State-of-the-Art Review: Infectious Diarrhea.

Andi L Shane, Mark D Gonzalez, Amanda M Roy, Geoffrey A Preidis, Michael H Woodworth

Journal: Clinical infectious diseases : an official publication of the Infectious Diseases Society of America 2025;81(5):e250-e262

PMID: 41437889

Abstract

In this review, we describe a multidisciplinary approach to the care of a patient with diarrhea, known or suspected to be the result of an infection, incorporating infectious disease, gastroenterology, microbiology, and pharmacy clinical perspectives. We highlight updates in the epidemiology and etiologies of infectious diarrhea, considering both the individual and community impact of disease burden since the publication of the 2017 Infectious Diseases Society of America endorsed guidelines addressing the management of infectious diarrhea. We consider the acute, chronic, and post-infectious intestinal and extra-intestinal manifestations of infectious diarrhea and the clinical challenges posed by each. We discuss the role of diagnostics, including molecular-based testing, often referred to as culture independent diagnostic testing, and culture-based platforms and their role in clinical care and public health surveillance. We discuss emerging antimicrobial resistance and the role of biotherapeutics as strategies to decrease the burden of infectious diarrhea.

© The Author(s) 2025. Published by Oxford University Press on behalf of Infectious Diseases Society of America. All rights reserved. For commercial re-use, please contact [email protected] for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact [email protected].

Address: Division of Pediatric Infectious Disease, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, Georgia, USA.; Department of Pathology, Children's Healthcare of Atlanta, Atlanta, Georgia, USA.; Department of Pharmaceutical Services, Zuckerberg San Francisco General, University of California San Francisco, San Francisco, California, USA.; Division of Gastroenterology, Hepatology & Nutrition, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, USA.; Division of Infectious Disease, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.
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