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General Information:
- Acute diarrheal illness is a common cause of morbidity and mortality disproportionately affecting low and middle income countries
- Acute diarrhea poses the greatest threat to the immunocompromised, children, and the elderly
- Stool samples are costly and frequently don’t provide information altering the course of treatment in acute, non-severe diarrhea
- However, for acute diarrhea, a single stool sample should be obtained when diarrhea is associated with:
- fever (≥38.5°C)
- a severe coexisting condition in a hospitalized patient on antibiotics
- persistent diarrhea (≥14 days)
- profuse cholera-like watery diarrhea
- dehydration
- dysentery
- an elderly or immunocompromised patient
- food handlers, nursing home residents, and daycare workers
- The stool sample must be processed by the lab within 4 hours to directly visualize parasites and within 12 hours for routine microbiologic staining.
Bottom Line for the EM Physician: Use these guidelines to test stool only when helpful to patient care and avoid flushing resources down the toilet.
University of Maryland Section of Global Emergency Health
Author: Alex Skog
References
DuPont HL. Acute infectious diarrhea in immunocompetent adults. N Engl J Med. 2014 Apr 17;370(16):1532–40.
Fischer Walker CL, Perin J, Aryee MJ, Boschi-Pinto C, Black RE. Diarrhea incidence in low- and middle-income countries in 1990 and 2010: a systematic review. BMC Public Health. 2012;12:220.