Acute diarrhea causes

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Chandrakala Yannam, MD [2] Sudarshana Datta, MD [3]

Overview

Common causes of acute diarrhea in both developing and developed nations are infections. Infectious agents responsible for majority of cases include Norovirus, Salmonella, Shigella, Clostridium perfringens, Staphylococcus aureus, Rotavirus, Shigella, Enterotoxigenic E.coli (ETEC), Campylobacter and Cryptosporidium parvum. Less commonly, acute diarrhea may be be caused by Norwalk viruses or may be associated with systemic infections including influenza, urinary tract infections, and HIV infection. Other common causes of acute diarrhea include food allergies and drug side effects. Less commonly, acute diarrhea can be a symptom in the initial stages of systemic conditions including Ischemic colitis, Hyperthyroidism, Tropical sprue and with disorders of digestion and the absorption process.

Causes

Causes of acute diarrhea based on infectious agents are enlisted below. Common causes of diarrhea differ based on geographical location, food hygiene standards, sanitation, water supply, and the season.

Bacterial causes of diarrhea

• Shigella species ( S.dysentriae, S.flexneri, S.sonneii, S.boydii)
• Vibrio cholerae
• Non-typhoidal Salmonella: S.typhimurium, S.enterica
• Campylobacter jejuni
• Clostridium difficile: Antibiotic associated diarrhea (eg: Amoxicillin with clavulanic acid, Clindamycin, Cephalosporins)
• Yersinia enterocolitica
• Aeromonas
• Sepsis:
  • Staphylococcus aureus (staphylococcal toxic shock syndrome [TSS])
  • Salmonella septicemia
• Hemolytic uraemic syndrome (Shiga toxin producing E. coli ETEC)
• Shigella species
• Clostridium difficile
• Campylobacter jejuni
• Escherichia coli:
  • ETEC
  • EPEC
  • EHEC
  • EIEC
  • EAEC
• Vibrio parahemolyticus
• Aeromonas
• Plesiomonas shigelloides
• Mycobacterium Avium complex
• Bacillus cereus
• Clostridium perfringens
• Listeria monocytogenes

Viral causes of diarrhea

• Rotavirus
• Norovirus
• Adenovirus
• Astrovirus
• Calcivirus
• Influenza virus
• Human immunodeficiency virus
• CMV
• Astrovirus
• Norwalk virus

Protozoa

• Entamoeba histolytica
• Cryptosporidium parvum

• Entamoeba histolytica
• Giardia lamblia
• Microsporidia
• Isospora

Systemic infections

• Sepsis
• Urinary tract infection
• Appendicitis
• Intussusception
• Short bowel syndrome
• Radiation enteritis
• Chemotherapy induced enteritis
• Hyperthyroidism
• Irritable bowel syndrome
• Tropical sprue
• Ischemic colitis
• VIPoma
• Infectious colitis

Disorders of digestive/absorptive processes

• Glucose-galactose malabsorption
• Sucrase-isomaltase deficiency
• Late-onset (adult-type) hypolactasia, leads to lactose intolerance

Medications

• Antibiotics, mostly with Cephalosporins
• Magnesium containing antacids
• Laxatives
• Antiretroviral agents
• Chemotherapeutic agents
• Antifungals
• Digoxin
• Lactulose

Ingestion of plants (eg, hyacinths, daffodils, Amanita species mushrooms)

Food allergies

• Cow's milk protein allergy
• Soy protein allergy

Organophosphate poisoning

Opium withdrawal

Life Threatening Causes

Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.

