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Infectious Diarrhoea – Information for GPs

Referral criteria / commissioning position

Definition of acute diarrhoea – 3 or more episodes a day, <14d and sample takes shape of pot

NOTE: If E Coli 0157 or HUS is clinically suspected then please call the hospital switchboard and ask for Microbiology Consultant Operational enquiries for Scarborough.

  • About 20% of the population develop infectious intestinal disease (IID) per year
  • Most infectious diarrhoea is a self-limited, usually viral illness. Nearly half last less than one day
  • If the diarrhoea has stopped, culture is rarely indicated, as recovery of the pathogen is unlikely
  • Infectious diarrhoea should be considered in parallel with other causes of diarrhoea

When to send a faecal specimen

  • Patient systemically unwell; needs hospital admission and/or antibiotics
  • Blood or pus in stool
  • Acute painful or bloody diarrhoea in previously healthy children to exclude E.coli 0157 infection
  • Post antibiotics and hospitalisation (C.difficile)
  • Diarrhoea after foreign travel (you should request ova, cysts and parasites (OCP))
  • Persistent diarrhoea when Giardia is suspected
  • For reassurance, as diagnosis of infection may exclude other pathologies

When advised by Health Protection Unit

  • Suspected public health hazard e.g. diarrhoea in food handlers, healthcare workers, children after farm visits (E.coli 0157) or at nurseries, elderly residents in care homes or other high risk situations
  • Outbreaks of diarrhoea in family, community etc. when isolating the organism may help pinpoint outbreak source
  • Contacts of patients with certain organisms, e.g. E.coli 0157, where there may be serious clinical sequelae

History that should be included on form to help determine diagnostic methods

  • Thorough clinical evaluation of a patient is needed to guide laboratory testing and therapy
  • Please state if submitted at request of HPU, CCDC or EHO

Clinical features:

  • Systemic illness, fever, bloody stool
  • Symptoms; duration, recurrent, chronic
  • Severe abdominal pain (Campylobacter)
  • Immunosuppression

Epidemiological setting:

  • Food intake e.g. barbecue, restaurant, eggs, chicken, shellfish
  • Recent foreign travel and to which country
  • Recent antibiotic, PPI or hospitalisation (C.Difficile)
  • Family or nursing home (norovirus)
  • Exposure to untreated water (protozoa) or animals
  • Contact with other affected individuals or outbreak

There’s further information in this Quick Reference Guide for Primary Care.

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