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Small Intestinal Infections

  • Small Intestine (D Sachar, Section Editor)
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Abstract

Small intestinal infections are extremely common worldwide. They may be bacterial, viral, or parasitic in etiology. Most are foodborne or waterborne, with specific etiologies differing by region and with diverse pathophysiologies. Very young, very old, and immune-deficient individuals are the most vulnerable to morbidity or mortality from small intestinal infections. There have been significant advances in diagnostic sophistication with the development and early application of molecular diagnostic assays, though these tests have not become mainstream. The lack of rapid diagnoses combined with the self-limited nature of small intestinal infections has hampered the development of specific and effective treatments other than oral rehydration. Antibiotics are not indicated in the absence of an etiologic diagnosis, and not at all in the case of some infections.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. Guerrant RL, Kosek M, Lima AAM, Lorntz B, Guyatt HL. Updating the DALYs for diarrhoeal disease. Trends Parasitol. 2002;18(5):191–3.

    Article  PubMed  Google Scholar 

  2. Checkley W, Buckley G, Gilman RH, et al. Multi-country analysis of the effects of diarrhoea on childhood stunting. Int J Epidemiol. 2008;37(4):816–30. doi:10.1093/ije/dyn099.

    Article  PubMed  PubMed Central  Google Scholar 

  3. CDC National Health report: leading causes of morbidity and mortality and associated behavioral risk and protective factors—United States, 2005–2013. http://www.cdc.gov/mmwr/preview/mmwrhtml/su6304a2.htm. Accessed 6 Jan 2016.

  4. Network S, Sites US. Morbidity and Mortality Weekly Report ( MMWR ) Incidence and trends of infection with pathogens transmitted commonly through food—foodborne diseases active. 2015;914:1–7.

  5. Preliminary incidence and trends of infection with pathogens transmitted commonly through food—foodborne diseases active surveillance network, 10 U.S. Sites, 2006–2014. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6418a4.htm. Accessed 7 Jan 2016. Good review on trends in foodborne illnesses.

  6. CDC vital signs 2015. http://www.cdc.gov/vitalsigns/pdf/2015-11-vitalsigns.pdf. Accessed 7 Jan 2016.

  7. Kelly C. Food poisoning. Chapter 111 Sleisenger and Fordtran’s gastrointestinal and liver disease: pathophysiology/diagnosis/management. 10th edition.

  8. Popoff MR. Multifaceted interactions of bacterial toxins with the gastrointestinal mucosa. Future Microbiol. 2011;6(7):763–97. doi:10.2217/fmb.11.58.

    Article  CAS  PubMed  Google Scholar 

  9. Dasti JI, Tareen AM, Lugert R, Zautner AE, Gross U. Campylobacter jejuni: a brief overview on pathogenicity-associated factors and disease-mediating mechanisms. Int J Med Microbiol. 2010;300(4):205–11. doi:10.1016/j.ijmm.2009.07.002.

    Article  CAS  PubMed  Google Scholar 

  10. de Jong HK, Parry CM, van der Poll T, Wiersinga WJ. Host-pathogen interaction in invasive Salmonellosis. PLoS Pathog. 2012;8(10), e1002933. doi:10.1371/journal.ppat.1002933.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Yuki N, Hartung H-P. Guillain-Barré syndrome. N Engl J Med. 2012;366(24):2294–304. doi:10.1056/NEJMra1114525.

    Article  CAS  PubMed  Google Scholar 

  12. Scallan E, Griffin PM, Angulo FJ, Tauxe RV, Hoekstra RM. Foodborne illness acquired in the United States—unspecified agents. Emerg Infect Dis. 2011;17(1):16–22. doi:10.3201/eid1701.091101p2. Very good review on epidemiology of foodborne illnesses.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Slutsker L, Ries AA, Greene KD, Wells JG, Hutwagner L, Griffin PM. Escherichia coli O157:H7 diarrhea in the United States: clinical and epidemiologic features. Ann Intern Med. 1997;126(7):505–513. http://www.ncbi.nlm.nih.gov/pubmed/9092315. Accessed 7 Jan 2016.

  14. Norovirus | U.S. Trends and Outbreaks | CDC. http://www.cdc.gov/norovirus/trends-outbreaks.html. Accessed 7 Jan 2016.

  15. Cortes JE, Curns AT, Tate JE, et al. Rotavirus vaccine and health care utilization for diarrhea in U.S. Children. N Engl J Med. 2011;365(12):1108–17. doi:10.1056/NEJMoa1000446.

    Article  CAS  PubMed  Google Scholar 

  16. Gastañaduy P a, Curns AT, Parashar UD, Lopman B a. Gastroenteritis hospitalizations in older children and adults in the United States before and after implementation of infant rotavirus vaccination. JAMA. 2013;310(8):851–3. doi:10.1001/jama.2013.170800.

