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Gastrointestinal Infections

  • David V. Alcid
Chapter

Abstract

Gastrointestinal infections are common in older adults, but the clinical presentation in the old may be atypical. The elderly have a suboptimal immune system, with a decline in T cell and B cell function, and a reduced T Cell CD28 expression. Proneness to infections is contributed to by decline in gastric acidity often by acid-neutralizing agents or stomach surgery. Infections due to opportunistic pathogens may not be recognized early, as the elderly are not considered immunocompromised. Antibiotics should be used judiciously; dose must be adjusted for renal and hepatic function. While inappropriate or excessive antimicrobial use can result in adverse effects such as Clostridium difficile infection, early empiric antimicrobials are indicated in select situations in older adults. Antibiotics must be used in conjunction with other measures, such as hemodynamic monitoring, fluids, and electrolyte replacement.

Keywords

Clostridium Difficile Infection Hemolytic Uremic Syndrome Liver Abscess Shiga Toxin Gastrointestinal Infection 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    Goronzy JJ, Fulbright JW, Crowson CS, Poland GA, et al. Value of immunological markers in predicting responsiveness to influenza vaccination in elderly individuals. J Virol. 2001;75:12182–7.PubMedCrossRefGoogle Scholar
  2. 2.
    Meyer KC. Aging. Proc Am Thorac Soc. 2005;2:433–9.PubMedCrossRefGoogle Scholar
  3. 3.
    Vergis EN, Brennen C, Wagener M, Muder RR. Pneumonia in long term care: a prospective case control study of risk factors and impact on survival. Arch Intern Med. 2001;161:2378–81.PubMedCrossRefGoogle Scholar
  4. 4.
    Ratnake RN. Diarrhea in old age. In: Pilotto A, Malfertheiner P, Holt PR, editors. Aging and the gastrointestinal tract. New York: Karger; 2003. p. 187–99.CrossRefGoogle Scholar
  5. 5.
    Berman P, Hogan DB, Fox RA. The atypical presentation of infection in old age. Age Aging. 1987;16:201–7.CrossRefGoogle Scholar
  6. 6.
    Leonard J, Marchall JK, Moayyedi P. Systematic review of the risk of enteric infection in patients taking acid suppression. Am J Gastroenterol. 2007;102:2047–56.PubMedCrossRefGoogle Scholar
  7. 7.
    Neal KR, Scott HM, Slack RC, et al. Omeprazole as a risk factor for campylobacter gastroenteritis: case-control study. BMJ. 1996;312(7028):414–5.PubMedCrossRefGoogle Scholar
  8. 8.
    Flores J, Okhuysen PC. Genetics of susceptibility to infection with enteric pathogens. Curr Opin Infect Dis. 2009;22(5):471–6.PubMedCrossRefGoogle Scholar
  9. 9.
    Thielman MN, Guerrant RL. Acute infectious diarrhea. N Engl J Med. 2004;350:38–47.PubMedCrossRefGoogle Scholar
  10. 10.
    DuPont HL. Guidelines on acute infectious diarrhea in adults. Am J Gastroenterol. 1997;92:1962–75.PubMedGoogle Scholar
  11. 11.
    Guerrant RL, Van Gilder T, Steiner TS, et al. Practice guidelines for the management of infectious diarrhea. Clin Infect Dis. 2001;32:331–51.PubMedCrossRefGoogle Scholar
  12. 12.
    Bresee J, Widdowson M, Monroe S, et al. Foodborne viral gastroenteritis: challenges and opportunities. Clin Infect Dis. 2002;35:748–53.PubMedCrossRefGoogle Scholar
  13. 13.
    Bender JB, Smith KE, McNees AA, et al. Emerging Infections Program FoodNet Working Group: Factors affecting surveillance data on Escherichia coli O157 infections collected from FoodNet sites, 1996–1999. Clin Infect Dis. 2004;38 Suppl 3:S157–64.PubMedCrossRefGoogle Scholar
  14. 14.
    Musher DM, Musher BL. Contagious acute gastrointestinal infections. N Engl J Med. 2004;351:2417–27.PubMedCrossRefGoogle Scholar
  15. 15.
    Martin SJ, Yost RJ. Infectious diseases in the critically ill patients. J Pharm Pract. 2011;24(1):35–43.PubMedCrossRefGoogle Scholar
  16. 16.
    Campylobacter Sentinel Surveillance Scheme Collaborators. Ciprofloxacin resistance in Campylobacter jejuni: case-case analysis as a tool for elucidating risks at home and abroad. J Antimicrob Chemother. 2002;50(4):561–8.CrossRefGoogle Scholar
  17. 17.
    Engberg J, Neimann J, Nielsen EM, et al. Quinolone-resistant Campylobacter infections: risk factors and clinical consequences. Emerg Infect Dis. 2004;10:1056–63.PubMedCrossRefGoogle Scholar
