Bacterial Gastroenteritis is the most common digestive problem that occurs due to inflammation of your stomach and intestine. It is characterized by nausea, vomiting, abdominal pain, and fever (that can be on and off). Gastroenteritis can be bacterial, viral, and parasitic in origin. It usually lasts for 2 weeks or less.
Gastroenteritis is the most commonly presenting digestive problem nowadays in every clinical setup. It is the leading cause of death worldwide. About 1.5 to 2.5 million people die due to this disease. It is the second most common cause of death in children. Overall, 3-4 billion people are affected every year.
In 2015, about 2.5 billion cases were reported, out of which 1.3-1.4 million people died due to gastroenteritis. Therefore, diagnosing and treating it early is critical to avoid complications.¹

What is Bacterial Gastroenteritis?

Bacterial gastroenteritis (also known as intestinal flu or diarrhea) is derived from the Greek words. “Gastro” means stomach, and “enteron” means intestine. Therefore, gastroenteritis is collectively defined as inflammation of your stomach and intestine that occurs due to bacteria.
It is a gastrointestinal pathology in which the contraction of your bowl or motility of your bowel increases, resulting in diarrhea or loose motion. Medically, diarrhea is defined as 3-4 loose stools or watery stools per day. It can be due to bacterial overgrowth that can occur due to drinking contaminated water or food or due to viral and parasites. It is characterized by abdominal pain, nausea, vomiting, dehydration, with or without fever.

Bacterial gastroenteritis

Classifications:

The classification of bacterial gastroenteritis depends upon the duration of the symptoms. According To duration, it is classified into four types. These are

Acute

If the duration of the symptoms is about 14 or fewer than 14 days, it is acute bacterial gastroenteritis.

Persistent

If the duration is more than 14 days but less than 40 days, then it is persistent bacterial gastroenteritis.

Chronic

If the symptoms remain for more than 30 days, then it is chronic bacterial gastroenteritis.

Recurrent

If the symptoms of gastroenteritis recur after 7 to 10 days, it is recurrent bacterial gastroenteritis.²

Difference between Viral & Bacterial Gastroenteritis

Bacterial gastroenteritis is an infection in your stomach and intestine that causes irritation and inflammation of your digestive tract (stomach and intestine). It most commonly affects children with an age greater than two years. It is characterized by high-grade fever, chills, abdominal pain, diarrhea, and vomiting. During stool examination, fecal leukocytes are present. In bacterial gastroenteritis, you can have bloody stools too. It is associated with travel, animal exposure, and consumption of meat.
Viral gastroenteritis is more common than bacterial gastroenteritis. It affects children under two years of age. The symptoms of viral and bacterial gastroenteritis are almost the same. However, in viral gastroenteritis, there is a low-grade fever and no blood in stools. On stool examination, the fecal leukocytes are absent. The viruses include rotavirus and norovirus.

Symptoms of Bacterial Gastroenteritis

The signs and symptoms of gastroenteritis vary from person to person and depend upon The type of bacterial infection. These symptoms appear within 12-72 hours after ingesting food contaminated with bacteria. Symptoms of bacterial gastroenteritis include the following:³

Abdominal pain (cramps)
Sudden diarrhea (watery stools or bloody stools)
Lethargy
Drowsiness
Nausea and vomiting
Electrolyte disturbance due to vomiting and diarrhea
Fever can be high-grade or low-grade
Decreased appetite

Causes of Bacterial Gastroenteritis

Gastroenteritis can occur due to bacterial, viral, parasitic, or fungal infections. Viral gastroenteritis is more common than bacterial, but here, we will discuss bacterial gastroenteritis.
Most of the time, bacterial gastroenteritis is caused by eating food or drinking water contaminated by bacteria, also called food poisoning. Multiple types of bacteria can target your digestive tract. These are:

E-Coli:

It is usually present in beef, petting zoos, and children’s care centers.

Campylobacter:

This bacteria is found in poultry, unpasteurized milk products, traveling abroad, and puppies.

Clostridium difficile:

It can be found in hospitals, seafood, previous use of antibiotics, and meat. It can spread from person to person in hospitals.

Salmonella:

Salmonella is found on contaminated eggs, chicken, and pets.

Shigella:

It can also spread from person to person through contact and through contaminated water, food, and fecal matter.⁴

Who is at risk of getting Bacterial Gastroenteritis?

Bacterial gastroenteritis can occur at any time at any age. However, some factors can make you more prone to this disease. These risk factors are:⁵

Age: older than 60 or 65 years
Living in a nursing care home
Eating uncooked food or raw foods and milk
Immunocompromised
Drinking alcohol
Living in an unhygienic environment
Diabetes Mellitus

How to diagnose Bacterial Gastroenteritis?

