Traveler's diarrhea differential diagnosis: Difference between revisions

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__NOTOC__
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{{Traveler's diarrhea}}
{{Traveler's diarrhea}}
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{{CMG}} {{AE}} {{YD}}
==Overview==
Traveler's diarrhea must be differentiated from other causes of fever, abdominal pain, and diarrhea, such as [[acute pancreatitis]], [[appendicitis]], [[bowel obstruction]], [[diverticulitis]], [[drug reaction]], [[hyperthyroidism]], [[inflammatory bowel disease]], [[mesenteric ischemia]], [[peritonitis]], and [[pneumonia]].  
==Traveler's Diarrhea Differential Diagnosis==
==Traveler's Diarrhea Differential Diagnosis==
The table below lists the underlying pathogens known to cause acute inflammatory diarrhea:<ref name="pmid14702426">{{cite journal| author=Thielman NM, Guerrant RL| title=Clinical practice. Acute infectious diarrhea. | journal=N Engl J Med | year= 2004 | volume= 350 | issue= 1 | pages= 38-47 | pmid=14702426 | doi=10.1056/NEJMcp031534 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14702426  }} </ref><ref name="pmid15537721">{{cite journal| author=Khan AM, Faruque AS, Hossain MS, Sattar S, Fuchs GJ, Salam MA| title=Plesiomonas shigelloides-associated diarrhoea in Bangladeshi children: a hospital-based surveillance study. | journal=J Trop Pediatr | year= 2004 | volume= 50 | issue= 6 | pages= 354-6 | pmid=15537721 | doi=10.1093/tropej/50.6.354 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15537721  }} </ref>
===Infectious Differential Diagnoses===
 
The following are the infectious differential diagnoses of traveler's diarrhea. Common infectious differential diagnoses and differentiating features are shown in the table below.
{| style="border: 0px; font-size: 90%; margin: 3px;" align=center
The table below lists the underlying bacterial pathogens associated with acute diarrhea:<ref name="pmid14702426">{{cite journal| author=Thielman NM, Guerrant RL| title=Clinical practice. Acute infectious diarrhea. | journal=N Engl J Med | year= 2004 | volume= 350 | issue= 1 | pages= 38-47 | pmid=14702426 | doi=10.1056/NEJMcp031534 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14702426  }} </ref><ref name="pmid15537721">{{cite journal| author=Khan AM, Faruque AS, Hossain MS, Sattar S, Fuchs GJ, Salam MA| title=Plesiomonas shigelloides-associated diarrhoea in Bangladeshi children: a hospital-based surveillance study. | journal=J Trop Pediatr | year= 2004 | volume= 50 | issue= 6 | pages= 354-6 | pmid=15537721 | doi=10.1093/tropej/50.6.354 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15537721  }} </ref>
{| style="border: 0px; font-size: 90%; margin: 3px;" align=center
! style="background: #4479BA; padding: 5px 5px;" rowspan=2 | {{fontcolor|#FFFFFF|Pathogen}}
! style="background: #4479BA; padding: 5px 5px;" rowspan=2 | {{fontcolor|#FFFFFF|Pathogen}}
! style="background: #4479BA; padding: 5px 5px;" rowspan=2  | {{fontcolor|#FFFFFF|Transmission}}
! style="background: #4479BA; padding: 5px 5px;" rowspan=2  | {{fontcolor|#FFFFFF|Transmission}}
Line 36: Line 39:
! style="padding: 5px 5px; background: #F5F5F5;" | +
! style="padding: 5px 5px; background: #F5F5F5;" | +
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold;" | [[Escherichia coli|''E. coli'' (EHEC or EIEC)]]
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold;" | ''Escherichia coli''
| style="padding: 5px 5px; background: #F5F5F5;" | Foodborne transmission, ingestion of undercooked hamburger meat
| style="padding: 5px 5px; background: #F5F5F5;" | Foodborne transmission, ingestion of undercooked hamburger meat
! style="padding: 5px 5px; background: #F5F5F5;" | ±
! style="padding: 5px 5px; background: #F5F5F5;" | -
! style="padding: 5px 5px; background: #F5F5F5;" | +
! style="padding: 5px 5px; background: #F5F5F5;" | +
! style="padding: 5px 5px; background: #F5F5F5;" | ++
! style="padding: 5px 5px; background: #F5F5F5;" | ++
! style="padding: 5px 5px; background: #F5F5F5;" | ++
! style="padding: 5px 5px; background: #F5F5F5;" | + (EHEC or EIEC), - (ETEC, EAEC, EPEC)
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold;" | ''[[Clostridium difficile]]''
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold;" | ''[[Clostridium difficile]]''
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|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold;" | ''[[Yersinia]]''
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold;" | ''[[Yersinia]]''
| style="padding: 5px 5px; background: #F5F5F5;" | Community-aquired, foodborne transmission
| style="padding: 5px 5px; background: #F5F5F5;" | Community-acquired, foodborne transmission
! style="padding: 5px 5px; background: #F5F5F5;" | ++
! style="padding: 5px 5px; background: #F5F5F5;" | ++
! style="padding: 5px 5px; background: #F5F5F5;" | +
! style="padding: 5px 5px; background: #F5F5F5;" | +
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|}
|}