    Article  PubMed  Google Scholar 

  17. Lopman B. Global burden of norovirus and prospects for vaccine development.

  18. Future directions for research on enterotoxigenic Escherichia coli vaccines for developing countries. Relev épidémiologique Hebd / Sect d’hygiène du Secrétariat la Société des Nations = Wkly Epidemiol Rec / Heal Sect Secr Leag Nations. 2006;81(11):97–104. http://www.ncbi.nlm.nih.gov/pubmed/16671213. Accessed 8 Jan 2016.

  19. Ahmed T, Bhuiyan TR, Zaman K, Sinclair D, Qadri F. Vaccines for preventing enterotoxigenic Escherichia coli (ETEC) diarrhoea. Cochrane Database Syst Rev. 2013;7(7), CD009029. doi:10.1002/14651858.CD009029.pub2.

    PubMed  Google Scholar 

  20. Foodborne Diseases Active Surveillance Network (FoodNet). Emerg Infect Dis. 2012;3:581–583.

  21. Muniesa M, Hammerl JA, Hertwig S, Appel B, Brüssow H. Shiga toxin-producing Escherichia coli O104:H4: a new challenge for microbiology. Appl Environ Microbiol. 2012;78(12):4065–73. doi:10.1128/AEM.00217-12.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. CDC—Campylobacter, technical information—NCZVED. http://www.cdc.gov/nczved/divisions/dfbmd/diseases/Campylobacter/technical.html. Accessed 8 Jan 2016.

  23. FoodNet 2012 Surveillance Report. http://www.cdc.gov/foodnet/PDFs/2012_annual_report_508c.pdf. Accessed 7 Jan 2016.

  24. Epps SVR, Harvey RB, Hume ME, Phillips TD, Anderson RC, Nisbet DJ. Foodborne Campylobacter: Infections, metabolism, pathogenesis and reservoirs. Int J Environ Res Public Health. 2013;10(12):6292–304. doi:10.3390/ijerph10126292.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Incidence and trends of infection with pathogens transmitted commonly through food—Foodborne Diseases Active Surveillance Network, 10 U.S. sites, 1996–2012. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6215a2.htm. Accessed 6 Jan 2016.

  26. Multistate Outbreak of Salmonella Poona Infections Linked to Imported Cucumbers | Multistate Outbreak of Salmonella Poona Infections Linked to Imported Cucumbers | September 2015 | Salmonella | CDC. http://www.cdc.gov/Salmonella/poona-09-15/. Accessed 8 Jan 2016.

  27. Grass JE, Gould LH, Mahon BE. Epidemiology of foodborne disease outbreaks caused by Clostridium perfringens, United States, 1998–2010. Foodborne Pathog Dis. 2013;10(2):131–6. doi:10.1089/fpd.2012.1316.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Loharikar A, Newton AE, Stroika S, et al. Cholera in the United States, 2001–2011: a reflection of patterns of global epidemiology and travel. Epidemiol Infect. 2015;143(4):695–703. doi:10.1017/S0950268814001186.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Liu L, Johnson HL, Cousens S, et al. Global, regional, and national causes of child mortality: an updated systematic analysis for 2010 with time trends since 2000. Lancet. 2012;379(9832):2151–61. doi:10.1016/S0140-6736(12)60560-1.

    Article  PubMed  Google Scholar 

  30. Chen WH, Greenberg RN, Pasetti MF, et al. Safety and immunogenicity of single-dose live oral cholera vaccine strain CVD 103-HgR, Prepared from new master and working cell banks. Clin Vaccine Immunol. 2014;21(1):66–73. doi:10.1128/CVI.00601-13.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Cholera | PaxVax—socially responsible vaccines. http://paxvax.com/cholera. Accessed 8 Jan 2016.

  32. Collier SA, Stockman LJ, Hicks LA, Garrison LE, Zhou FJ, Beach MJ. Direct healthcare costs of selected diseases primarily or partially transmitted by water. Epidemiol Infect. 2012;140(11):2003–13. doi:10.1017/S0950268811002858.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. Painter JE, Gargano JW, Collier SA, Yoder JS. Giardiasis surveillance—United States, 2011–2012. MMWR Surveill Summ. 2015;64 Suppl 3:15–25. http://www.ncbi.nlm.nih.gov/pubmed/25928582. Accessed 8 Jan 2016.

  34. Painter JE, Gargano JW, Collier SA, Yoder JS. Morbidity and mortality weekly report (MMWR) Giardiasis Surveillance—United States , 2011 – 2012. 2015:2011–2012.

  35. Buss BF, Joshi MV, O’Keefe AL, et al. Regional investigation of a cyclosporiasis outbreak linked to imported romaine lettuce—Nebraska and Iowa, June–August 2013. Epidemiol Infect. 2013;2015:1–11. doi:10.1017/S0950268815002484.

