cryptosporidium treatment metronidazole

Tinidazole, metronidazole. CDC is not responsible for Section 508 compliance (accessibility) on other federal or private website. There is positive evidence of human fetal risk based on adverse reaction data from investigational or marketing experience or studies in humans, but potential benefits may warrant use in pregnant women despite potential risks. Some children have growth problems after having cryptosporidiosis. The most common causes in the United States are viruses, such as norovirus; bacteria, such as Salmonella, Escherichia coli, Campylobacter, and Listeria; and parasites, such as Toxoplasma gondii and Giardia. The samples are then examined in a lab for the presence of parasites. E. coli is commonly divided into two broad types, Shiga toxinproducingof which E. coli O157:H7 is the best studiedand non-Shiga toxinproducing, which includes enteropathogenic, enteroinvasive, enteroaggregative, and diffusely adherent E. coli. Enterotoxins in the small bowel caused by E. coli, C. perfringens, and viruses produce excessive secretions of fluids and electrolytes that overwhelm the large bowel; therefore, they are typically associated with watery diarrhea. Metronidazole is an antimicrobial medication that has antiprotazoal . However, it is not effective in severely immunocompromised patients and there is limited data in infants. Go to the nearest ER if you cant keep any food or liquid down, have more than 10 episodes of watery diarrhea in a day or have symptoms of severe dehydration, including: Cryptosporidiosis spreads easily and can be hard to completely avoid. The schedule may depend on the exact dosage form or strength of the medication. Treatment with metronidazole (or tinidazole) is followed by a 10-day course of diloxanide furoate. The gut microbiome composition changed significantly, and . The developmental cycle is similar to Isospora spp. Once inside your body, the parasite passes through your digestive tract and infects your stool. Has a potential for abuse less than those in schedules 1 and 2. Clipboard, Search History, and several other advanced features are temporarily unavailable. Other common symptoms include fever, bloody diarrhea, abdominal cramping, headache, dehydration, myalgia, and arthralgias.4 Patients may have several symptoms or only one. You may even develop a new vaginal yeast infection, which may need to be treated with antifungal medication. Symptoms in people with normal immune systems usually last for about 1 to 2 weeks. x][\7n.I=#U,=sT%M*V6Mb E:Ax~ZZ=_8|:a=nnex_n3,]~SyYZ Yo:kN|qx-jQx,\sqysz8s+m9{Y R6Essq\+&^ Qu;7OT`0|:n5"X]g~cio-_M M,Vi8c{OU ;lZXz^3?g>Mto H5_/4O0NaYFup5> _}?YBwHXzG'7o{RVO^laG~\wun~nV8N .bUr8xONcJUMs`bpsr@f}9EA3-^ !XKlpv%8/$?NMh>IOutn6~8/Lg/zOnqX7Nv df1l"RX:x6l-Fg-* i]|u4Tu[]8; t;GZ8~Uy HP]9}?SESRcYi~4uU\#LcU:se7V}u^nNXTR6`YXhwD:EzbA14]6!@x|J@0/]i q"K'^/W2aiY#g&:U[orpKd*4PRhuR:AZ['?\Ej$txz,bu You usually get it from contaminated water in public pools or other recreational swimming areas. The site is secure. While initially reported in immunocompromised such as AIDS patients, cryptosporidiosis has now been documented as a major cause of childhood diarrhea and an important factor in childhood malnutrition. While taking metronidazole and for 3 days after your last dose: Do not drink alcohol or consume foods, medicines, or other products that contain alcohol or propylene glycol. Dont swim if you have diarrhea. Giardia duodenalis (C&D) trophozoites measure 9 to 21 long, 5 to 15 wide, and 2 to 4 thick. If youre prescribed antiprotozoal medication for cryptosporidiosis, it can take five days or more to start feeling better. Giardia infection occurs worldwide in most domestic and wild mammals and many birds. Metronidazole (25 mg/kg) administered orally, twice a day, for 5 to 7 days was successful in clearing Giardia infections in adult laboratory-reared cats. Other tests that can be considered include serum chemistry (including albumin levels), C-reactive protein levels, complete blood count, blood cultures, urinalysis, abdominal radiography, anoscopy, and endoscopy, if warranted by the severity and pattern of symptoms.5 In severe cases of infectious diarrhea, toxic megacolon should be considered, which can be identified on plain abdominal radiography.4 Severe inflammatory changes can also be seen on computed tomography. 