Parenteral Diarrhea: Medical Myth or Reality?

Researchers have described parenteral diarrhea's association with extraintestinal infections for more than a century, but the evidence is impressively limited, which perpetuates claims that it is a medical myth and not an actual clinical entity.But it matters that noninfectious diarrhea and vomiting are sometimes associated with bacterial infections such as acute urinary tract infections because this can create diagnostic confusion. Diarrhea and vomiting in a girl or woman with a febrile UTI could lead to a misdiagnosis of acute gastroenteritis. Febrile UTIs are often pyelonephritis, so missing the diagnosis has significant clinical implications such as renal scarring. Diarrhea, on the other hand, can serve as a diagnostic clue to an associated UTI if one is aware of parenteral diarrhea. Watch Dr. Mellick diagnose a 2-year-old girl with parenteral diarrhea in this video.Diarrhea is frequently associated with scores of systemic medical diseases. It is not uncommon for infectious conditions that do not primarily affect the gastrointestinal tract to cause diarrhea. Reisinger, et al., wrote that the pathogenesis of parenteral diarrhea includes cytokine action, intestinal inflammation, sequestration of red blood cells, apoptosis, increased permeability of endothelial cells in the gut microvasculature, and direct invasion of gut epithelial cells by various infectious agents. (Nat Clin Pract Gastroenterol Hepatol. 2005;2[5]:216; https://bit.ly/3MNUWu0.)Systemic infections re...
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