    Google Scholar 

  36. Outbreaks of cyclosporiasis—United States. MMWR Morb Mortal Wkly Rep. 2013;62(43):862. http://www.ncbi.nlm.nih.gov/pubmed/24172881. Accessed January 8, 2016.

  37. Turkeltaub JA, McCarty TR, Hotez PJ. The intestinal protozoa: emerging impact on global health and development. Curr Opin Gastroenterol. 2015;31(1):38–44. doi:10.1097/MOG.0000000000000135.

    Article  PubMed  Google Scholar 

  38. Reddington K, Tuite N, Minogue E, Barry T. A current overview of commercially available nucleic acid diagnostics approaches to detect and identify human gastroenteritis pathogens. Biomol Detect Quantif. 2014;1(1):3–7. doi:10.1016/j.bdq.2014.07.001. Good review on current molecular panels.

    Article  Google Scholar 

  39. Binnicker MJ. Multiplex molecular panels for the diagnosis of gastrointestinal infection: performance, result interpretation and cost-effectiveness. J Clin Microbiol. 2015. doi:10.1128/JCM.02103-15. Another good review on the utility and cost effectiveness of molecular panels.

    Google Scholar 

  40. Rand KH, Tremblay EE, Hoidal M, Fisher LB, Grau KR, Karst SM. Multiplex gastrointestinal pathogen panels: implications for infection control ☆. Diagn Microbiol Infect Dis. 2015;82(2):1–4. doi:10.1016/j.diagmicrobio.2015.01.007.

    Article  Google Scholar 

  41. Goldenberg SD, Bacelar M, Brazier P, Bisnauthsing K, Edgeworth JD. A cost benefit analysis of the Luminex xTAG Gastrointestinal Pathogen Panel for detection of infectious gastroenteritis in hospitalised patients. J Infect. 2014;44(5):504–11. doi:10.1016/j.jinf.2014.11.009.

    Google Scholar 

  42. Baron EJ, Miller JM, Weinstein MP, et al. A guide to utilization of the microbiology laboratory for diagnosis of infectious diseases: 2013 recommendations by the Infectious Diseases Society of America (IDSA) and the American Society for Microbiology (ASM)(a). Clin Infect Dis. 2013;57(4):e22–121. doi:10.1093/cid/cit278. Good review on recommended work-up for small intestinal infections -- including commonly available tests and how to order them.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Thomson ABR, Chopra A, Clandinin MT, Freeman H. Recent advances in small bowel diseases: part I. World J Gastroenterol. 2012;18(26):3336–52. doi:10.3748/wjg.v18.i26.3336. Evaluates recent advances in basic sciences in small intestinal disease and their clinical application.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Thiagarajah JR, Donowitz M, Verkman AS. Secretory diarrhoea: mechanisms and emerging therapies. Nat Rev Gastroenterol Hepatol. 2015;12(8):446–57. doi:10.1038/nrgastro.2015.111. Good review on pathophysiology of infectious diarrhea and emerging therapies.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Lee KJ. Pharmacologic agents for chronic diarrhea. Intest Res. 2015;13(4):306–12. doi:10.5217/ir.2015.13.4.306.

    Article  PubMed  PubMed Central  Google Scholar 

  46. Switaj TL, Winter KJ, Christensen SR. Diagnosis and management of foodborne illness. Am Fam Physician. 2015;92(5):358–365. http://www.ncbi.nlm.nih.gov/pubmed/26371569. Accessed 1 Feb 2016.

  47. Ooi ST, Lorber B. Gastroenteritis due to Listeria monocytogenes. Clin Infect Dis. 2005;40(9):1327–32. doi:10.1086/429324.

    Article  PubMed  Google Scholar 

  48. Büla CJ, Bille J, Glauser MP. An epidemic of food-borne listeriosis in western Switzerland: description of 57 cases involving adults. Clin Infect Dis. 1995;20(1):66–72. http://www.ncbi.nlm.nih.gov/pubmed/7727673. Accessed 1 Feb 2016.

  49. Bassily S, Farid Z, el-Masry NA, Mikhail EM. Treatment of intestinal E. histolytica and G. lamblia with metronidazole, tinidazole and ornidazole: a comparative study. J Trop Med Hyg. 1987;90(1):9–12. http://www.ncbi.nlm.nih.gov/pubmed/3546716. Accessed 1 Feb. 2016.

  50. Rossignol JF, Ayoub A, Ayers MS. Treatment of diarrhea caused by Giardia intestinalis and Entamoeba histolytica or E. dispar: a randomized, double-blind, placebo-controlled study of nitazoxanide. J Infect Dis. 2001;184(3):381–4. doi:10.1086/322038.

