Etiology of Diarrhea

Specific Infectious causes of Diarrhea

Bacteria
Infantile (common)
Enterotoxigenic E. coli
Campylobacter jejuni
Shigella
Enteropathogenic E. coli
Older children

Virus
Rotavirus leading cause of
diarrheal disease in two years of
life
Norwalk virus - vomiting and
diarrhea in older children and
adults

Parasite
Worldwide: Cryptosporidium
Watery diarrhea:
E. histolytica and G. lamblia

V. cholera 01

PATHOGENIC MECHANISMS

TOXINS (25%)
Examples: E.coli, V.cholerae
Action: release toxins on the intestinal mucosa which stimulate cyclic AMP then decrease the absorption of
the Na+ from the gut lumen by villus tips and increase the secretion by the mucosal crypts of NaCl and
water into gut lumen
Recovery: normal regeneration process of intestinal mucosa, longer in malnourished children
Antibiotics: reduce V. cholera, no helpful effect in E. coli

INVASION (10-20%)
Ex: Shigella, some E.coli, C. jejuni
Action: invasion of the mucosa and actual destruction of mucosal cells; followed by production of
microabscesses and ulcers leading to presence of RBC and WBC in the stool; much greater nutritional
losses than toxigenic
Recovery: healing takes longer due to tissue destruction

VIRUSES (50%)
Ex: Rotavirus
Action: invade the intestinal cells and alter the functioning and reproduction, leading to blunting of the
villi, as well as reduction in absorption and net secretion
General symptoms such as malaise and mild fever

PARASITES
Action: similar to invasive bacteria
Giardia: does not lead to dysentery but rather to a mild, more prolonged diarrhea with epigastric distress,
bulky stools and the presence of the Giardia organism in the upper small intestine; often absent in stool so
to find them, special procedures are used such as string test, cathartic, mucosal biopsy
Amoeba: pathologic situation causes diarrhea and dysentery; characterized by presence of vegetative
forms of amoeba in stools; carrier/non-pathologic situation has amoebic cysts
Crytosporidium (5% of childhood diarrhea)
Helminths: Strongyloides and Trichuris cause diarrhea

Specific enteropathogens
Escherichia coli

Enterotoxigenic E. coli : major cause of dehydrating diarrhea under 5 yrs old and adults. Virulence factors
(1) colonization factors that allow ETEC to adhere to receptors on the enterocytes and (2) enterotoxins

Enteropathogenic E. coli : cause watery diarrhea accompanied by vomiting and fever in infants and
children up to 2 yrs

Enteroadherent E. coli : long lasting watery diarrhea. Adheres tightly to the small intestine mucosa and
produces typical morphological changes

Enteroinvasive E. coli : not commonly found pathogen. Causes sporadic foodborne cases and outbreaks of
diarrhea. Similar to Shigella penetrate within colonic epithelial cells & cause dysentery

Enterohaemorrhagic E. coli : cause sporadic hemorrhagic colitis in improperly cooked meat