Systemic Infections Associated with Diarrhea
Among the listed options, Legionnaires' disease, measles, listeriosis, and viral hepatitis can all cause diarrhea, while rubella typically does not.
Legionnaires' Disease
Legionnaires' disease (Legionella pneumonia) is well-recognized as a cause of diarrhea in patients with community-acquired pneumonia. When diarrhea occurs in the context of pneumonia, it is particularly suggestive of legionellosis 1. This represents a systemic infection where the primary site is respiratory, but gastrointestinal manifestations are common enough to be diagnostically useful.
Measles
Measles causes diarrhea as part of its systemic manifestation. While the provided evidence doesn't specifically detail measles, it is a well-established systemic viral infection that commonly presents with diarrhea, particularly in children, as part of the constellation of fever, rash, and mucosal involvement.
Listeriosis
Listeria monocytogenes definitively causes acute febrile gastroenteritis with diarrhea. At least 7 outbreaks of foodborne gastroenteritis due to L. monocytogenes have been documented 2. The illness typically occurs 24 hours after ingestion and lasts approximately 2 days, with common symptoms including fever, watery diarrhea, nausea, headache, and joint/muscle pains 2.
- L. monocytogenes can cause gastroenteritis in otherwise healthy individuals and more severe invasive disease in immunocompromised patients 3
- Common symptoms include fever, watery diarrhea, nausea, headache, and pains in joints and muscles 3
- Many patients experience diarrhea antecedent to the development of bacteremia or meningoencephalitis 2
- L. monocytogenes should be considered as a possible etiology in outbreaks of febrile gastroenteritis when routine cultures fail to yield a pathogen 2
Viral Hepatitis
Viral hepatitis can present with diarrhea as part of the prodromal phase. While the provided evidence doesn't specifically detail hepatitis, it is clinically recognized that acute viral hepatitis (particularly hepatitis A) commonly presents with gastrointestinal symptoms including diarrhea, nausea, and vomiting before the onset of jaundice.
Rubella
Rubella typically does NOT cause diarrhea. This systemic viral infection primarily manifests with rash, lymphadenopathy, and low-grade fever, but gastrointestinal symptoms are not characteristic features of the disease.
Clinical Context
The pathogenesis of diarrhea in primarily non-gastrointestinal infections includes cytokine action, intestinal inflammation, increased permeability of endothelial cells in the gut microvasculature, and direct invasion of gut epithelial cells by various infectious agents 1. Travel-associated systemic infections presenting with fever and diarrhea include malaria, dengue fever, and SARS 1.
A critical pitfall to avoid: When evaluating patients with systemic infections and diarrhea, consider that the diarrhea could represent an adverse reaction to antibiotics rather than the infection itself 1. This is particularly relevant when diarrhea develops during the course of treatment rather than as an initial symptom.