Bacterial gastroenteritis should be diagnosed and treated early to avoid serious complications. The diagnosis depends upon history, physical examination, laboratory investigation, and radiological studies.

History:

A good history will help your doctor in diagnosing your disease. A history of gastroenteritis includes the following questions regarding your disease:

Onset and duration of symptoms
Is there any history of fever associated with diarrhea?
Do you have nausea or vomiting? If yes, what is the color and volume of the vomiting
Do you have diarrhea? If yes, then ask about the color (watery or bloody)
Do you have abdominal pain or cramps?
Food History?
Traveling history?
Previous history of antibiotic treatment?

Physical Examination:

Your doctor will thoroughly examine you during the physical examination. He will palpate and auscultate your abdomen to check tenderness and bowel sounds. Physical findings include:

Signs of dehydration (sunken eyes, lethargy, dry mouth, skin pinches go back slowly)
Perianal erythema
Abdominal tenderness
Sluggish bowel sounds
Tachycardia
Hypotension

Doctor examining child with gastroenteritis

Laboratory Investigation:

Laboratory investigations are necessary to diagnose the bacterial gastroenteritis. These investigations include:

A complete blood picture of this patient shows a decrease in Hb counts due to a chronic bacterial infection that causes bloody stools.
White blood cell count shows an increase in neutrophil count that indicates the presence of bacterial infections.
Blood culture is advised in case of high-grade fever
Serum electrolyte level shows an imbalance in body electrolyte levels (potassium and sodium)
Fecal leukocytes
Stool pH that is reduced, indicating the presence of reducing substances
Stool culture

Most cases of bacterial gastroenteritis resolve independently, and empirical antibiotic treatment or bacterial stool cultures are generally unnecessary. By the time culture results are available, symptoms of acute diarrhea often subside, making the cultures unnecessary for most patients. The main focus should be on relieving symptoms, rehydration, and preventing the spread of the infection. However, stool cultures are recommended for patients with severe or prolonged diarrhea, symptoms of invasive disease, or a medical history that suggests potential complications. According to the American College of Gastroenterology, routine stool cultures should be done for patients with severe or persistent diarrhea, high fever, bloody stools, or the presence of stool leukocytes, lactoferrin, or occult blood.⁶⁷
Cultural media is usually advised to check specific bacteria causing gastroenteritis. Different bacteria have different cultures. These are:

Blood Agar

All aerobic bacteria and yeast are detected on this culture media.

Skirrow Agar

It is specific for campylobacter species.

Macconkey Agar

This agar permits lactose fermentation and inhibits the growth of gram-positive bacteria.

SM Agar

It is also specific for enterohemorrhagic E-coli.

Thiosulphate-citrate-bile source (TCBS)

This agar is selective for vibrio cholera species.

CCFE Agar

CCFE agar is specific for clostridium difficile species

Radiological Studies:

Radiological investigations are rarely advised in bacterial gastroenteritis. Your doctor may advise it in severe and complicated cases or to rule out other pathologies. Radiological studies include:

X-ray abdomen
Ultrasound abdomen
CT abdomen with or without contrast

How to treat Bacterial Gastroenteritis?

In most cases, bacterial gastroenteritis is a self-limiting disease that settles down independently without any interventions. However, in severe cases, supportive measures and pharmacological treatment are necessary.

Supportive Measure:

It is necessary to give supportive measures to a patient who has gastroenteritis and is dehydrated. In supportive measures, your doctor will provide you with rehydration therapy through the oral route if the patient can tolerate it orally. However, if the patient can not take it orally, then the doctors will give IV rehydration. Intravenous maintenance fluid at frequent intervals minimizes discomfort and vomiting and replenishes electrolyte imbalance.

Pharmacotherapy:

Many medicines are used to treat bacterial gastroenteritis and to alleviate its symptoms. These medicines include:

Antibiotics

Doctors do not usually recommend antibiotics for bacterial gastroenteritis, but they may advise them in severe cases and immunocompromised patients. Due to resistance, antibiotics such as Macrolides, like azithromycin, are preferred over fluoroquinolones. Meanwhile, pseudomembranous colitis develops due to extensive antibiotic use. Therefore, stopping causative medicine and initiating metronidazole can help treat pseudomembranous colitis.
If Vibrio is the causative agent, your doctor may recommend tetracycline. In pregnant women with listeria infection, ampicillin is the drug of choice.
According To the World Health Organization, antibiotic use is recommended in young children who have bloody diarrhea.

