Introduction The clinical syndrome associated with infective diarrhoea is well known, however there are few studies which have rigorously analysed the characteristics in history, examination and investigation in a single cohort of patients.
Methods This was a retrospective cohort study of patients admitted to the gastroenterology department of a single tertiary care teaching hospital with a culture positive episode of bacterial infective diarrhoea, excluding Clostridium difficile. Data was collected from clinical notes of patients presenting over an 8 year period (2004 – 2012) with a follow up period of 12 months from the date of admission.
Results 103 patients were included in the study; 59 (57%) males, mean age 43 (17–101). Organisms cultured were; Campylobacter 84, Salmonella 13, Shigella 2, E coli 4. Mean duration of symptoms was 5.7 days (1–14) while patient gave history of; abdominal pain 88% (91), per rectal (PR) bleeding 52% (53), vomiting 43% (44), weight loss 22% (23), food history 27% (28), and recent travel 8.5% (9). 13 patients (12%) had pre-existing inflammatory bowel disease (IBD) and 35 patients (34%) were on a PPI. Examination revealed; fever (>37.5) 35% (35), tachycardia 27% (28) and hypotension in 4% (5) patients. Blood test showed; elevated CRP (>10) in 98% patients [median 81 (IQR 99)], high white cell count (>11) in 12% [median 7.8 (IQR 3.7)] and a raised platelet count (>400) in 5% patients [median 241 (IQR 92)]. Steroids were given to 24 (23%) patients, 9 had pre-existing IBD, mean duration 3 days where as 30 patients (29%) were given a course of antibiotics after the culture results were known. Mean length of stay was 5 days (1 – 30); there were 3 in-patient deaths and no surgical interventions. At 12 months 1 patient was diagnosed with IBD but there were no deaths or episodes of re-infection.
Conclusion Acute onset diarrhoeal symptoms associated with abdominal pain, vomiting, or pr bleed and elevated inflammatory markers especially CRP should raise the suspicion of an infective aetiology even if the patient has pre-existing IBD. One in three patients was noted to have pyrexia but contrary to popular belief a history of travelling or food was not a common occurrence.
Disclosure of Interest None Declared.