Infectious Diarrhoeas in the Elderly

  • Nages Nagaratnam
  • Kujan Nagaratnam
  • Gary Cheuk
Reference work entry

Abstract

Diarrhoea can be mild or severe in the elderly and severe diarrhoea in the elderly can be life-threatening. Clostridium difficile is the most common cause of nosocomial diarrhoea and disproportionally affects the elderly and in those above the age of 65 years and remains a disease of the elderly. The elderly are at increased risk of dying from dehydration and electrolyte abnormalities and impaired mobility and are frequently institutionalised. The present review summarises the infectious diarrhoeas with the main focus on Clostridium difficile and management.

Keywords

Diarrhoeas in the elderly Clostridium difficile Salmonella Heidelberg Campylobacter jejuni Cryptosporidium 

References

  1. 1.
    Faruque ASG, Malik RI, Kahu AI, Huq S, Salam MA, Sak SD, et al. Diarrhoea in elderly population: aetiology and clinical characteristics. Scand J. 1991;265:3280–4.Google Scholar
  2. 2.
    Lew JF, Glass RI, Gangarosa RE, Cohen IP, Bern C, Moe CL, et al. Diarrhoeal deaths in the United States 1979 through 1987. A special problem for the elderly. JAMA. 1991;265:3280–4.CrossRefPubMedGoogle Scholar
  3. 3.
    Hoffman J, Zeitz. Small bowel disease in the elderly:diarrhoea and malabsorption.. Best Practice & Res Clin Gastroenterol. Vol 16 Issue 1 pp 17–36 (abstract) Website: http://benkinghub.elsevier.com.retrieve/pii/S152169180 2902635.
  4. 4.
    Bennett RG, Greenough WB. Approach to acute diarrhoea in the elderly. Gastrenterol Clin North Am. 1993;22:517–33.Google Scholar
  5. 5.
    Layton MC, Calliste SG, Gomez TM, Patton C, Brooks S. A mixed foodborne outbreak with Salmonella heidelberg and Campylobacter jejuni in a nursing home. Infect Control Hosp Epidemiol. 1997;18:115–21.CrossRefPubMedGoogle Scholar
  6. 6.
    Villalobos-Zuniga MA, Boza-Cordero R. Epidemiologic, clinical and microbiologic description of an outbreak of Clostridium difficile associated diarrhoea in Costa Rica. Acta med.costarric. 2012;54(3):Jul/Sep. 2012.Google Scholar
  7. 7.
    Bennett RG. Diarrhoea among residents of long-term care facilities. Infect Control Hosp Epidemiol. 1993;14:397–404.CrossRefPubMedGoogle Scholar
  8. 8.
    Neill MA, Rice SK, Ahmad NV, Flanigan TO. Cryptosporodiosis: an unrecognised cause of diarrhoea in elderly hospitalised patients. Clin Infect Dis 1996;22:168–70.CrossRefPubMedGoogle Scholar
  9. 9.
    Olives JP, Mas E. Viral acute diarrhoea, clinical and evaluative aspects. Arch Pediatr 2007;14 Suppl 3-S152–5.CrossRefPubMedGoogle Scholar
  10. 10.
    Ratnaike RN, Jones TE. Mechanisms of drug-induced diarrhoea in the elderly. Drugs and Aging 1998;13:245–253.CrossRefPubMedGoogle Scholar
  11. 11.
    Jagai JY, Naumova E. Closridium difficile –associated infection, diarrhoea and colitis. United States Emerg Infect Dis. 2009;15:343–344.CrossRefPubMedGoogle Scholar
  12. 12.
    Digg NG, Surawicz CM. Clostridium difficile infection: still principally a disease of the elderly. Review. Future Medicine. Therapy. 2010;7(3);295–301.Google Scholar
  13. 13.
    Jump RLP. Clostridium difficile infection in older adults. Aging Health.2013;9(4):403–414.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Mcdonald LC, Killgore GE, Thompson A, et al. An epidemic, toxin gene-variant strain of Clostridium difficile. NEJM. 2005;353(23):2433–2441.CrossRefPubMedGoogle Scholar
  15. 15.
    Loo VG, Poirier L, Miller MA, et al. A predominantly clonal multi-institutional outbreak of Clostridium difficile- associated diarrhoea with high morbidity and mortality. NEJM. 2005;353(23):2442–2449.CrossRefPubMedGoogle Scholar
  16. 16.
    Warny M, Pein J, Fang A, Killgore G, Thompson A, Brazier J, et al. Toxin production by an emerging strain of Clostridium difficile associated disease in North America ad Europe. Lancet. 2005;366(9491):1079–1084.CrossRefPubMedGoogle Scholar
  17. 17.
