disorder and its treatment is in the article.

Medically reviewed by

Dr. Kaushal Bhavsar

Published At August 30, 2022
Reviewed AtJanuary 30, 2023

Introduction

Inflammation in the stomach or small intestine leads to diarrhea due to increased bowel movement. It may or may not be associated with abdominal pain, fever, and vomiting. Increased bowel frequency is defined as three or more loose, watery stools in 24 hours or at least 200 grams of feces per day. Bacterial gastroenteritis can be bacterial, viral, fungal, and parasitic. The symptoms include diarrhea, vomiting, nausea, and abdominal pain. The cases of bacterial gastroenteritis are generally self-limiting, which means it can stop itself. However, some supportive management and antibiotic therapy can cure the disease.

What Are the Causes of Bacterial Gastroenteritis?

The cause of gastroenteritis can be bacterial, viral, fungal, or parasitic. However, this article is about the bacterial cause of gastroenteritis. The most common causative agents are adenovirus, rotavirus, and norovirus. Besides these viruses, bacterias causing gastroenteritis are enterotoxigenic Escherichia coli (ETEC) and Clostridium perfringens. Bacteria are responsible for more severe cases of gastroenteritis than other pathogens. Some other bacteria causing the infection are Campylobacter and nontyphoidal Salmonella.

What Is the Epidemiology of Bacterial Gastroenteritis?

Bacterial gastroenteritis is one of the most common diseases around the world. It is associated with almost 1.5 to 2.5 million death cases per year. One of the most common diseases affecting children below five years, approximately more than four billion children are affected by the disease every year.

What Is the Classification of Bacterial Gastroenteritis?

Depending on the duration of symptoms, gastroenteritis can be classified into the following categories:

  • Acute Gastroenteritis: 14 days or less than the duration of symptoms.

  • Persistent Gastroenteritis: Symptoms visible for more than 14 days but not exceeding 30 days.

  • Chronic Gastroenteritis: Duration of symptoms lasts for more than 30 days.

  • Recurrent Gastroenteritis: Recurrence of diarrhea after every seven days of no signs.

What Are the Symptoms of Bacterial Gastroenteritis?

The signs presented by patients of bacterial gastroenteritis are:

  • Diarrhea: Watery or loose stool with or without the presence of bloodstains.

  • Nausea: The feeling of vomiting and stomach discomfort.

  • Vomiting: Forceful throwing up of the contents of the stomach.

  • Abdominal pain.

  • Fever: Increased body temperature, suggesting an aggressive organism as the causative agent.

  • Dehydration due to excessive diarrhea.

In severe cases, the following symptoms are observed:

  1. Dry Mucous Membranes: Xerostomia or dry mouth can occur due to excess water loss from the body (dehydration).

  2. Decrease in Elasticity of the Skin: It does not easily come to its original shape if the skin is stretched and pulled.

  3. Tachycardia: Increase in heart rate with almost 100 beats per minute.

  4. Bloody Stools: Inflammation of the stomach lining and intestine can cause ulcers due to mucosal abrasion of the gut wall.

  5. Hypotension: Decreased blood pressure.

  6. Orthostasis: A normal physiological reaction of the sympathetic system to overcome a fall in blood pressure when a person was lying down and assumed back to an upright position.

How to Evaluate Bacterial Gastroenteritis?

  • Thorough medical history and physical examination are the first steps in evaluating the disease. Physical examination presents tenderness in the abdomen.

  • A serum electrolyte panel is indicated to check for abnormal electrolyte levels in severe fluid volume loss cases.

  • With the help of blood tests, though a complete blood test cannot help differentiate between bacterial causes and other causes, it can help evaluate the severity and other complications. Such as, in cases of bacterial invasion and pseudomembranous colitis, there is an increase in white blood cell count.

  • Blood testing is advised to diagnose bacterial pathogens in cases with excessive dehydration and volume loss, severe abdominal pain, pregnancy, elder individuals above 70 years of age, and immunocompromised patients. A stool culture can help identify three common bacteria - Campylobacter, Shigella, and Salmonella.

