Traveler's diarrhea differential diagnosis: Difference between revisions

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__NOTOC__
__NOTOC__
{{Traveler's diarrhea}}
{{Traveler's diarrhea}}
{{CMG}} {{AE}} {{YD}}
'''''To review the differential diagnosis of diarrhea, click [[Diarrhea#Differential Diagnosis of Diarrhea of other diseases|here]].'''''
==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]].
{{CMG}}; {{AE}} {{SSH}}, {{SMP}}
 
==Traveler's Diarrhea Differential Diagnosis==
==Traveler's Diarrhea Differential Diagnosis==
===Infectious Differential Diagnoses===
'''The following table outlines the major differential diagnoses of traveler's diarrhea.'''<ref name="Casburn-JonesFarthing2004">{{cite journal|last1=Casburn-Jones|first1=Anna C|last2=Farthing|first2=Michael Jg|title=Traveler's diarrhea|journal=Journal of Gastroenterology and Hepatology|volume=19|issue=6|year=2004|pages=610–618|issn=0815-9319|doi=10.1111/j.1440-1746.2003.03287.x}}</ref><ref name="KamatMathur2006">{{cite journal|last1=Kamat|first1=Deepak|last2=Mathur|first2=Ambika|title=Prevention and Management of Travelers’ Diarrhea|journal=Disease-a-Month|volume=52|issue=7|year=2006|pages=289–302|issn=00115029|doi=10.1016/j.disamonth.2006.08.003}}</ref><ref name="PfeifferDuPont2012">{{cite journal|last1=Pfeiffer|first1=Margaret L.|last2=DuPont|first2=Herbert L.|last3=Ochoa|first3=Theresa J.|title=The patient presenting with acute dysentery – A systematic review|journal=Journal of Infection|volume=64|issue=4|year=2012|pages=374–386|issn=01634453|doi=10.1016/j.jinf.2012.01.006}}</ref><ref name="pmid24506120">{{cite journal |vauthors=Barr W, Smith A |title=Acute diarrhea |journal=Am Fam Physician |volume=89 |issue=3 |pages=180–9 |year=2014 |pmid=24506120 |doi= |url=}}</ref><ref name="pmid29255768">{{cite journal |vauthors=Amil Dias J |title=Celiac Disease: What Do We Know in 2017? |journal=GE Port J Gastroenterol |volume=24 |issue=6 |pages=275–278 |year=2017 |pmid=29255768 |doi=10.1159/000479881 |url=}}</ref><ref name="pmid29254859">{{cite journal |vauthors=Kotloff KL, Riddle MS, Platts-Mills JA, Pavlinac P, Zaidi AKM |title=Shigellosis |journal=Lancet |volume= |issue= |pages= |year=2017 |pmid=29254859 |doi=10.1016/S0140-6736(17)33296-8 |url=}}</ref><ref name="Yamamoto-FurushoBosques-Padilla2017">{{cite journal|last1=Yamamoto-Furusho|first1=J.K.|last2=Bosques-Padilla|first2=F.|last3=de-Paula|first3=J.|last4=Galiano|first4=M.T.|last5=Ibañez|first5=P.|last6=Juliao|first6=F.|last7=Kotze|first7=P.G.|last8=Rocha|first8=J.L.|last9=Steinwurz|first9=F.|last10=Veitia|first10=G.|last11=Zaltman|first11=C.|title=Diagnóstico y tratamiento de la enfermedad inflamatoria intestinal: Primer Consenso Latinoamericano de la Pan American Crohn's and Colitis Organisation|journal=Revista de Gastroenterología de México|volume=82|issue=1|year=2017|pages=46–84|issn=03750906|doi=10.1016/j.rgmx.2016.07.003}}</ref><ref name="BorbélyOsterwalder2017">{{cite journal|last1=Borbély|first1=Yves M|last2=Osterwalder|first2=Alice|last3=Kröll|first3=Dino|last4=Nett|first4=Philipp C|last5=Inglin|first5=Roman A|title=Diarrhea after bariatric procedures: Diagnosis and therapy|journal=World Journal of Gastroenterology|volume=23|issue=26|year=2017|pages=4689|issn=1007-9327|doi=10.3748/wjg.v23.i26.4689}}</ref><ref name="CrawfordRamani2017">{{cite journal|last1=Crawford|first1=Sue E.|last2=Ramani|first2=Sasirekha|last3=Tate|first3=Jacqueline E.|last4=Parashar|first4=Umesh D.|last5=Svensson|first5=Lennart|last6=Hagbom|first6=Marie|last7=Franco|first7=Manuel A.|last8=Greenberg|first8=Harry B.|last9=O'Ryan|first9=Miguel|last10=Kang|first10=Gagandeep|last11=Desselberger|first11=Ulrich|last12=Estes|first12=Mary K.|title=Rotavirus infection|journal=Nature Reviews Disease Primers|volume=3|year=2017|pages=17083|issn=2056-676X|doi=10.1038/nrdp.2017.83}}</ref><ref name="pmid11068510">{{cite journal |vauthors=Kist M |title=[Chronic diarrhea: value of microbiology in diagnosis] |language=German |journal=Praxis (Bern 1994) |volume=89 |issue=39 |pages=1559–65 |year=2000 |pmid=11068510 |doi= |url=}}</ref><ref name="pmid4014291">{{cite journal |vauthors=Guerrant RL, Shields DS, Thorson SM, Schorling JB, Gröschel DH |title=Evaluation and diagnosis of acute infectious diarrhea |journal=Am. 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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:<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>
<span style="font-size:85%">'''Abbreviations:''' '''GI:''' [[Gastrointestinal tract|Gastrointestinal]], '''CBC''': [[Complete blood count]], '''WBC:''' [[White blood cells|White blood cell]], '''RBC''': [[Red blood cell]], '''Plt:''' [[Platelet]], '''Hgb:''' [[Hemoglobin]], '''ESR''': [[Erythrocyte sedimentation rate]], '''CRP''': [[C-reactive protein|C–reactive protein]], '''IgE:''' [[Immunoglobulin E]], '''IgA:''' [[Immunoglobulin A]], '''ETEC:''' [[Escherichia coli enteritis]], '''EPEC''': [[Escherichia coli|Enteropathogenic Escherichia coli]], '''EIEC''': [[Escherichia coli enteritis|Enteroinvasive Escherichia coli]], '''EHEC''': [[Escherichia coli|Enterohemorrhagic Escherichia coli]], '''EAEC''': [[Escherichia coli enteritis|Enteroaggregative Escherichia coli]], '''Nl''': Normal, '''ASCA''': [[Anti saccharomyces cerevisiae antibodies]], '''ANCA''': [[Anti-neutrophil cytoplasmic antibody|Anti–neutrophil cytoplasmic antibody]], '''DNA''': [[DNA|Deoxyribonucleic acid]], '''CFTR''': [[Cystic fibrosis transmembrane conductance regulator]], '''SLC10A2''': [[SLC10A2|Solute carrier family 10 member 2]], '''SeHCAT''': [[SeHCAT|Selenium homocholic acid taurine or tauroselcholic acid]], '''IEL''': Intraepithelial [[Lymphocyte|lymphocytes]], '''MRCP''': [[Magnetic resonance cholangiopancreatography]], '''ANA''': [[Antinuclear antibodies]], '''AMA''': [[Anti-mitochondrial antibody]], '''LDH''': [[Lactate dehydrogenase]], '''CPK''': [[Creatine phosphokinase]], '''PCR''': [[Polymerase chain reaction]], '''ELISA''': [[Enzyme linked immunosorbent assay (ELISA)|Enzyme–linked immunosorbent assay]], '''LT''': Heat–labile [[enterotoxin]], ST: Heat–stable [[enterotoxin]], '''RT-PCR''': Reverse–transcriptase [[polymerase chain reaction]], '''CD4:''' [[CD4|Cluster of differentiation 4]], '''HIV''': [[Human Immunodeficiency Virus (HIV)|Human immunodeficiency virus]], '''RUQ''': [[RUQ|Right-upper quadrant]], '''VIP''': [[Vasoactive intestinal peptide]], '''GI:''' [[Gastrointestinal tract|Gastrointestinal]], '''FAP''': [[Familial adenomatous polyposis]], '''HNPCC''': [[Hereditary nonpolyposis colorectal cancer]], '''MTP''': [[Microsomal triglyceride transfer protein]], '''Scl‑70''': Anti–[[Type I topoisomerase|topoisomerase I]], '''TSH''': [[Thyroid-stimulating hormone]], '''T4''': [[Thyroxine]], '''T3''': [[Triiodothyronine]], '''DTR''': [[Deep tendon reflex]], '''RNA''': [[RNA|Ribonucleic acid]]</span>  
  {| style="border: 0px; font-size: 90%; margin: 3px;" align=center
 