    Cober ED, Malani PN.Clostridium difficile infection in the “oldest”old:cinical outcomes in patients aged 80 years and older. J AmerGeriatr Soc. 2009;57(4):659–662.CrossRefGoogle Scholar
  18. 18.
    Zilberberg MD, Short AF, Micek ST, Doherty JA, Kollef MH. Clostridium difficile- associated disease and mortality among the elderly critically ill. Crit Care Med. 2009;37(9):2583–2589.CrossRefPubMedGoogle Scholar
  19. 19.
    Garey KW, Sethi S, Yadav Y, Dupont HL. Meta-analysis to assess risk factors for recurrent Clostridium difficile infection. J Hosp Infect. 2008;70(4):298–304.CrossRefPubMedGoogle Scholar
  20. 20.
    Dumyati G, Stevens V, Hannett GE, et al. Community-associated Clostridium difficile infections, Montoe County, New York, USA. Emerg Infect Dis. 2012;18:392–400.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Khanna S, Pardi DS, Aronon SL, et al. The epidemiology of community-acquired Clostridium difficile infection: a population basedstudy. Am J Gastroenterol. 2012;107:89–95.CrossRefPubMedGoogle Scholar
  22. 22.
    Nelson R. Antibiotic treatment for cLostridium difficile-associated diarrhea in adults. 2007.Cochrane Database Syst, Rev 3, CD004610.Google Scholar
  23. 23.
    Leonard J, Marshall JK, Moayyedi P. Systematic review of the risk ofenteric infection in patients taking acid suppression. Am J Gastrenterol. 2007;102(9):2047–2056.CrossRefGoogle Scholar
  24. 24.
    Dial S, Delaney JA, Barkun AN, Suisa S. Use of gastric acid-suppressive agents and the risk of community-acquired Clostridium difficile – associated disease. JAMA. 2005;294:2989–2995.CrossRefPubMedGoogle Scholar
  25. 25.
    Tleyjeh IM, Abdulhak AA, Raiz M, et al. The association between histamine 2 receptor antagonist use and Clostridium difficile infection: a systematic review and meta-analysis. PLoS ONE8. e56498. 2013.Google Scholar
  26. 26.
    Laffan AM, Bellantoni MF, Greenough WB III,Zenilman JM. Burden of Clostridium in a lon-term care facility. J Am Geriatr Soc. 2006;54(7):1068–1073.CrossRefPubMedGoogle Scholar
  27. 27.
    Ratnaike RN. Diarrhoea in the elderly. Epidemiological and aetiologicsl features. J Gastrenterol Hepatol. 1990;449–458.Google Scholar
  28. 28.
    Whyte LA, Jenkins HR. Pathophysiology of diarrhoea. Paed Child Health. 2012; 22:443–447.CrossRefGoogle Scholar
  29. 29.
    Binder HJ. Pathophysiology of acute diarrhoea. Am J Med. 1990;88(6A): 25–45.Google Scholar
  30. 30.
    Website. Pathology of diarrhoea. http://www.vivo.colostate.edu/hbooks/pathphys/digestion/smallgut/diarrhoea.html retreived 9 January 2015.
  31. 31.
    Dundas S, Todd WTA. Acute diarrhoea and fever. General Medical Review CME. http://www.rcpe.ac.uk/education/education/CME/infect-dis/dundas/dundas_2.html
  32. 32.
    Wilhelmi I, Roman E, Sanchez-Farquier A. Viruses causing gastroenteritis. Clin Microbiol Infect. 2003;(4):247–62.Google Scholar
  33. 33.
    Pentland B, Pennington CR The diarrhoeas in the elderly. Age Aging .1980;9(2):90–92. 1980CrossRefGoogle Scholar
  34. 34.
    Jeandel C, Laurain MC, Decottignies F. Infectious diarrhoea in the aged. Rev Prat.1996;146(2):184–8 .Google Scholar
  35. 35.
    Kirk MD, Veitch MG, Hall GV. Gastroenteritis and foodborne diseases in elderly people living in long term care. J Roy Soc Trop Med Hyg. 2010;51:397–404.Google Scholar
  36. 36.
    Chen PL, Lee HC, Lee NY et al. Non-typhoidal samolnella bacteria in elderly patients: an increased risk of endovascular infections, osteomyelitis and mortality. Epidemiol infect.2012;140(10):2037–44.CrossRefPubMedGoogle Scholar
  37. 37.
    Pereira AA. Salmonella bacterium may present vascular infections in the form aneurysm. Dynamics 2006;17(4):16–8.PubMedGoogle Scholar
  38. 38.
    Chen PL, Chan CM, Wu CJ, et al. Extraintestinal focal infections in adults with nontyphoidal salmonella bacteria: predisposing factors and clinical outcome. J Intern Med. 2007;61(1):91–100.CrossRefGoogle Scholar
  39. 39.
