UMEM Educational Pearls

Title: Don't Muddy the Water: Know when to get a stool sample for acute diarrhea

Keywords: diarrhea, international, infectious disease, stool, parasite (PubMed Search)

Posted: 5/28/2014 by Andrea Tenner, MD (Updated: 12/26/2024)
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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.