Shigellosis differential diagnosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: João André Alves Silva, M.D. [2]

Overview

Shigellosis must be differentiated from other diseases that cause fever, bloody diarrhea, dehydration, tachycardia and low blood pressure, such as Ebola, Typhoid fever, Malaria and Lassa fever. The laboratory must be told specifically to test the samples for shigella, since this test is not commonly done.

Differentiating Shigellosis from other Diseases

The table below summarizes the findings that differentiate Shigellosis from other conditions that cause fever and hemorrhage:

Disease	Findings
Ebola	Presents with fever, chills vomiting, diarrhea, generalized pain or malaise, and sometimes internal and external bleeding, that follow an incubation period of 2-21 days.
Typhoid fever	Presents with fever, headache, rash, gastrointestinal symptoms, with lymphadenopathy, relative bradycardia, cough and leucopenia and sometimes sore throat. Blood and stool culture can confirm the presence of the causative bacteria.
Malaria	Presents with acute fever, headache and sometimes diarrhea (children). A blood smears must be examined for malaria parasites. The presence of parasites does not exclude a concurrent viral infection. An antimalarial should be prescribed as an empiric therapy.
Lassa fever	Disease onset is usually gradual, with fever, sore throat, cough, pharyngitis, and facial edema in the later stages. Inflammation and exudation of the pharynx and conjunctiva are common.
Yellow fever and other Flaviviridae	Present with hemorrhagic complications. Epidemiological investigation may reveal a pattern of disease transmission by an insect vector. Virus isolation and serological investigation serves to distinguish these viruses. Confirmed history of previous yellow fever vaccination will rule out yellow fever.
Others	Viral hepatitis, leptospirosis, rheumatic fever, typhus, and mononucleosis can produce signs and symptoms that may be confused with Ebola in the early stages of infection.

The table below lists the underlying pathogens known to cause acute inflammatory diarrhea:

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	++	+	++	+
E. coli (EHEC or EIEC)	Foodborne transmission, ingestion of undercooked hamburger meat	±	+	++	++
Clostridium difficile	Nosocomial spread, antibiotic use	+	±	+	+
Yersinia	Community-aquired, 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	±	++	+	+

References

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