16th ed. Antibiotic therapy can shorten the duration of symptoms and may prevent bacteremia in older adults, newborns, and immunocompromised patients.4 Recommended treatment regimens for foodborne pathogens are outlined in Table 5.8,18,19,2124 Ciprofloxacin is no longer recommended for treatment of Campylobacter infection; a macrolide, such as erythromycin, is recommended instead.24. Generic name: metronidazole (oral/injection) It is also very common in humans. Giardiasis: Treatment and prevention. What happens if you drink alcohol with metronidazole? May harm an unborn baby. Cryptosporidium now causes over half of the reported waterborne disease outbreaks associated with swimming in chlorinated public swimming pools 9. Before 1997 Jun;56(6):637-9. doi: 10.4269/ajtmh.1997.56.637. Cryptosporidium (cryptosporidiosis) . Common metronidazole side effects may include: depression, trouble sleeping, feeling irritable; nausea, vomiting, loss of appetite, stomach pain; vaginal itching or discharge, pain during sex; This is not a complete list of side effects and others may occur. 2004 Feb;2(1):43-9. doi: 10.1586/14787210.2.1.43. These cookies perform functions like remembering presentation options or choices and, in some cases, delivery of web content that based on self-identified area of interests. Acetate is easily oxidized by our body into carbon dioxide (CO2), which we then breathe out. post treatment. Fever, vomiting and loss of appetite occur less commonly. In: Review of Medical Microbiology and Immunology. . Cryptosporidium enteritis is an infection of the small intestine characterized by diarrhea, which is caused by the parasite cryptosporidium. In immmunocompromised humans, infections may also occur in the large intestine, respiratory tract, biliary tract, pancreatic duct, and other sites. The only drug that has FDA approval for treatment of Cryptosporidium is nitazoxanide [ 2 ]. 5 0 obj This is because metronidazole not only kills the bacteria responsible for conditions such as bacterial vaginosis, but useful bacteria in the vaginal flora that help to keep other microbes in check. Stool tests may also be used to monitor the effectiveness of any treatment you receive. Children with severe dehydration should be hospitalized and given intravenous fluids.6,7 When oral rehydration therapy or intravenous fluid administration is used in infants, care should be taken to minimize interruptions in breastfeeding or formula feeding.6,7. Diarrhea within 24 to 48 hours of ingestion is most often caused by Campylobacter jejuni in individual cases or Salmonella in outbreaks.4 Foodborne illnesses commonly associated with fever are caused by Vibrio cholerae non-O1, Shigella, and C. jejuni (Table 4). Metronidazole is an antibiotic especially effective against anaerobic infections. Site of Infection and Pathogenesis. Epub 2022 Dec 26. Dont drink caffeinated beverages or alcohol. eCollection 2023. Do not use metronidazole to treat trichomoniasis during the first trimester of pregnancy. Expert Rev Anti Infect Ther. It contains 4 sporozoites and a residium. Replacement of fluids and electrolytes is the critically important first step in the management of this diarrheal illness. 2016 Aug 12;2(8):530-7. doi: 10.1021/acsinfecdis.6b00094. Antimicrob Agents Chemother. 2022 Nov 3:1-11. doi: 10.1007/s11259-022-10025-6. Diagnosis and management of a foodborne illness are based on the history and physical examination. Since you can still spread cryptosporidiosis even once your symptoms are gone, ask your employer or school when you or your child can come back. Get emergency medical help if you have signs of an allergic reaction to metronidazole (hives, itching, warmth or tingling; fever, joint pain; dry mouth, dry vagina; stuffy nose, difficult breathing, swelling in your face or throat) or a severe skin reaction (fever, sore throat, burning eyes, skin pain, red or purple skin rash with blistering and peeling). 