 
===Non-infectious Differential Diagnoses===
The following are the non-infectious differential diagnoses of ''E. coli enteritis'':
*[[Acute pancreatitis]]
*[[Adrenal insufficiency]] and [[Adrenal insufficiency|Waterhouse-Friedrichsen syndrome]]
*[[Allergy]] (e.g. [[insect bite allergy]] or [[anaphylaxis]])
*[[Appendicitis]]
*[[Bowel obstruction]]
*[[Diverticulitis]]
*[[Drug reaction]] (e.g. [[antimicrobial agents]], [[antihypertensive therapy]], [[chemotherapy]], [[anticonvulsants]])
*[[Endometriosis]]
*[[Familial Mediterranean fever]]
*[[Gastrointestinal perforation]]
*[[Hyperthyroidism]]
*[[Ileus]]
*[[Inflammatory bowel disease]] ([[Crohn's disease]] or [[ulcerative colitis]])
*[[Intussusception]]
*[[Ischemic colitis]]
*[[Ketoacidosis]]
*[[Mesenteric ischemia]]
*[[Necrotizing enterocolitis]]
*[[Ogilvie syndrome]]
*[[Peritonitis]]
*[[Pneumonia]]
*Poisoning and toxicity (e.g. [[carbon monoxide poisoning]], [[organophosphate poisoning]], [[Digitoxin|digitoxin toxicity]])
*[[Ruptured abdominal aortic aneurysm]]
*[[Spider bite]]
*[[Volvulus]]
*[[Urinary tract infection]]
To view a comprehensive list of abdominal pain differential diagnoses, click [[Abdominal pain causes|'''here''']].<br>
To view a comprehensive list of diarrhea differential diagnoses, click [[Diarrhea causes|'''here''']].
== References ==
== References ==
{{reflist|2}}
{{reflist|2}}

Revision as of 21:29, 29 February 2016

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Yazan Daaboul, M.D.

Overview

Traveler's diarrhea must be differentiated from other causes of fever, abdominal pain, and diarrhea, such as acute pancreatitis, appendicitis, bowel obstruction, diverticulitis, drug reaction, hyperthyroidism, inflammatory bowel disease, mesenteric ischemia, peritonitis, and pneumonia.

Traveler's Diarrhea Differential Diagnosis

Infectious Differential Diagnoses

The following are the infectious differential diagnoses of traveler's diarrhea. Common infectious differential diagnoses and differentiating features are shown in the table below. The table below lists the underlying bacterial pathogens associated with acute diarrhea:[1][2]

Pathogen Transmission Clinical Manifestations
Fever Nausea/Vomiting Abdominal Pain Bloody Stool
Salmonella Foodborne transmission, community-acquired ++ + ++ +
Shigella Community-acquired, person-to-person ++ ++ ++ +
Campylobacter Community-acquired, ingestion of undercooked poultry ++ + ++ +
Escherichia coli Foodborne transmission, ingestion of undercooked hamburger meat - + ++ + (EHEC or EIEC), - (ETEC, EAEC, EPEC)
Clostridium difficile Nosocomial spread, antibiotic use + ± + +
Yersinia Community-acquired, foodborne transmission ++ + ++ +
Entamoeba histolytica Travel to or emigration from tropical regions + ± + ±
Aeromonas Ingestion of contaminated water ++ + ++ +
Plesiomonas Ingestion of contaminated water or undercooked shellfish, travel to tropical regions ± ++ + +

Non-infectious Differential Diagnoses

The following are the non-infectious differential diagnoses of E. coli enteritis:

To view a comprehensive list of abdominal pain differential diagnoses, click here.
To view a comprehensive list of diarrhea differential diagnoses, click here.

References

  1. ↑ Thielman NM, Guerrant RL (2004). "Clinical practice. Acute infectious diarrhea". N Engl J Med. 350 (1): 38–47. doi:10.1056/NEJMcp031534. PMID 14702426.
  2. ↑ Khan AM, Faruque AS, Hossain MS, Sattar S, Fuchs GJ, Salam MA (2004). "Plesiomonas shigelloides-associated diarrhoea in Bangladeshi children: a hospital-based surveillance study". J Trop Pediatr. 50 (6): 354–6. doi:10.1093/tropej/50.6.354. PMID 15537721.

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