  • In cases of bloody diarrhea, additional testing for Shiga toxin and leukocytes in feces is done to look for enterotoxigenic Escherichia Coli (ETEC).

What Is the Treatment of Bacterial Gastroenteritis?

  • Antibiotic Therapy: In bacterial gastroenteritis, especially in Shiga toxin-producing E.coli, antibiotics should be advised. Azithromycin or Fluoroquinolones can be advised in severe cases like greater than six to seven stools in a day and fever, cases of elderly people (above 70 years), and mucus or blood in the stool. In pregnant women, the drug of choice is Ampicillin. It is also stated by the recent guidelines of the centers for disease control and prevention that oral Vancomycin or Fidaxomicin should be advised in nonsevere cases and Metronidazole for severe cases of bacterial gastroenteritis.

  • Supportive Management: It includes rehydration in cases of dehydration. The preferable route is oral administration. If there are difficulties in oral rehydration, the intravenous route is used. The fluid intake should be slow, and in small amounts, as fast consumption can worsen nausea. Easy-to-digest food like bananas, rice, toast, and chicken should be started. Consumption of caffeine and alcohol should be avoided.

  • Symptomatic Therapy: Loperamide is advised in cases of afebrile and non-bloody diarrhea.

Which Diseases Are Similar to Bacterial Gastroenteritis?

The most similar diseases to bacterial gastroenteritis are viral or fungal manifestations of gastroenteritis.

  • Crohn’s Disease: This is a non-curing inflammatory disease of the bowel causing severe diarrhea, weight loss, abdominal pain, fatigue, and malnutrition.

  • Microscopic Colitis: Inflammation of the large intestine (colon) causes persistent watery and loose diarrhea. As the name suggests, the disease is diagnosed only after a microscopic view of the colon.

  • Lactose Intolerance: Difficulty digesting lactose (sugar) in the milk can cause issues such as gas, diarrhea, and bloating after consuming dairy products.

  • Pseudomembranous Colitis: Clostridium difficile causes swelling and inflammation of the colon (large intestine). This infection is common after antibiotic usage and causes diarrhea.

  • Irritable Bowel Syndrome: A common chronic disorder of the large intestine is showing symptoms such as abdominal pain, cramping, bloating, diarrhea, constipation, or both of these.

  • Celiac Disease: Also known as gluten-sensitive enteropathy or celiac sprue. It is an immune reaction of the body towards gluten found in barley, wheat, and rye. The classic symptom of the disease is diarrhea, followed by fatigue, bloating, and anemia (low blood count).

  • Malabsorption Syndrome: Disorders of the small intestine in which the intestine is not capable of absorbing enough nutrients leading to diarrhea, weight loss, and effects on other organs such as the brain, bones, liver, and nervous system.

  • Acute HIV Infection: HIV is characterized by suppressing the body's immune system, thus increasing the chances of gastrointestinal infections and inflammations. The most common infections could cause diarrhea, abdominal pain, and digestive issues.

What Are the Complications of Bacterial Gastroenteritis?

  • Dehydration and electrolyte depletion are the common complications seen in almost all cases.

  • Transformation of acute gastroenteritis into chronic diarrhea leads to lactose intolerance or bacterial overgrowth in the small intestine.

  • Enteric Fever: Also known as typhoid fever, is an infection caused by Salmonella typhi.

  • Septicemia: Infection of blood by bacteria is known as septicemia or sepsis. It is one of the most extreme responses of the body to an infection. According to the organism involved, the death rate in cases of septic shock is as high as 50 %.

  • Guillain-Barre Syndrome: A rare disorder where the body's immune system attacks its nerves. The symptoms start with tingling and weakness in the upper and lower limbs leading to paralysis of the whole body.

  • Reactive Arthritis: Swelling and joint pain triggered by an infection in other parts of the body such as the intestines, urinary tract, or genitals. In cases of gastroenteritis by Salmonella, Campylobacter, or Yersinia, there are chances of reactive arthritis.