2001 Jun 15;32(12):1792-4. doi: 10.1086/320751. Bookshelf 2023 Feb;21(2):167-173. doi: 10.1080/14787210.2023.2160704. https://www.uptodate.com/contents/search. This material is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment. In animal studies (mice and rats), this medicine caused certain types of cancers or tumors. AHFS DI Monograph, Prescribing Information, Drug class: Definitive diagnosis can be made only through stool culture or more advanced laboratory testing. An organism-specific diagnosis can help clinicians to narrow treatment recommendations, aid public health professionals, and prevent unnecessary procedures. In 2004, the FDA licensed nitazoxanide for all persons 1 year of age. Make a donation. Bloody diarrhea with abdominal pain should prompt consideration of inflammatory damage to the intestinal mucosa or an infection (e.g., C. jejuni, Salmonella enteritidis, enteroinvasive E. coli) affecting the large bowel. A. Clinton White Jr receives royalties from UpToDate and Harrison's Internal Medicine for chapters on a different subject. Metronidazole is not approved to treat vaginal infections in girls who have not begun having menstrual periods. Its so small that you can only see it with a microscope. Tell your doctor if you have symptoms such as itching or discharge during or after treatment with this medicine. This content is owned by the AAFP. Compliance with Ethics Guidelines: Conflict of Interest: Hayley Sparks, Gayatri Nair, Alejandro Castellanos-Gonzalez, and declare that they have no conflict of interest. In cases of suspected foodborne illness or in the setting of an outbreak, stool and vomitus samples should be sent for testing. Gharpure R, Perez A, Miller AD, Wikswo ME, Silver R, Hlavsa MC. Experts estimate that nearly 15-20 percent of all feline diarrhea cases are Clostridium perfringens related. Clostridium perfringens is a bacterial infection of the intestines with which most cats develop long-term clinical symptoms of diarrhea and clinical signs associated with . Can you have sex while taking metronidazole? Metronidazole is effective against Bacteroides fragilis, for example, which is a normal bacterial member of the gut and mouth microbiomes but can also be a culprit in wound infection, abscesses, chest infection (often associated with pneumonia), and liver infection. Advertising on our site helps support our mission. Children between 1 and 4 are the most likely to get cryptosporidiosis. in ducks was 39.9 % (365 out of 915 ducks). If you are treating a vaginal infection, your sexual partner may also need to take metronidazole so you don't become reinfected. Signs and symptoms of Cryptosporidium infection. All information these cookies collect is aggregated and therefore anonymous. Cryptosporidiosis spreads easily. Protozoal Intestinal Infections and Trichomoniasis. If you have cryptosporidiosis, avoid eating or drinking anything that makes diarrhea and dehydration worse, like alcohol and caffeine. Treatment is aiming for cessation of clinical signs and not for complete elimination of the agent. Keep an eye on your symptoms. Abuse may lead to severe psychological or physical dependence. Accessed Nov. 3, 2020. Cotto-Rosario A, Miller EYD, Fumuso FG, Clement JA, Todd MJ, O'Connor RM. To help diagnose giardia infection (giardiasis), your doctor is likely to test a sample of your stool. Bartelt LA. Drugs.com provides accurate and independent information on more than 24,000 prescription drugs, over-the-counter medicines and natural products. a blood thinner - warfarin, Coumadin, Jantoven. Dont swim in public pools or have sex for two weeks after having diarrhea. 2022 Dec 30;12(1):61. doi: 10.3390/pathogens12010061. Oral rehydration therapy is effective in preventing and treating dehydration in patients of all ages. Please enable it to take advantage of the complete set of features! It can now be prescribed for all patients 1 year of age. INTRODUCTION. Sports drinks and soft drinks have a high carbohydrate-to-sodium ratio and total osmolality, and can exacerbate diarrhea.19, Clinical assessment should be used to guide rehydration therapy. This site needs JavaScript to work properly. How long does it take for metronidazole to work? Severe diarrhea can lead to life-threatening complications. . Unauthorized use of these marks is strictly prohibited. Cryptosporidiosis is of considerable importance in neonatal ruminants, in which it is characterized by mild to severe diarrhea, lethargy, and poor growth rates. Author disclosure: No relevant financial affiliations. Rapid loss of fluids from diarrhea may be especially life threatening to babies. Has a high potential for abuse. You also may be given instructions about how to bring in a sample of your stool. This list is not complete and many other drugs may interact with metronidazole. They help us to know which pages are the most and least popular and see how