Conduite à tenir devant une diarrhée aiguë. Étiologies

Abstract

Acute diarrheas are a common disease, and their high frequency constitutes an important problem in terms of public health. Most of the time, they have an infectious origin and spontaneous complete recovery is achieved within less than three days. In practice, history of diarrhea, physical examination and environmental identification are the main points for selecting patients who will need medical explorations. Only 1% of patients need immediate laboratory complementary investigations, i.e., stool analysis, either because their symptomatology indicates potential underlying acute colitis (bloody stools, localized abdominal pain), or when there is an underlying frail condition associated with an immediate risk for the patient, or in case of a particular context such a stay in a tropical area. The practitioner has to inform the biologist on all symptoms and relevant information so as to optimize the analysis and its cost-effectiveness. Until the laboratory results are available, such selected patients require antibiotic treatment (quinolones). These investigations are also needed in case of >3-day persistent diarrhea. When stool samples are free of bacteria or parasite, and when acute diarrhea persists more than 5 days, a specialist should be visited. Thus, only a small proportion of patients with acute diarrhea will undergo endoscopy, probably cases of colitis or recto colitis. Early re-hydration remains the preferential treatment of acute diarrhea in children since, for more than two decades, it has demonstrated its efficacy in reducing mortality, particularly in developing countries.