Background: Infectious diarrhea is the most common cause of diarrhea worldwide and
is responsible for more deaths than other gastrointestinal tract diseases such as gastrointestinal cancers,
peptic ulcer disease or inflammatory bowel disease. Diarrheal disease still represents the 8th
leading cause of death worldwide, with more than 1,6 million attributed fatalities in 2016 alone.
The majority of cases can be divided into three principal clinical presentations: acute watery diarrhea
lasting 5-10 days and normally self-limiting, bloody diarrhea (dysentery), and persistent diarrhea
with or without intestinal malabsorption.
Methods: We performed an electronic search on PUBMED of the scientific literature concerning
infectious diarrhea and its clinical management.
Aim: In this review article, we analyze the most important causes of infectious diarrhea and their
constellation of signs and symptoms, providing an update on the diagnostic tools available in today’s
practice and on the different treatment options.
Conclusion: Even though the majority of intestinal infections are self-limiting in immunocompetent
individuals, specific diagnosis and identification of the causative agent remain crucial from
public health and epidemiological perspectives. Specific diagnostic investigation can be reserved
for patients with severe dehydration, more severe illness, persistent fever, bloody stools, immunosuppression,
and for cases of suspected nosocomial infection or outbreak and it includes complete
blood count, creatinine and electrolytes evaluation, determination of leukocytes and lactoferrin
presence in the stools, stool culture, together with C. difficile testing, PCR, ova and parasites'
search, endoscopy and abdominal imaging. Since acute diarrhea is most often self-limited and
caused by viruses, routine antibiotic use is not recommended for most adults with mild, watery diarrhea.
However, when used appropriately, antibiotics are effective against shigellosis, campylobacteriosis,
C. difficile colitis, traveler’s diarrhea, and protozoal infections. Furthermore, antibiotics use
should be considered in patients who are older than 65 years, immunocompromised, severely ill, or