visitors move around the site. Adequate and well-controlled studies have failed to demonstrate a risk to the fetus in the first trimester of pregnancy (and there is no evidence of risk in later trimesters). Tell your doctor about all your current medicines. Identification of Cryptosporidium parvum active chemical series by Repurposing the open access malaria box. Metronidazole is an antibiotic used to treat Clostridium difficile diarrhea, amebic liver abscess, amebic dysentery, bacterial vaginosis and other infections. In: Harrison's Principles of Internal Medicine. However, these results should not delay empiric treatment if a foodborne illness is suspected. Disclaimer. Cryptosporidiosis is spread through the fecal-oral route, which means you get it from accidentally swallowing poop (feces) that has parasites in it. Protozoal intestinal infections and trichomoniasis. In patients with clinically significant vomiting, antiemetics can alleviate symptoms and reduce the need for hospitalization and intravenous fluid administration. In most people, your immune system will fight off Cryptosporidium and the symptoms of cryptosporidiosis will go away. An official website of the United States government. Persistent symptoms may also represent re-infection or other causes of illness besides cryptosporidiosis. cryptosporidium treatment metronidazole. . Your provider will give you a sterile container and instructions on how to get a sample. Nitazoxanide: a new thiazolide antiparasitic agent. Cryptosporidium parvum: Oro-fecal: Diarrhea: Ooocysts in stool: Paromycin (investigational) Isospora belli: Oro-fecal: Giardiasis-like . sharing sensitive information, make sure youre on a federal Front Cell Infect Microbiol. Albendazole and nitazoxanide are effective against giardiasis but require multiple doses. Although these recommendations have been shown to reduce the risk of foodborne illness in the United States, the risk increases with travel. % Cryptosporidiosis Outbreaks United States, 20092017. While you may initially bring your symptoms to the attention of your family doctor, he or she may refer you to a gastroenterologist a doctor who specializes in digestive system disorders. Clin Infect Dis. The reaction has been referred to as a disulfiram-like reaction disulfiram is a medication given to people to discourage alcohol consumption. There is a need for a highly effective treatment for cryptosporidiosis in immunodeficient patients, but the quest for such a drug has proven to be elusive. Shake the oral suspension (liquid). FOIA You usually get it from contaminated water in public pools or other recreational swimming areas. Repurposing of drugs developed for other indications and development of inhibitors for novel targets offer hope for improved therapies, but none have advanced to clinical studies. 1. vomiting. Metronidazole is also used to treat infections of the gallbladder and bile . Avoid getting water in your mouth if you swim in lakes, rivers or public pools. is a leading cause of diarrheal disease morbidity and mortality .Recent estimates suggest Cryptosporidium spp. It had previously been licensed in 2002 for only children aged 1-11 years. Diarreia causada por Cryptosporidium parvum em pacientes peditricos com 1 a 11 anos de idade Em dois estudos duplo-cegos controlados, em pacientes peditricos com diarreia causada por Cryptosporidium parvum, um curso de trs dias de tratamento com nitazoxanida suspenso oral (100 mg, duas vezes ao dia em crianas de 12 a 47 meses; 2.4 Cryptosporidium spp. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. If you have a healthy immune system, cryptosporidiosis usually goes away on its own in about two weeks. Accessed Nov. 3, 2020. For accuracy, you may be asked to submit several stool samples collected over a period of days. While not effective against Cryptosporidium, nitroimidazoles such as metronidazole or tinidazole are effective treatments for giardiasis and can be administered as a single dose. There is a lack of accepted safety for use under medical supervision. R01 AI089441/AI/NIAID NIH HHS/United States. Antiprotozoal medications stop protozoa like Cryptosporidium from growing in your body. Dogs get infected with Cryptosporidium canis, while cats get C. felis and humans get C. parvum and C.hominis . Treatment. . This medicine will not treat a viral infection such as the common cold or flu. government