Acute appendicitis Acute kidney failure Acute pancreatitis Anaphylaxis Angioedema Carbon monoxide poisoning Digoxin toxicity Ergotism

Food poisoning Heavy metal poisoning Herbal extract overdose Infectious diarrhea Inflammatory bowel disease Insect bite allergy Intususception

Ischemic colitis Organophosphate poisoning Pesticide poisoning Pseudomembranous colitis Severe combined immunodeficiency Staphylococcal toxic shock syndrome Waterhouse-Friederichsen syndrome

Common Causes

ACE inhibitors Alcohol intoxication Alcohol withdrawal Amebiasis Anti retroviral agents Antifungals Bacillary dysentery Bacterial toxin Bile acid sequestrant Campylobacter jejuni Cephalosporins Chemotherapeutic agents

Cholestatic jaundice Citalopram Colitis Colorectal polyps Diabetic neuropathy Diverticulitis Doxycycline Entamoeba histolytica Escherichia coli Food poisoning Fosfomycin Helminthiasis Hepatitis A Hepatitis E

Inflammatory bowel disease Lactose intolerance Macrolides Malabsorption syndrome Opioid withdrawal Proton pump inhibitors Pseudomembranous colitis Radiation sickness Salmonellosis Statins Thiazide diuretics Triptans