    Article  CAS  PubMed  Google Scholar 

  51. Amadi B, Mwiya M, Musuku J, et al. Effect of nitazoxanide on morbidity and mortality in Zambian children with cryptosporidiosis: a randomised controlled trial. Lancet (Lond, Engl). 2002;360(9343):1375–80. doi:10.1016/S0140-6736(02)11401-2.

    Article  Google Scholar 

  52. Fischer TK, Bresee JS, Glass RI. Rotavirus vaccines and the prevention of hospital-acquired diarrhea in children. Vaccine. 2004;22 Suppl 1:S49–54. doi:10.1016/j.vaccine.2004.08.017.

    Article  CAS  PubMed  Google Scholar 

  53. Wikswo ME, Hall AJ. Outbreaks of acute gastroenteritis transmitted by person-to-person contact—United States, 2009–2010. MMWR Surveill Summ. 2012;61(9):1–12. http://www.ncbi.nlm.nih.gov/pubmed/23235338. Accessed 8 Jan 2016.

  54. Kovaleva J, Peters FTM, van der Mei HC, Degener JE. Transmission of infection by flexible gastrointestinal endoscopy and bronchoscopy. Clin Microbiol Rev. 2013;26(2):231–54. doi:10.1128/CMR.00085-12.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  55. Notes from the field: New Delhi metallo-β-lactamase-producing Escherichia coli associated with endoscopic retrograde cholangiopancreatography—Illinois, 2013. MMWR Morb Mortal Wkly Rep. 2014;62(51–52):1051. http://www.ncbi.nlm.nih.gov/pubmed/24381080. Accessed 8 Jan 2016.

  56. Killeen S, Martin ST, Hyland J, O’ Connell PR, Winter DC. Clostridium difficile enteritis: a new role for an old foe. Surgery. 2014;12(5):256–62. doi:10.1016/j.surge.2014.01.008. Review on small intestinal C. difficile.

    CAS  Google Scholar 

  57. Steffen R, Hill DR, DuPont HL. Traveler’s diarrhea: a clinical review. JAMA. 2015;313(1):71–80. doi:10.1001/jama.2014.17006. A very good account of traveler’s diarrhea.

    Article  CAS  PubMed  Google Scholar 

  58. Zboromyrska Y, Hurtado JC, Salvador P, et al. Aetiology of traveller’s diarrhoea: evaluation of a multiplex PCR tool to detect different enteropathogens. Clin Microbiol Infect. 2014;20(10):O753–9. doi:10.1111/1469-0691.12621.

    Article  CAS  PubMed  Google Scholar 

  59. DuPont HL. Review article: the antimicrobial effects of rifaximin on the gut microbiota. Aliment Pharmacol Ther. 2016;43 Suppl 1:3–10. doi:10.1111/apt.13434.

    Article  CAS  PubMed  Google Scholar 

  60. Patel R, DuPont HL. New approaches for bacteriotherapy: prebiotics, new-generation probiotics, and synbiotics. Clin Infect Dis. 2015;60 Suppl 2:S108–21. doi:10.1093/cid/civ177. Review on the current status of probiotics.

    Article  PubMed  PubMed Central  Google Scholar 

  61. Cello JP, Day LW. Idiopathic AIDS enteropathy and treatment of gastrointestinal opportunistic pathogens. Gastroenterology. 2009;136(6):1952–65. doi:10.1053/j.gastro.2008.12.073. Good review of AIDS-related small intestinal infections.

    Article  CAS  PubMed  Google Scholar 

  62. Brenchley JM, Douek DC. HIV infection and the gastrointestinal immune system. Mucosal Immunol. 2008;1(1):23–30. doi:10.1038/mi.2007.1.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  63. Krones E, Högenauer C. Diarrhea in the immunocompromised patient. Gastroenterol Clin N Am. 2012;41(3):677–701. doi:10.1016/j.gtc.2012.06.009. Good review on all-cause diarrhea in immunocompramised patients.

    Article  Google Scholar 

  64. Lawlor G, Moss AC. Cytomegalovirus in inflammatory bowel disease: pathogen or innocent bystander? Inflamm Bowel Dis. 2010;16(9):1620–7. doi:10.1002/ibd.21275.

    Article  PubMed  Google Scholar 

  65. Bhaijee F, Subramony C, Tang S-J, Pepper DJ. Human immunodeficiency virus-associated gastrointestinal disease: common endoscopic biopsy diagnoses. Pathol Res Int. 2011;2011:247923. doi:10.4061/2011/247923.

    Article  Google Scholar 

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  1. Department of Medicine and Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, Mount Sinai St. Luke’s and Mount Sinai West Hospitals, New York, NY, USA

    Khushboo Munot & Donald P. Kotler

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Munot, K., Kotler, D.P. Small Intestinal Infections. Curr Gastroenterol Rep 18, 31 (2016). https://doi.org/10.1007/s11894-016-0502-4

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