site. You can review and change the way we collect information below. You get cryptosporidiosis from contaminated water, like pools or lakes, or from other people. It is presently not approved to treat immunodeficient persons because nitazoxanide oral suspension and nitazoxanide tablets have not been shown to be superior to placebo for the treatment of diarrhea caused by Cryptosporidium in HIV-infected or immunodeficient patients 1. In such cases, longer courses of treatment might be needed. About 10% of women report a vaginal yeast infection (vaginal candidiasis) as a side effect of metronidazole treatment. Discussion. stream Jameson JL, et al., eds. Incidence of Cryptosporidium spp. Last reviewed by a Cleveland Clinic medical professional on 08/24/2022. The https:// ensures that you are connecting to the https://www.cdc.gov/parasites/giardia/index.html. Cryptosporidium Feco-oral; human or anima trophozoites attached to gut wall. A single copy of these materials may be reprinted for noncommercial personal use only. We also searched Essential Evidence Plus, UpToDate, OVID, and the Internet, specifically focusing on information contained in the CDC and FDA websites, as well as the Cochrane library. Metronidazole (50 mg/kg, PO, every 24 hours for 3-5 days) can be administered for treatment. amebicides, aminoglycosides, For professionals: This material is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment. For oral dosage forms (capsules or tablets): For amebiasis infections: Adults500 or 750 milligrams (mg) 3 times a day for 5 to 10 days. fever. Application of Proteomics to the Study of the Therapeutics and Pathogenicity of. Do not share this medicine with another person, even if they have the same symptoms you have. Continue reading. Not all uses of metronidazole are approved for treating children and teenagers. INTRODUCTION. Large clinical trials in humans have never been conducted to confirm this interaction. Many people who do have problems often get better on their own in a few weeks. Consumer information on food safety is available from the CDC at http://www.cdc.gov/foodsafety/facts.html or from the U.S. Food and Drug Administration at http://www.fda.gov/Food/FoodborneIllnessContaminants/FoodborneIllnessesNeedToKnow/default.htm or http://www.foodsafety.gov, or by calling (888) SAFEFOOD ([888] 7233366). Symptoms include: The parasite Cryptosporidium causes cryptosporidiosis. Abuse may lead to moderate or low physical dependence or high psychological dependence. If you need to go back and make any changes, you can always do so by going to our Privacy Policy page. Most cases of acute infectious diarrhea are viral, and improper use of empiric antibiotics is associated with increased morbidity caused by adverse effects and Clostridium difficile colitis. Prevention is the first step in combatting foodborne illnesses. Cryptosporidium is considered a common, contagious parasite in dogs and other animals. Brand names: Flagyl, Flagyl ER, Flagyl I.V., RTU, Metro I.V., Protostat, Metryl https://www.uptodate.com/contents/search. Cloacal swabs were collected every 2 months for 6 months to measure C. serpentis shedding by probe . Cryptosporidium is an intracellular protozoan parasite that is associated with self-limited diarrhea in immunocompetent hosts and severe debilitating diarrhea with weight loss and malabsorption in immunocompromised patients (eg, patients with acquired immunodeficiency syndrome [AIDS]). On the other hand, Masood et al . This content does not have an Arabic version. It has a currently accepted medical use in treatment in the United States. eCollection 2022 Nov. Aziz AFE, Roshidi N, Othman N, Mohd Hanafiah K, Arifin N. Diagnostics (Basel). Cryptosporidium spp. It causes watery diarrhea and other gastrointestinal (gut) symptoms. What symptoms should prompt me to call you or go to the ER? Treatment of cryptosporidiosis: nitazoxanide yes, but we can do better. What should I do if my symptoms get worse or change? Cryptosporidium species and Giardia intestinalis are the most common enteric protozoan pathogens affecting humans worldwide. You should not use this medicine if you are allergic to metronidazole, secnidazole, or tinidazole, or if: you consumed foods or medicines that contain propylene glycol in the past 3 days; or. When a person consumes alcohol, the body breaks it down in two steps. All Rights Reserved. It is important