    Strausbaugh LJ. Emerging Health Care-Associated Infectios in the Geriatric Population. Emerg Infect Dis. 2001;7(2):268–271.CrossRefPubMedPubMedCentralGoogle Scholar
  40. 40.
    Maroo S, Lamoot JT. Recurrent Clostridium difficile. Gastroenterology. 2006;130(4):1311–1316.CrossRefPubMedGoogle Scholar
  41. 41.
    Dupont HL. Diagnosis and management of Clostridium difficile infection. Clin Gastrenterol Hepatol. 2013;11(10):1216–23.CrossRefGoogle Scholar
  42. 42.
    Bartlett JG, Gerding DN. Clinical recognition and diagnosis of Clostridium difficile infection. Clin Infect Dis. 2008;46(suppl 7):S12–S18.CrossRefPubMedGoogle Scholar
  43. 43.
    George WL, Suttert L, Citron D, Fiinegold SM. Selected and differential medium for isolation of Clostridium difficile. J Clin Microbiol. 1978;9:214–9.Google Scholar
  44. 44.
    Riley TV, Cooper M, Bell B, Golledge CL. Commuity-acquired Clostridium difficile-associated diarrhoea. Clin Infect Dis. 1995;28(sup 2):263–5.CrossRefGoogle Scholar
  45. 45.
    Davis TK, Mckee R, Schnadower D, Tarr P. Treatment of Shiga toxin producing Escheri coli infection. Inf Dis Clin Natl Ass. 2013;27(3):577–597.CrossRefGoogle Scholar
  46. 46.
    Blaser MJ, Wells JG, Feldman PA, Pollard RA, Allen JR, The Collaorative Diarrhoea Diseases Study Group Centre in the United States: a multicentre study. Ann Inter Med. 1983:98:360–5.CrossRefGoogle Scholar
  47. 47.
    Acheson D, Allos M. Campylobacter jejuni infections. Update on emergency issues and trends. Clin Inf Dis. 2001;32(5):1201–1206.CrossRefGoogle Scholar
  48. 48.
    Nachamkin I, Szymanski CM, Blaser MJ. Campylobacter. 3rd ed. ASM Press, American Society for Microbiology. Washington, DC. 2008.Google Scholar
  49. 49.
    Rees JM, Sondam SE, Gregson NA, Hughes RAC. Campylobacter jejuni and Guillan-Barre syndrome. NEJM. 1995;333:1374–1379.CrossRefPubMedGoogle Scholar
  50. 50.
    Niyogi SK. Shigellosis. J Microbiol. 2005;43(2):133–43.PubMedGoogle Scholar
  51. 51.
    Gerok W. Pathophysiology of chronic diarrhoea. Praxis (Bern 1994). 2000;89(41):1635–41.Google Scholar
  52. 52.
    Dryden MS, Gabb RJ, Wright SK. Emphirical treatment of severe acute community-acquired gastroenteritis with ciprofloxacin. Clin Infect Dis.1996;22: 1019–25.CrossRefPubMedGoogle Scholar
  53. 53.
    Sirinavin S, Garner P. Antibiotics for treating salmonella gut infections. Cochrane Database Syst Rev. 2000(2):D001 167.Google Scholar
  54. 54.
    Cohen SH, Gerdong DN, Johnson S, Kelly CP, Loo VG, McDonald LC, et al. Clinical practice guidelines for Clostridium difficile infection in adults.2010 update by the Society for Health care Epidemiology of America (SHEA) and Infectious Diseases Society of America (DSA). Infect Control Hosp Epidemiol. 2010:31(5):451–55.CrossRefGoogle Scholar
  55. 55.
    Onwnezobe IA, Oshan PO, Odigwe CC. Antibiotics for treating symptomatic nontypical salmonella infections. Cochrane Database Syst Rev 2012 Nov 4 11.CD001167.2012.Google Scholar
  56. 56.
    Vukelic D, Trkulja V, Salkovic-Petusic M. Single dose of azythiomycin versus 5 days of erythromycin or no antibiotics in the treatment of campylobacter enterocoli-it is in children. A prospective randomized assessor or blind study. J Pediatr Gastroenterol Nutr. 2010;50:404–10.PubMedGoogle Scholar
  57. 57.
    Bhattacharya SK, Sar D. An evaluation of current shigellosis treatment. Expert Opin Pharmther. 2003;4(8):1315–20.CrossRefGoogle Scholar
  58. 58.
    Goodgame RW. Understanding intestinal spore forming protozoa crytosporidia microsporida, isopora cyclospora. Ann Inter Med. 1990.;15:124(4):429–41.CrossRefGoogle Scholar
  59. 59.
    Flanigan TP, Soave R. Cryptosporidosis. Prog Clin Parasitol. 1993:1–20.Google Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Nages Nagaratnam
    • 1
  • Kujan Nagaratnam
    • 1
  • Gary Cheuk
    • 2
  1. 1.The University of SydneyWestmead Clinical SchoolWestmeadAustralia
  2. 2.Rehabilitation and Aged Care ServiceBlacktown-Mt Druitt HospitalMount DruittAustralia

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