What is the management approach for infectious diarrhea following mushroom ingestion?

Management of Infectious Diarrhea Following Mushroom Ingestion

Rehydration therapy with reduced osmolarity oral rehydration solution (ORS) is the cornerstone of treatment for infectious diarrhea following mushroom ingestion, with antimicrobial therapy generally not recommended unless specific indications are present. 1, 2

Assessment and Initial Management

• Evaluate hydration status and severity of illness to guide treatment approach 2
• For mild to moderate dehydration: Administer ORS as first-line therapy for all age groups 1, 2
• For severe dehydration: Initiate isotonic intravenous fluids (lactated Ringer's or normal saline) until pulse, perfusion, and mental status normalize 1, 2
• After stabilization with IV fluids, transition to ORS to replace remaining fluid deficit 1
• Continue appropriate maintenance fluids and replace ongoing stool losses with ORS until diarrhea resolves 1, 2

Nutritional Management

• Continue human milk feeding in infants and children throughout the diarrheal episode 1
• Resume age-appropriate usual diet during or immediately after rehydration 1, 2
• Do not withhold food during diarrheal episodes, as this can worsen nutritional status 2

Antimicrobial Therapy Considerations

• Empiric antimicrobial therapy is generally not recommended for most people with acute watery diarrhea following mushroom ingestion 1, 2
• Consider empiric antimicrobial therapy only in specific situations:
  • Immunocompromised patients 1
  • Ill-appearing young infants, especially those <3 months with suspected bacterial etiology 1
  • Patients with fever, abdominal pain, and bloody diarrhea suggesting shigellosis 1
  • Recent international travelers with fever ≥38.5°C or signs of sepsis 1
• If antimicrobial therapy is indicated in adults, options include a fluoroquinolone or azithromycin, based on local susceptibility patterns 1
• For children requiring antimicrobials, options include a third-generation cephalosporin (for infants <3 months or those with neurologic involvement) or azithromycin 1
• Modify or discontinue antimicrobial treatment when a specific pathogen is identified 1, 2
• Avoid antimicrobial therapy for infections with STEC O157 and other Shiga toxin 2-producing E. coli due to increased risk of hemolytic uremic syndrome 1, 2

Adjunctive Therapies

• Antimotility drugs (e.g., loperamide) should not be given to children <18 years with acute diarrhea 1, 2
• Loperamide may be given to immunocompetent adults with acute watery diarrhea, but avoid in inflammatory or febrile diarrhea 1, 2
• Antinausea/antiemetic agents may be considered once the patient is adequately hydrated, but are not a substitute for fluid and electrolyte therapy 1

Special Considerations for Mushroom-Related Diarrhea

• Mushroom ingestion can cause gastrointestinal symptoms through various mechanisms, including toxin-mediated effects, indigestibility, immunological reactions, or ethanol intolerance 3
• Gastrointestinal symptoms following mushroom ingestion require careful evaluation, as they may represent early manifestations of potentially serious mushroom poisoning 3, 4
• The timing of symptom onset is critical:
  • Early symptoms (<6 hours after ingestion) often indicate less serious poisoning 4
  • Late symptoms (>6 hours after ingestion) may suggest Amanita phalloides poisoning, which can progress to hepatic failure 4, 5
• Monitor for signs of hepatic injury in patients with suspected toxic mushroom ingestion 5, 6

Follow-up Considerations

• Follow-up testing is not recommended in most people following resolution of diarrhea 1
• Consider clinical and laboratory reevaluation in patients who do not respond to initial therapy 1
• For persistent symptoms (≥14 days), consider noninfectious conditions including inflammatory bowel disease and irritable bowel syndrome 1
• Reassess fluid/electrolyte balance, nutritional status, and antimicrobial therapy in patients with persistent symptoms 1

Prevention

• Emphasize hand hygiene, especially after using the toilet, changing diapers, before/after food preparation, and after handling animals 2
• Educate patients about the risks of consuming wild mushrooms without expert identification 3, 4