Causes by Organ System

Cardiovascular	Portal vein thrombosis, superior mesenteric artery syndrome
Chemical / poisoning	Acrodynia, Amlodipine besylate and Atorvastatin calcium trihydrate, acute zinc toxicity, arsenic poisoning, Azacitidine , Cabozantinib carbamate insecticide poisoning, carbon monoxide poisoning, chlordane toxicity, chloroform toxicity, copper toxicity, diazinon poisoning, glutaraldehyde toxicity, heavy metal poisoning, lead poisoning, mercury poisoning, metal fume fever, naphthalene poisoning, organophosphate poisoning, paraquat toxicity, selenium toxicity, thallium toxicity
Dermatologic	Acrodermatitis enteropathica, necrotizing fasciitis
Drug Side Effect	Ambenonium, 2C-B, 5-HT3 antagonist, 5-methoxy-diisopropyl tryptamine, abacavir, Acamprosate calcium, acarbose, acebutolol, Acetylcysteine, acyclovir, acitretin, aconitine, adefovir, afatinib, alatrofloxacin, albendazole, aldesleukin, Alemtuzumab, alendronate, aliskiren, allopurinol, alosetron, alpha-amanitin, alpha-glucosidase inhibitor, alprazolam, altretamine, ambenonium chloride, amifostine, amiloride, aminocaproic acid, aminophylline, amlexanox, amlodipine, Amlodipine besylate and Atorvastatin calcium trihydrate, ammonium lauryl sulfate, amoxicillin, amphetamine, amphotericin B, amprenavir, amitriptyline, anadenanthera peregrina, anagrelide, anakinra, anastrozole, Anidulafungin, anisindione, Apremilast, aprepitant, atazanavir, atenolol, atorvastatin, atovaquone, Atropine, auranofin, azithromycin, aztreonam, bacitracin, baclofen, barium nitrate, barium sulfate, Basiliximab, Benzphetamine, benazepril, bentiromide, bepridil, betaxolol, Bethanechol chloride, bevacizumab, bezafibrate, bicalutamide, biguanide, bisacodyl, bisoprolol, bortezomib, Bosutinib, bromocriptine, brompheniramine, bumetanide, buspirone, busulfan, candesartan, capecitabine, carbamazepine, carbidopa, carboplatin, carvedilol, cefaclor, cefadroxil, cefamandole nafate, cefazolin, cefazolin, cefdinir, Cefditoren, cefepime, Cefixime, cefoperazone, cefotaxime, cefotetan disodium, cefoxitin, cefpodoxime, Cefprozil, Ceftaroline fosamil, ceftazidime, Ceftibuten, ceftizoxime, ceftriaxone, cefuroxime, cephalexin, cephradine, Ceritinib, cerivastatin, cetuximab, cevimeline, Chenodiol, chloral hydrate, chlorambucil, chlordiazepoxide, chlorodyne, chlorothiazide, chlorpheniramine, Chlorpropamide, chlorthalidone, cholestyramine, ciclosporin, cidofovir, cilostazol,, cinacalcet, cisapride, citalopram, cladribine, clamoxyquine, clarithromycin, clavulanic acid, clindamycin, clofarabine, clofibrate, clomipramine, clonazepam, clopidogrel, clorazepate, Conjugated estrogens/bazedoxifene, colchicine, colistimethate, conjugated estrogens, Crizotinib, cyclophosphamide, cyproheptadine, cytarabine, dactinomycin, dalfopristin, dantrolene, daptomycin, darbepoetin alfa, darifenacin, darunavir, dasatinib, daunorubicin, deferasirox, delavirdine, demeclocycline, Denileukin diftitox deracoxib, desoxyn, Dexchlorpheniramine, dextroamphetamine, dextromethorphan, diacerein, diazepam, diclofenac, dicloxacillin, didanosine, diflunisal, digitoxin, digoxin, diltiazem, dipyridamole, dirithromycin, disopyramide, docetaxel, dofetilide, dolasetron, donepezil, doripenem, doxorubicin, doxycycline, DTPA, duloxetine, Ecallantide, eculizumab, efavirenz, Elvitegravir, emtricitabine, Emtricitabine, Rilpivirine Hydrochloride, And Tenofovir Disoproxil Fumarate enalapril, endosulfan, enoxacin, entacapone, Epirubicin hydrochloride, eplerenone, epoetin alfa, ergotamine, erlotinib, Eliglustat, erythromycin, esomeprazole, estazolam, estradiol, ethacrynic acid, ethosuximide, etidronate, etodolac, etoposide, exemestane, exenatide, ezetimibe, famciclovir, famotidine, felbamate, Ferric oxyhydroxide, fexofenadine, floxuridine, foscarnet sodium, fluconazole, flucytosine, fludarabine, fluoride, fluorouracil, fluoxetine, flurazepam, Flurbiprofen, flutamide, fluticasone, fluvastatin, fluvoxamine, fosamprenavir, foscarnet, fosinopril, frovatriptan, fulvestrant, gabapentin, galantamine, ganciclovir, gatifloxacin, gefitinib, gemcitabine, gemeprost, gemfibrozil, glatiramer, Glipizide, Glyburide