Conclusion:

Bacterial gastroenteritis is bowel inflammation that causes diarrhea due to increased bowel movements. The infection can be viral, fungal, or parasitic as well. Other symptoms include fever, abdominal pain, and vomiting. There can be dehydration due to excessive fluid loss from the body in some cases. In these cases, the administration of fluids either orally or intravenously is done. The treatment starts with antibiotic therapy, followed by supportive therapy.

Frequently Asked Questions

1.

How Long Can You Have Bacterial Gastroenteritis?

Bacterial gastroenteritis is a bacterial infection causing inflammation of the stomach and intestinal tissues. It may last around one to three days. However, severe infection may last for weeks and cause serious complications if left untreated. Consult the physician when symptoms appear.

2.

What Is the Quickest Approach to Treat Gastroenteritis?

 
Gastroenteritis pain can be relieved by taking Paracetamol. In addition, intake of plain foods such as soup, bread, pasta, and rice would help. Plenty of fluid intake is also necessary if the individual is dehydrated. Although home remedies could help, seeking help from a physician is advisable once the symptoms appear.

3.

How Is Bacterial Gastroenteritis Treated?

Mild cases of bacterial gastroenteritis heal on their own without treatment. However, the individual has to drink plenty of water to compensate for water lost due to vomiting and diarrhea. Some patients require antibiotic coverage for a week to recover. Severe cases can lead to dehydration, kidney disease, neurological problems, and even death if not treated.

4.

Which Antibiotic Is Most Effective for Bacterial Gastroenteritis?

 
Ampicillin is found to be the most effective antibiotic for treating bacterial gastroenteritis. Sulfamethoxazole, Fluoroquinolones, and Cephalosporins are also a few effective alternatives. In addition to antibiotics, fluid and electrolyte replacements are also necessary for early recovery.

5.

Does Gastroenteritis Spread Easily?

 
Gastroenteritis is the inflammation of the stomach and intestinal tissues caused by bacteria and viruses. They are found to spread quickly if proper hygiene is not maintained. Hence, specific hygienic measures like washing hands would help prevent the spreading of or contracting the disease.

6.

How Can You Distinguish Between Gastroenteritis and Food Poisoning?

 
Food poisoning is an illness caused by contaminated food, where symptoms occur within a few hours or weeks of exposure to foodborne or waterborne pathogenic organisms. However, gastroenteritis is caused due to bacteria or viruses, and the incubation period may be around 24 to 72 hours.

7.

How Can You Distinguish Between Bacterial and Viral Gastroenteritis?

Gastroenteritis can be identified as bacterial or viral through its symptoms. For example, bacterial gastroenteritis leads to diarrhea with blood and mucus. In contrast, viral gastroenteritis causes watery diarrhea with no mucus and blood. Hence medical history, physical examination, and stool tests can distinguish between bacteria or viruses.

8.

What Distinguishes Gastroenteritis From Gastritis?

Gastritis is the inflammation of the stomach lining alone, caused due to infection and excessive alcohol intake. It can lead to indigestion, nausea, vomiting, loss of appetite, and abdominal pain. In contrast, gastroenteritis is the inflammation of the stomach and intestinal tissues caused by bacteria and viruses. It can lead to nausea, vomiting, bloody diarrhea, stomach pain, headache, and a low-grade fever.

9.

How Long Does Gastroenteritis Take To Develop?

Gastroenteritis can be found symptomatic within 24 hours of the entry of the infectious organism. However, some cases present symptoms as early as one hour or as long as 60 days. The primary symptoms include nausea, vomiting, and diarrhea, sometimes with blood.

10.

Can Stress Lead To Gastroenteritis?

Stress cannot directly cause gastroenteritis, but it can aggravate the symptoms. However, certain studies suggest that a stressful life is a reason for the onset and exacerbation of the symptoms. They can lead to gastrointestinal symptoms like loss of appetite, cramping, bloating, and inflammation.
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Dr. Kaushal Bhavsar
Dr. Kaushal Bhavsar

Pulmonology (Asthma Doctors)

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