  18. 18.
    Kassenborg HD, Smith KE, Vugia DJ, et al. Fluoroquinolone-resistant Campylobacter infections: eating poultry outside of the home and foreign travel are risk factors. Clin Infect Dis. 2004;38 Suppl 3:S279–84.PubMedCrossRefGoogle Scholar
  19. 19.
    Kuschner RA, Trofa AF, Thomas RJ, et al. Use of azithromycin for the treatment of Campylobacter enteritis in travelers to Thailand, an area where ciprofloxacin resistance is prevalent. Clin Infect Dis. 1995;21(3):536–41.PubMedCrossRefGoogle Scholar
  20. 20.
    Muscarella LF. Inconsistencies in endoscope-reprocessing and infection-control guidelines: the importance of endoscope drying. Am J Gastroenterol. 2006;101(9):2147–54.PubMedCrossRefGoogle Scholar
  21. 21.
    Agrawal D, Muscarella LF. Delayed reprocessing of endoscopes. Gastrointest Endosc. 2011;73(4):853–4.PubMedCrossRefGoogle Scholar
  22. 22.
    Chang HG, Tserenpuntsag B, Kacica M, et al. Hemolytic uremic syndrome incidence in New York. Emerg Infect Dis. 2004;10:928–31.PubMedCrossRefGoogle Scholar
  23. 23.
    Ramaswamy V, Cresence VM, Rejitha JS, et al. Listeria—review of epidemiology and pathogenesis. Microbiol Immunol Infect. 2007;40:4–13.Google Scholar
  24. 24.
    Farber JM, Peterkin PI. Listeria monocytogenes, a food-borne pathogen. Microbiol Mol Biol Rev. 1991;55(3):476–511.Google Scholar
  25. 25.
    Kean BH. The diarrhea of travelers to Mexico. Summary of five-year study. Ann Intern Med. 1963;59:605–14.PubMedGoogle Scholar
  26. 26.
    DuPont HL, Ericsson CD. Prevention and treatment of traveler’s diarrhea. N Engl J Med. 1993;328(25):1821–7.PubMedCrossRefGoogle Scholar
  27. 27.
    Tjoa WS, DuPont HL, Sullivan P, et al. Location of food consumption and travelers’ diarrhea. Am J Epidemiol. 1977;v106(1):61–6.Google Scholar
  28. 28.
    Gorbach S, Edelman R. Travelers’ diarrhea: National Institutes of Health Consensus Development Conference. Rev Infect Dis. 1986;8 Suppl 2:S109–233.CrossRefGoogle Scholar
  29. 29.
    Singh E, Redfield D. Prophylaxis for travelers’ diarrhea. Curr Gastroenterol Rep. 2009;11(4):297–300.PubMedCrossRefGoogle Scholar
  30. 30.
    Widdowson MA, Cramer EH, Hadley L, et al. Outbreaks of acute gastroenteritis on cruise ships and on land: identification of a ­predominant circulating strain of Norovirus-United States, 2002. J Infect Dis. 2004;190(1):27–36.PubMedCrossRefGoogle Scholar
  31. 31.
    Drinka PJ. Norovirus outbreaks in nursing homes. J Am Geriatr Soc. 2005;53(10):1839–40.PubMedCrossRefGoogle Scholar
  32. 32.
    Lin H, Ng S, Chan S, et al. Institutional risk factors for norovirus outbreaks in Hong Kong elderly homes: a retrospective cohort study. BMC Public Health. 2011;11:297.PubMedCrossRefGoogle Scholar
  33. 33.
    Lopman BA, Reacher MH, Vipond IB, et al. Clinical manifestation of norovirus gastroenteritis in heath care settings. Clin Infect Dis. 2004;39(3):318–24.PubMedCrossRefGoogle Scholar
  34. 34.
    Wu HM, Fornek M, Schwab KJ, et al. A norovirus outbreak at a long-term-care facility: the role of environmental surface contamination. Infect Control Hosp Epidemiol. 2005;26(10):802–10.PubMedCrossRefGoogle Scholar
  35. 35.
    White Jr AC. Cryptosporidiosis (Cryptosporidium hominis, Cryptosporidium parvum, other species). In: Mandell GL, Bennett JE, Dolin R, editors. Principles and practice of infectious diseases. 6th ed. Philadelphia: Elsevier Churchill Livingstone; 2005. p. 3215–28.Google Scholar
  36. 36.
    MacKenzie WR, Hoxie NJ, Proctor ME, et al. A massive outbreak of cryptosporidium infection transmitted through the public water supply. N Engl J Med. 1994;331:161–7.CrossRefGoogle Scholar
  37. 37.
    Chappell CL, Okhuysen PC, Sterling CR, et al. Infectivity of Cryptosporidium parvum in healthy adults with pre-existing anti-C. parvum serum IgG. Am J Trop Med Hyg. 1999;60:157–64.PubMedGoogle Scholar
  38. 38.
    Neill MA, Rice SK, Ahmad NV, Flanigan TP. Cryptosporidiosis: an unrecognized cause of diarrhea in elderly hospitalized patients. Clin Infect Dis. 1996;22:168–70.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  1. 1.Department of MedicineSaint Peter’s University HospitalNew BrunswickUSA

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