and Metformin, glycopyrrolate, granisetron, griseofulvin, guanethidine, guanfacine, hydralazine, hydrochlorothiazide, hydroxychloroquine, Hydroxyprogesterone caproate hydroxyurea, hyoscyamine, ibandronate, Ibritumomab Tiuxetan ibuprofen, idarubicin, Idelalisib, Idursulfase, imatinib, Imiglucerase infliximab, interferon alfacon-1 , Interferon alfa-2b , interferon beta-1b, irinotecan hydrochloride, iron supplements, isocarboxazid, isradipine, itraconazole, Ivacaftor, Ivermectin, Ixabepilone, ketoconazole, Ketorolac tromethamine, Lactulose, lamivudine, lamotrigine, lanreotide, lansoprazole, lanthanum,Lapatinib, leflunomide, lenalidomide, letrozole, leuprolide, levalbuterol, levetiracetam, Lenvatinib, levocarnitine, levodopa, levofloxacin, Linaclotide, Lincomycin Hydrochloride, linezolid, liothyronine sodium, lisinopril, lithium, lomefloxacin, lopinavir, loracarbef, loratadine, lorazepam, loxapine, magnesium hydroxide, mebendazole, mechlorethamine, meclofenamate, Mercaptopurine, mefenamic acid, mefloquine, megestrol, Meloxicam, meprobamate, mercaptopurine, meropenem, mesalazine, mesna, mesoridazine, Metirosine, metformin, methamphetamine, methenamine, methotrexate, methoxychlor, methsuximide, methyclothiazide, methylergonovine, methyprylon, metoclopramide, metolachlor, metolazone, metoprolol, metronidazole, Micafungin sodium, miconazole, mifepristone, miglitol, Miglustat, miltefosine minocycline, misoprostol, mitotane, mitoxantrone, moclobemide, modafinil, moexipril, moricizine, moxifloxacin, mycophenolate, nabumetone, nafcillin, naltrexone, naphthalene, naproxen and esomeprazole magnesium, natalizumab, natamycin, nateglinide, nelfinavir, nevirapine, Niacin/simvastatin, niclosamide, Nilotinib, Nintedanib, nizatidine, norfloxacin, nystatin, ofloxacin, Olsalazine, omalizumab, omeprazole, ondansetron, oseltamivir, oxaliplatin, oxazepam, oxcarbazepine, oxtriphylline, oxybutynin, Palbociclib, palivizumab, pancrelipase, Panitumumab, pantoprazole, Paromomycin sulfate, Paroxetine, Pasireotide, pegaspargase, peginterferon alfa-2a, peginterferon alfa-2b, pemetrexed, pemoline, penbutolol, penicillin, pentamidine, pentostatin, pergolide, perindopril, perphenazine, Pertuzumab, phenazopyridine, Phenoxymethylpenicillin, phentermine, pilocarpine, pimecrolimus, pimozide, Pirfenidone, piroxicam, Plerixafor, Potassium iodide, plicamycin, polythiazide, posaconazole, Potassium chloride, Potassium citrate, pramipexole, pramlintide, prazepam, praziquantel, prazosin, procainamide, procarbazine, promethazine, propafenone, propranolol, permethrin, protriptyline, pseudoephedrine, Pyrantel pamoate, pyridostigmine, quinapril, quinidine, quinupristin, rabeprazole, Radium chloride, ramipril, Ramucirumab, ranitidine, rasagiline, Rasburicase, repaglinide, reserpine, retapamulin, ribavirin, rifabutin, rifampin, rilmenidine, riluzole, risedronate, risperidone, ritonavir, rituximab, rivastigmine, rizatriptan, Riluzole, roflumilast, Sacrosidase, salsalate, saquinavir mesylate, Saxagliptin hydrochloride and Metformin hydrochloride sargramostim, Secukinumab, selegiline, sevelamer, sildenafil, Siltuximab, simethicone, simvastatin, sirolimus, sitagliptin, sodium oxybate, sodium picosulfate, sodium polystyrene sulfonate, solanine, solifenacin, sorafenib, sotalol, sparfloxacin, spironolactone, stavudine, streptozocin, sulfadiazine, sulfasalazine, sulfisoxazole, sulfisoxazole, sulindac, sumatriptan, sunitinib, tacrine, Tacrolimus, tamsulosin, tedizolid, tegaserod, telbivudine, telithromycin, telmisartan, temozolomide, teniposide, tenofovir, terbinafine, teriparatide, tetraferric tricitrate decahydrate, Thallous Chloride Tl 201, theophylline, thiabendazole, thioguanine, thioridazine, thiothixene, thyroxine, ticlopidine, Tigecycline, tiludronate, tipranavir, tocopherol, tolcapone, Tolmetin, topiramate, topotecan, Trametinib dimethyl sulfoxide, trandolapril, tranylcypromine, trastuzumab, trazodone, treprostinil, Tretinoin, triamterene, triazolam, trifluoperazine, trihexyphenidyl, trimeprazine, trimethadione, trimethobenzamide, trimetrexate glucuronate, trimipramine, triprolidine, trovafloxacin, valacyclovir, valganciclovir, valproic acid, valsartan, verapamil, Vandetanib, Vilazodone, vinblastine, voriconazole, vorinostat, zanamivir, Zafirlukast, zidovudine, ziprasidone, zoledronic acid, zolmitriptan, Zoledronate
