小结
定义
病史和体格检查
关键诊断因素
- 大量水样腹泻
- 血容量不足的证据
其他诊断因素
- 年龄＜5 岁
- 摄食贝类
- 近期重度霍乱样疾病的家族史
- 呕吐
- 发热
- 腹痛
- 昏睡或昏迷
危险因素
- 饮用被污染的水
- 食用被污染的食物
- 环境卫生较差
- 近期出现的大雨和洪水
- 胃酸分泌减少
- O 型血
- 营养不良
- 艾滋病病毒 (HIV) 感染
- 缺少母乳喂养
诊断性检查
首要检查
- 全血细胞计数 (FBC)
- 血清电解质
- 血清尿素和肌酐
- 血清乳酸
- 动脉血气 (ABG)
- 心电图
- 粪便的暗视野/位相差显微镜检查
- 快速粪便试纸检查
需考虑的检查
- 粪便革兰染色
- 对液体粪便、粪便悬浮液或直肠拭子进行粪便培养
- 使用抗血清确定细菌的血清型
- 抗菌谱（敏感）
- 胸腔 X 线检查和腹部 X 线检查
新兴检查
- 粪便酶联免疫吸附测定（ELISA）试验
- 粪便分子检测
- 粪便环介导等温扩增 (loop-mediated isothermal amplification, LAMP) 试验
治疗流程
轻度至中度血容量不足：无呕吐症状
呕吐或重度血容量不足
撰稿人
作者
Marcus Eder, MBBS, MD, MSc, MRCP, FRCPath, DTM&H
Specialist in Infectious Diseases and Clinical Microbiology (UK)
Rega (Rettungsflugwacht/Air Rescue/Guarde Aérienne)
Switzerland
利益声明
ME declares that he has no competing interests.
Rekha Lopez, BSc, MBBS, MRCP, MSc, FRCPath
Consultant Microbiologist
Lister Hospital
East and North Hertfordshire NHS Trust
London
UK
利益声明
RL declares that she has no competing interests.
鸣谢
Dr Marcus Eder and Dr Rekha Lopez would like to gratefully acknowledge Dr Justin Green, a previous contributor to this topic.
利益声明
JG is employed by, and holds stock in, GlaxoSmithKline (GSK). GSK has had no involvement in the preparation of this document, and the views expressed are those of the author.
同行评议者
David Sack, MD
Professor
Department of International Health
Johns Hopkins Bloomberg School of Public Health
Baltimore
MD
利益声明
DS is an author of some studies referenced in this topic.
Nur H. Alam, MD
Scientist
Clinical Sciences Division
International Centre for Diarrhoeal Disease Research
Dhaka
Bangladesh
利益声明
NHA is co-author of a study referenced in this topic.
Jaya Shankar Kaushik, MD
Registrar
Department of Pediatrics
University College of Medical Sciences
New Delhi
India
利益声明
JSK is the author of a reference cited in this topic.
鉴别诊断
- 其他感染性腹泻
- 阿米巴痢疾
- 类圆线虫和其他肠道蠕虫
更多 鉴别诊断指南
- WHO 标准的病例定义
- 霍乱资料便览
更多 指南患者教育信息
Diarrhoea in adults
Diarrhoea in children
更多 患者教育信息
登录或订阅即可浏览 BMJ Best Practice 临床实践完整内容
内容使用需遵循免责声明