Review Article | Published:

Diarrhea caused by primarily non-gastrointestinal infections

Nature Clinical Practice Gastroenterology & Hepatology volume 2, pages 216222 (2005) | Download Citation



Infectious diseases that do not primarily affect the gastrointestinal tract can cause severe diarrhea. The pathogenesis of this kind of diarrhea includes cytokine action, intestinal inflammation, sequestration of red blood cells, apoptosis and increased permeability of endothelial cells in the gut microvasculature, and direct invasion of gut epithelial cells by various infectious agents. Of the travel-associated systemic infections presenting with fever, diarrhea occurs in patients with malaria, dengue fever and SARS. Diarrhea also occurs in patients with community-acquired pneumonia, when it is suggestive of legionellosis. Diarrhea can also occur in patients with systemic bacterial infections. In addition, although diarrhea is rare in patients with early Lyme borreliosis, the incidence is higher in those with other tick-borne infections, such as ehrlichiosis, tick-borne relapsing fever and Rocky Mountain spotted fever. Unfortunately, it is often not established whether diarrhea is an initial symptom or develops during the course of the disease. The real incidence of diarrhea in some infectious diseases must also be questioned because it could represent an adverse reaction to antibiotics.

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  1. EC Reisinger is full Professor of Medicine and Chairman, and C Fritzsche is a fellow, Division of Tropical Medicine and Infectious Diseases, Department of Medicine, University of Rostock Medical School, Rostock, Germany.

    • Emil C Reisinger
    •  & Carlos Fritzsche
  2. R Krause is Associate Professor of Medicine and Director of the Division of Infectious Diseases, and GJ Krejs is full Professor of Medicine and Chairman, Division of Gastroenterology, Department of Internal Medicine, Medical University of Graz, Austria.

    • Robert Krause
    •  & Guenter J Krejs


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The authors declare no competing financial interests.

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Correspondence to Emil C Reisinger.

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