Ear Nose Throat	Otitis media in children
Endocrine	Addison's disease, carcinoid syndrome, diabetes insipidus, diabetic neuropathy, glucagonoma, Graves disease, hyperthyroidism, hypoaldosteronism, multiple endocrine neoplasia type 1 neuroendocrine tumors, somatostatinoma, subacute thyroiditis
Environmental	Abrus precatorious, agastache rugosa, alchornea castaneifolia, amanita phalloides poisoning, amnesic shellfish poisoning, azalea poisoning, bee stings, datura stramonium poisoning, endosulfan toxication, food poisoning, herbal extract overdose, honey intoxication, insect bite allergy, isomalt toxicity, lycorine, marine toxins, mushroom poisoning, narcissus pseudonarcissus, oleander poisoning, pesticide poisoning, phytohaemagglutinin poisoning, phytolacca americana toxicity, ricinus communis poisoning, snakebites, solanine poisoning
Gastroenterologic	Abdominal abscess, abdominal cancer, achlorhydria, acute appendicitis, acute gastritis, bile acid sequestrant, biliary atresia, biliary tract cancer, blind loop syndrome, caecitis, carcinoid syndrome, celiac disease, cholestatic jaundice, colitis, colonic inertia, colonic malakoplakia, colonic villous adenomata, colorectal cancer, colorectal polyps, Crohn's disease, diverticulitis, enteritis, enterocele, enterocolitis, food poisoning, fructose malabsorption, gastric dumping syndrome, gastrinoma, gastritis, gastro-enteropancreatic neuroendocrine tumor, gastroenteritis, gastrointestinal amyloidosis, glucose-galactose malabsorption, gluten sensitivity, Habba syndrome ileitis, inflammatory bowel disease, intestinal lymphangiectasis, intestinal pseudoobstruction, intususception, irritable bowel syndrome, ischemic colitis, lactose intolerance, listeriosis, malabsorption syndrome, malassimilation, Meckel diverticulitis, polyposis, proctitis, protein losing enteropathy, tropical sprue, ulcerative colitis, Whipple's disease, Zollinger-Ellison syndrome
Genetic	3-hydroxyacyl-coenzyme A dehydrogenase deficiency, 3-methylcrotonyl-CoA carboxylase deficiency, abetalipoproteinaemia, Arakawa's syndrome II, aromatic amino acid decarboxylase deficiency, aspartylglycosaminuria, Baber's syndrome, Brown-symmers disease, congenital adrenal hyperplasia, congenital disorder of glycosylation type 1B, congenital intrinsic factor deficiency, congenital short bowel syndrome, congenital toxoplasmosis, Cornelia de Lange syndrome 2, Cronkhite-Canada disease, dibasic aminoaciduria 2, Fabry's disease, familial amyloid polyneuropathy, galactosemia, Gardner's syndrome, Gilbert's syndrome, glutathione synthetase deficiency, Hartnup disease, hereditary angioedema, HNPCC, hyper IgM syndrome, hyperlipoproteinemia type I, inborn amino acid metabolism disorder, juvenile polyposis syndrome, lipoid congenital adrenal hyperplasia, malonic aciduria, malonyl-CoA decarboxylase deficiency, mucopolysaccharidosis, neuroblastoma, neurofibromatosis, Sanfilippo syndrome, Slone's disease, sphingolipidosis, sucrase-isomaltase deficiency, Turcot syndrome, very long-chain acyl-coenzyme A dehydrogenase deficiency, Von Gierke disease, Wiskott-Aldrich syndrome, X-linked agammaglobulinaemia
Hematologic	Amyloidosis, C1 esterase inhibitor, chronic myeloproliferative disorders, hyper IgM syndrome, idiopathic hypereosinophilic syndrome, megaloblastic anemia, myleofibrosis, neutropenia, porphyria Wiskott-Aldrich syndrome, X-linked agammaglobulinaemia
