Viral

Norwalk virus (most common in adults)

Most common type; small bowel secretory form; seen in family/school outbreaks especially during winter and summer; water-borne, person-to-person, and food-borne; prodrome of malaise then abrupt onset of diarrhea, nausea/vomiting, abdominal cramps, headache, low grade fever; resolves spontaneously; in adults is mild illness with diarrhea predominating; can be serious in children with vomiting predominant

Norwalk 12-60 hrs

Norwalk 12-72 hrs

Rotavirus (most common in children)

Rotavirus 1-3 days

Rotavirus 4-8 days

Bacterial

Salmonella

From contaminated food or water; can passed by asymptomatic carrier

3-10 days

3-6 weeks

Shigella

Contaminated food and water

1-2 days

3-7 days

Camplyobacter jejuni

Most common of bacterial causes

1-3 days

1 week

Staphylococcus

No prodrome; no fever; severe N/V; severe diarrhea, abdominal cramps; moderately common

1-6 hours after ingesting contaminated foods, especially meats

12-36 hours

All bacterial causes produce watery stools containing mucus, pus, and leukocytes; all occur after eating foods, especially meats, that also made others sick; and there is a high relapse rate

Traveler’s Diarrhea

Small bowel, secretory diarrhea caused by action of a toxin contaminating food or water; watery diarrhea with with stools; contains blood, pus and leukocytes

Found in persons who are in or have returned from a tropical environment

1-2 days

Chronic

Inflammatory bowel

Bloody stools, abdominal pain, weight loss, fever, arthralgias. Extraintestinal symptoms involving skin, joints, liver and/or heart

Irritable bowel

Motility disorder; alternating bouts of constipation and diarrhea. Loose stools after bout of abdominal pain which defecation relieves; early morning evacuation; tenesmus; rectal urgency; mucus on stool surface

Giardiasis lamblia

Can have an acute or gradual onset with explosive diarrhea; abdominal discomfort; distention; watery, foul smelling stools; flatulence; anorexia, nausea; weight loss

Most common parasitic diarrheal infection in United States and overseas; endemic to Rocky Mountains; history of drinking water contaminated by human waste; hikers and campers are at high risk

Days-months

Chronic pseudomembranous enterocolitis

Osmotic diarrhea caused by taking antibiotics, especially clindamycin or ampicillin, that kill normal bacteria present in the colon that metabolize carbohydrates that have not been absorbed; when not metabolized this material draws water to itself, producing a profuse, watery diarrhea and abdominal pain; allows a Clostridium difficile superinfection to occur

3 days-6 weeks

3-10 days

Lactase deficiency

Onset is usually adulthood with bloating, abdominal cramps, and diarrhea after ingesting more than customary intake of milk or milk products, which raises the lactose load; can cause failure to thrive in in children

Seen in Asians, Africans, and Jews and can occur in infants