With all the news coverage about Cyclospora recently and now a salmonella outbreak instead of giving you wise advice like don’t eat food that has been contaminated with feces I thought I would take a step back and review several potential causes for significant loose stools so you can start to understand the difference.
Potential causes of significant diarrhea can be from a variety of sources not just Cyclospora and include salmonella, E coli, clostridia difficile and other parasites like giardia to name a few.
READ ON for tips to help differentiate these and understand your treatment options….
Salmonella
Symptoms typically start 6 hours up to about 6 days after eating a contaminated food.
Symptoms include:
- Stomach cramps
- High fever
- Nausea/vomiting
- Headache
- Blood in the stool
- Diarrhea and often bloody
- Back pain
- Fatigue
- Aching joints
Causes: Sources include raw eggs, raw meats, unpasteurized milk, untreated water and can be spread by coming into contact with someone with salmonella
Treatment: supportive care
E coli (Shiga Toxin)
Symptoms start 3-4 days after eating contaminated food but can appear within 1-10 days.
- Severe stomach cramps
- Diarrhea that can be watery or even bloody
- Vomiting
- Low fever or often no fever at all
- Feeling tired or weak
Causes: Contaminated food especially undercooked meat, raw produce, unpasteurized drinks, tainted water, contact with others who have it
Treatment: supportive. Antibiotics can be dangerous for Ecoli and are often avoided unless severe cases.
Cyclospora parasite
Cyclospora symptoms start around 7 days ranging from 2-14 days
Symptoms include:
- Watery diarrhea (frequently explosive)
- Stomach cramps/pain
- Bloating/gas
- Loss of appetite
- Nausea
- Extreme fatigue
- Low grade fever
- Body aches
- Headaches
- *** often relapses!!
Causes: contaminated foods especially raw foods. Heat does kill this organism above 150F.
Untreated infections may last 10-12 weeks and keep relapsing
Treatment: Antibiotics. Flagyl (metronidazole) is not effective so treatment starts with Bactrim (TMP-Sulfa) as first line therapy and if you are allergic there are other options.
Giardia parasite
Symptoms start 1-3 weeks after exposure.
- Watery, foul-smelling stools
- Severe stomach cramps/pain
- Bloating/gas
- Nausea
- Fatigue
Contaminated water, food, person to person
Treatment:
Mild cases – may resolve on their own but most significant cases need antibiotic medication like Flagyl (metronidazole)
Clostridia difficile
Symptoms starts typically after a course of antibiotics or being exposed to someone in a hospital setting that has it.
- Watery diarrhea that is foul smelling and can be explosive
- Abdominal pain
- Fever
- Nausea
Causes: prior antibiotic use or contact with someone who has an active case
Treatment:
Antibiotics are needed
Supportive care includes:
- Stay hydrated by drinking fluids especially those with electrolytes. Pedialyte is often recommended.
- Clear liquids are best.
- Avoid high sugar drinks, alcohol or caffeine.
- Do not take over the counter anti-diarrheal aides unless instructed by your provider. Your body is having diarrhea to eliminate the toxins and stopping that from happening might create other issues.
- When you start to eat go to full liquids like broth and soft foods like rice.
See a physician if you have:
- Significant diarrhea that lasts more than 3 days
- Bloody diarrhea
- Blood in urine
- High fever over 102
- Inability to keep liquids down
- Signs of dehydration (dizzy, decreased urination)
Diagnosis
If you are having significant diarrhea that is not resolving the most important test to do is a stool analysis. The ordering provider needs to test for all of above pathogens. There are false negatives especially with Cyclospora so a degree of suspicion is important and repeat testing is often warranted.
To your health,
Laura