Pain Medication

Pain medications treat mild to moderate abdominal pain. These medications include tramadol and paracetamol to treat fever and pain.

Antiemetics

These medicines treat nausea and vomiting. Antiemetics include ondansetron, metoclopramide, and dimenhydrinate.

Antimotility Agents

These medicines can cause complications in patients who have bloody diarrhea and diarrhea that is complicated by fever. Therefore, it is necessary to use these medicines wisely. These medicines include loperamide and opiates. However, loperamide is not suitable for children because it tends to cross the blood-brain barrier and cause complications. Bismuth and salicylate are other options, but they can cause toxicity.⁸

Complications of Bacterial Gastroenteritis

Bacterial gastroenteritis is a self-limited disease. However, in severe cases, if it remains neglected and not treated, serious complications can result. These complications include:

Hemolytic uremic syndrome (HUS)
Fulminant liver failure
Urinary tract infections (UTI)
Meningitis
Cholecystitis
Pancreatitis
Septicemia
Enteric fever
Appendicitis
Intussusception
Cholangitis
Severe dehydration
Reiter syndrome
Inflammatory bowel disease

When to see your Doctor?

Bacterial gastroenteritis can cause complications if neglected. Therefore, immediately consult with your physician if you have the following symptoms.

Abdominal pain (cramps)
Bloating
3-4 loose stools per day
Bleeding from the stools
Nausea and vomiting
High-grade fever with chills

Prevention of Bacterial Gastroenteritis

You can prevent yourself and your loved ones from this disease by adopting the following preventive measures. These preventive measures decrease your risk of having this disease. ⁹

Wash your hands with good soap before eating or drinking foods because your hands contain bacteria that you can ingest during eating or drinking. Moreover, wash your hands after using the toilet.
Wash your hands before making food for your loved ones to protect them from the notorious disease.
Wash your fruits and vegetables before eating
Cook your fish, meat, and rice well enough to kill all the bacteria
Store your food at an optimum temperature to avoid spoiling of food
Wash your kitchen and dishes regularly
Drink filtered water or boiled water
Don’t cook food if you are ill

Recovery Time for Bacterial Gastroenteritis

Gastroenteritis usually lasts for a day or two and settles down on its own because your body combats bacterial and viral infections and lets them down. In individuals who are immunocompromised and have other comorbidities, it can last for weeks or more to go away.

Is Gastroenteritis Contagious?

Yes, infectious gastroenteritis is contagious. If you have bacterial gastroenteritis, it will also infect your poop (stool). Due to this, infection can spread from your poop to the surrounding area or who comes in contact with your stool.
Moreover, small traces of infected stools can stick to your hand while changing your baby’s diaper. Therefore, if you do not wash your hands with a good soap, then it can infect you.
It is important to cut your nails. Long nails can also be a source of spreading gastroenteritis.

What type of food should I take for Bacterial Gastroenteritis, and what not to take?

In bacterial gastroenteritis, you have to choose your food wisely and according to your doctor’s advice. The food you can eat is:

The BRAT diet (it includes bananas, rice, applesauce and toast)
Increase your fluid intake
Eat lean meats
Use lactose products if you are not sensitive to it
Breastfeeding in infants can also help

Avoid drinking or eating the following food if You have bacterial gastroenteritis.

Milk if you have lactose intolerance
Avoid dairy products
Stop drinking alcohol
Avoid eating spicy and fatty food
Stop smoking and nicotine use

Prognosis

With early diagnosis and proper management, the overall prognosis of this disease is good. Mortality can occur in rare cases where individuals are immunocompromised or have other comorbidities. Neonates, younger infants, and old people are at high risk of dehydration, malabsorption, and malnutrition and show a poorer prognosis than others.
The prognosis of bacterial gastroenteritis is poor in underdeveloped countries due to a lack of medical knowledge. While people can die in developing countries due to complications.

Conclusion

To conclude, gastroenteritis is inflammation of your stomach and intestines. It can be bacterial, viral, or parasitic. Symptoms of gastroenteritis are loose stools, dehydration, abdominal cramps, nausea, and vomiting. The treatment of gastroenteritis depends on causative agents. It is critical to take preventive measures to prevent the spread of this disease, as it is contagious. Moreover, gastroenteritis has a good prognosis if you treat it earlier. If you have symptoms of gastroenteritis, immediately consult your doctor for timely diagnosis and treatment.

Refrences

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Bacterial Gastroenteritis: Causes, Symptoms & Treatment

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