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Unexpected, acute and bloody diarrhea, with or without fever, is one of the most common symptom complex seen in the emergency department (ED). The majority of cases of gastroenteritis are viral, and etiologic agents include rotavirus, Campylobacter jejuni, Salmonella species, Salmonella typhi, or Shigella species. Recent exposure, recent travel within 4 weeks, and exposure to food and water in places that carry Campylobacter and Salmonella species are risk factors for acquiring Campylobacter and Salmonella Enteritis. Prevention of the spread of diarrhea in the community involves active surveillance and control of food and water quality and public education about hand hygiene (C). The distinction between bacterial and viral causes of gastroenteritis is of great importance. The most economical and effective means of treating mild to moderate gastroenteritis is supportive symptomatic care and oral rehydration therapy (C). Antimicrobial therapy is indicated for high-risk individuals with severe pneumonia, sepsis, severe dehydration, or meningitis; for diarrhea associated with ulcerative colitis, Shiga toxin-producing Escherichia coli, and enterotoxigenic Escherichia coli; for diarrhea associated with Campylobacter or Salmonella enteritis; and for acute hemorrhagic diarrhea. The incidence of bacterial gastroenteritis in the United States has been declining, which may be partially the result of improved sanitation and reduced fecal exposure. In adults, fluoroquinolones are probably first line therapy, and in children older than 1 year, macrolides are appropriate. There are a number of literature reports of fluoroquinolones (C) treating patients with invasive enterococcal disease caused by V. cholerae. Given the ominous nature of Campylobacter enteritis and salmonellosis, combination therapy has the potential to reduce the risk of long-term sequelae in children. In adult patients with Shiga toxin-producing Escherichia coli infection, at least one third of the patients will have hemolytic uremic syndrome (C), a rare but potentially devastating complication. There is no specific treatment for hemolytic uremic syndrome except supportive clinical care. Anecdotal evidence indicates that plasma exchange can be helpful. Acute viral gastroenteritis in the older child and adult is often self-limited and not due to Campylobacter or Salmonella species. 7211a4ac4a
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