that you still finish the course of metronidazole that your doctor has prescribed, even if you feel better, because the infection may still be present, and it could flare up or recur if you havent finished the course. We comply with the HONcode standard for trustworthy health information. A definitive diagnosis is not necessary to report a suspected foodborne illness. eCollection 2021. Drink unfiltered or untreated water (often while traveling, hiking or camping). Not all possible drug interactions are listed here. The site is secure. Microscopic evaluation for fecal polymorphonuclear leukocytes or lactoferrin measurements may be useful if an inflammatory etiology is suspected. Coming to a Cleveland Clinic location?Hillcrest Cancer Center check-in changesCole Eye entrance closingVisitation, mask requirements and COVID-19 information, Notice of Intelligent Business Solutions data eventLearn more. Gastroenteritis is infection of the bowels (intestines). Information on outbreaks, outbreak surveillance, and identified trends can be found at http://www.cdc.gov/foodsafety/fdoss/index.html or by calling the CDC at (800) CDC-INFO ([800] 2324636). June 29, 2022; seattle seahawks schedule 2023; psalms in spanish for funeral . Most foodborne illnesses are associated with vomiting or diarrhea (more than three loose stools in 24 hours). Symptoms and time of onset can narrow the differential diagnosis (Table 3) and help identify a likely pathogen.4 Early onset of vomiting and diarrhea results from ingestion of preformed toxins, most often S. aureus or Bacillus cereus. 1999 Dec;18(12):885-9. doi: 10.1007/s100960050424. The dormant (inactive) form of Cryptosporidium , called an oocyst . Metronidazole will not treat a vaginal yeast infection. Giardiasis is an intestinal infection with the protozoan parasite Giardia spp. On the other hand, Masood et al. Cryptosporidiosis is a disease usually caused by the parasites Cryptosporidium hominis and C. parvum. This can result in an overgrowth of the candida yeast. National Library of Medicine Seizures and other nervous system abnormalities have been reported in patients treated with metronidazole. Symptoms generally begin within a week of exposure . Epub 2022 Jul 4. Oral yeast infections (oral thrush or oral candidiasis) have also been reported with metronidazole oral treatment. This is because metronidazole not only kills the bacteria responsible for conditions such as bacterial vaginosis, but useful bacteria in the vaginal flora that help to keep other microbes in check. and transmitted securely. Skipping doses could make your infection resistant to medication. Drink plenty of fluids. Abdominal cramps, nausea, watery diarrhea, Abdominal cramps, diarrhea (may be bloody), fever, vomiting, Contaminated water, raw or undercooked poultry, unpasteurized milk, Blurred vision, diarrhea, difficulty swallowing, double vision, muscle weakness, vomiting; can cause respiratory failure and death, Fermented fish, improperly canned foods (especially home-canned vegetables), potatoes baked in aluminum foil, Intense abdominal cramps, watery diarrhea, Dried or precooked foods, gravy, meats, poultry, undercooked foods, Abdominal cramps, diarrhea (usually watery), slight fever, May be remitting and relapsing over weeks to months, Contaminated drinking water, cooked foods that are not reheated after contact with an infected food handler, uncooked foods, Abdominal cramps, diarrhea (usually watery), fatigue, loss of appetite, nausea, substantial weight loss, vomiting, Contaminated raw produce (e.g., basil, imported berries, lettuce), Abdominal cramps, vomiting, watery diarrhea, Food or water contaminated with human feces, Abdominal pain, severe diarrhea (often bloody), vomiting; can cause kidney failure, Contaminated drinking water, contaminated raw produce (e.g., sprouts), undercooked beef (especially hamburger), unpasteurized milk or juice, Abdominal pain, dark urine, diarrhea, fever, headache, jaundice, nausea, Contaminated drinking water, contaminated raw produce, cooked foods that are not reheated after contact with an infected food handler, shellfish from contaminated water, uncooked foods, 9 to 48 hours for gastrointestinal symptoms, 2 to 6 weeks for invasive disease, Diarrhea, fever, muscle aches, nausea; pregnant women may have mild flulike illness, and infection can lead to premature delivery or stillbirth; older adults