Iatrogenic	Adjustable gastric band, colonoscopy, dumping syndrome, graft versus host disease, percutaneous endoscopic gastrostomy, postileal resection, postvagotomy, radiation proctitis, rectal surgery, radiation sickness, short bowel syndrome, vaccination
Infectious Disease	Adenophorea, adenoviridae, aeromonas hydrophila, AIDS, amebiasis, ancylostoma duodenale, anguillulosis, anthrax, ascariasis, astrovirus, bacillary dysentery, bacillus cereus, bacterial toxin, balantidiasis, beef tapeworm, blastocystis hominis, borrelia anserina, botulism, campylobacter jejuni, candida, capillaria, cestoda, ciguatera poisoning, clostridium difficile, clostridium perfringens, clostridium sordellii, clostridium welchii, coccidia, cryptosporidiosis, cyclosporiasis, cysticercosis, cytomegalovirus, dientamoeba fragilis, diphyllobothrium infection, dipylidium caninum infection, Ebola, echinococcosis, ehrlichiosis, entamoeba histolytica, escherichia coli, fasciolopsiasis, filariasis, flavivirus, fusarium venenatum, giardia lamblia, hantavirus pulmonary syndrome, helminthiasis, hepatitis A, hepatitis B, hepatitis C, hepatitis D, hepatitis E, hepatitis X, hookworm infection, isosporiasis, katayama fever, lassa fever, legionella pneumophila, legionnaires' disease, leptospirosis, lymphogranuloma venereum, malaria, marburg virus, measles, metagonimiasis, mycobacterium avium complex, norwalk gastroenteritis, opisthorchis infection, paragonimus infection, pelvic abscess, pseudomembranous colitis, psittacosis, Q fever, rhabditida, rotavirus, roundworm, salmonellosis, sarcocystis, schistosomiasis, secernentea, shigellosis, small bowel bacterial overgrowth syndrome, staphylococcal food poisoning, staphylococcal toxic shock syndrome, streptobacillus, streptococcal infections, strongyloides, tapeworms, trematoda, trichinella spiralis, trichinosis, trichuriasis, tularemia, typhoid fever, vancomycin, vibrio cholerae, vibrio mimicus, vibrio parahemolyticus, vibrio vulnificus, visceral leishmaniasis, Whipple disease, whipworm infection, yersinia enterocolitica
Musculoskeletal / Ortho	No underlying causes
Neurologic	Common migraine, neuroblastoma, Waterhouse-Friederichsen syndrome
Nutritional / Metabolic	Folate deficiency, food allergies, food intolerances, iron supplements, kwashiorkor, lactose intolerance, milk allergy, pellagra, pernicious anemia, protein losing enteropathy, sucrose intolerance, vitamin C toxicity, zinc deficiency
Obstetric/Gynecologic	Childbirth, endometriosis, neonatal sepsis, ovarian cancer, ovarian hyperstimulation syndrome
Oncologic	Adrenal tumor, carcinoid syndrome, colorectal cancer, Ewing's sarcoma, Gardner's syndrome, gastric cancer, HNPCC, juvenile polyposis syndrome, Kaposi's sarcoma, multiple endocrine neoplasia type 1, neuroendocrine tumors, pancreatic adenoma, peritoneal mesothelioma, neuroendocrine tumors, ovarian cancer, small bowel lymphoma, somatostatinoma, thymus cancer, Vipoma,
Opthalmologic	No underlying causes
Overdose / Toxicity	Carbon monoxide toxicity, carnitine overuse, colchicine toxicity, digoxin toxicity, ergotism, heavy metal ingestion, mazindol
Psychiatric	Anxiety-tension syndrome, chronic fatigue syndrome, dissociative disorder, panic attack
Pulmonary	Anthrax, cystic fibrosis, diffuse systemic sclerosis, legionellosis
Renal / Electrolyte	Acute kidney failure, chronic renal failure, hyperchloremia
Rheum / Immune / Allergy	Acquired angioedema, Amyloidosis, anaphylaxis, autoimmune adrenalitis, autoimmune enteropathy, autoimmune polyendocrine syndrome, autonomic neuropathy, C1 esterase inhibitor, chronic granulomatous disease, complement 5 deficiency, hereditary angioedema, hyper IgM syndrome, Kawasaki disease, Omenn syndrome, Reiter’s syndrome, Satoyoshi syndrome, severe combined immunodeficiency, Wiskott-Aldrich syndrome, X-linked agammaglobulinaemia
Trauma	No underlying causes
Urologic	Proctitis, Reiter’s syndrome
Miscellaneous	Alcohol intoxication, alcohol withdrawal, anopsology

Causes in Alphabetical Order

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