and immunocompromised patients may develop bacteremia or meningitis, Deli meats, unpasteurized milk, soft cheeses made with unpasteurized milk, Norovirus (food poisoning, viral gastroenteritis, winter diarrhea), Abdominal cramps, diarrhea (more common in adults), fever, headache, nausea, vomiting (more common in children), Abdominal cramps, diarrhea, fever, vomiting, Cheese, contaminated raw produce, eggs, meat, poultry, unpasteurized milk or juice, Abdominal cramps, diarrhea, fever; stools may contain blood and mucus, Contaminated drinking water, contaminated raw produce, cooked foods that are not reheated after contact with an infected food handler, uncooked foods, Abdominal cramps, diarrhea, fever, sudden onset of severe nausea and vomiting, Unrefrigerated or improperly refrigerated cream pastries, meats, and potato or egg salad, Abdominal cramps, fever, nausea, vomiting, watery diarrhea (occasionally bloody), Abdominal pain, bleeding under the skin, bloodborne infection, diarrhea, fever, ulcers requiring surgical removal, vomiting; can be fatal to persons with liver disease or weakened immune systems, Undercooked or raw seafood (especially oysters), Acute abdominal pain, fever, and vomiting, Together, these symptoms raise suspicion for infectious diarrhea, Recent changes in diet and ingestion of foods included in recent recalls or undercooked foods should raise suspicion for foodborne illness, Longer duration raises concern for dehydration, Persons who work at child care centers or in close contact with others are at risk of viral diarrhea, Cross-contamination and transmission of pathogens are possible; may help narrow differential if cause is known in the other person, Hospitalization or nursing home admission, Raises suspicion for atypical causes of diarrhea, Can help determine possible comorbidities that suggest a cause, Stool characteristics (bloody, foul smelling, watery), Foul-smelling stools in patients with recent hospitalization or antibiotic use raise suspicion for, Watery stools raise suspicion for viral cause or, Travel to foreign countries, especially non-Western countries, should raise suspicion for infectious diarrhea, Decreased appetite, fever, jaundice, nausea, right upper-quadrant abdominal pain, vomiting, CBC, C-reactive protein level, liver function testing, right upper-quadrant ultrasonography, Abdominal pain, arthralgias, arthritis, fever, jaundice, malaise, nausea, vomiting, Ammonia levels, hepatitis panel, liver biopsy, liver function testing, ultrasonography, Fever, left lower-quadrant abdominal pain, Abdominal CT, CBC; contrast enema and colonoscopy may be considered, Abdominal pain, chronic diarrhea, occasional bloody diarrhea, weight loss, Colonoscopy with tissue biopsy, negative stool culture, Abdominal pain, diarrhea, hematochezia, melena, weight loss, Abdominal CT, arterial blood gas levels, blood chemistry panel, CBC, colonoscopy, electrocardiography, lactate levels, magnetic resonance angiography, Abdominal pain, anorexia, diarrhea, fever, nausea, vomiting, Diagnosis is generally clinical; may be confirmed by antigen-detecting enzyme immunoassay, immunofluorescence assay, microscopy, polymerase chain reaction testing, serology, or viral culture (although routine use of these tests is not necessary), Erythromycin, 500 mg 2 times per day for 5 days, Azithromycin, 10 mg per kg per day for 3 to 7 days, Azithromycin (Zithromax), 500 mg on day 1, then 250 mg on days 2 through 5, Ciprofloxacin, 500 mg 2 times per day for 3 days, TMP-SMX, 5/25 mg per kg 2 times per day for 3 days, TMP/SMX, 160/800 mg 2 times per day for 3 to 7 days, Azithromycin, 500 mg on day 1, then 250 mg on days 2 through 5, Ciprofloxacin, 500 mg 2 times per day for 5 to 7 days, TMP-SMX, 5/25 mg per kg 2 times per day for 5 to 7 days, Ceftriaxone, 1 to 2 g per day intramuscularly or intravenously for 5 to 7 days, Ceftriaxone, 50 to 100 mg per kg per day intramuscularly or intravenously for 5 to 7 days, Metronidazole (Flagyl), 750 mg 3 times per day for 5 to 10 days, Metronidazole, 30 to 50 mg per kg per day in 3 divided doses for 7 to 10 days, Paromomycin, 500 mg 3 times per day for 7 days, or iodoquinol (Yodoxin), 650 mg 3 times per day for 7 days, Paromomycin, 25 to 35 mg per kg per day in 3 divided doses for 5 to 10 days, Metronidazole, 250 to 750 mg 3 times per day for 7 to 10 days.

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