! style="background: #4479BA; padding: 5px 5px;" rowspan=2 | {{fontcolor|#FFFFFF|Pathogen}}
{| class="wikitable" style="border: 0px; font-size: 100%; margin: 3px;" align="center"
! style="background: #4479BA; padding: 5px 5px;" rowspan=2 | {{fontcolor|#FFFFFF|Transmission}}
! colspan="2" rowspan="5" style="background:#4479BA; color: #FFFFFF;" align="center" |Cause
! style="background: #4479BA; padding: 5px 5px;" colspan=4 | {{fontcolor|#FFFFFF|Clinical Manifestations}}
| colspan="9" style="background:#4479BA; color: #FFFFFF;" align="center" |'''Clinical manifestation'''
! colspan="9" rowspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" |'''Lab findings'''
! rowspan="5" style="background:#4479BA; color: #FFFFFF;" align="center" |Extra intestinal findings
! rowspan="5" style="background:#4479BA; color: #FFFFFF;" align="center" |Cause/Pathogenesis
! rowspan="5" style="background:#4479BA; color: #FFFFFF;" align="center" |Gold standard diagnosis
|-
! colspan="8" style="background:#4479BA; color: #FFFFFF;" align="center" |Symptoms
! rowspan="4" style="background:#4479BA; color: #FFFFFF;" align="center" |GI signs
|-
! colspan="2" rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Duration
! colspan="3" rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Diarrhea
! rowspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" |Fever
! rowspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" |Abdominal pain
! rowspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" |Weight loss
|-
! colspan="5" style="background:#4479BA; color: #FFFFFF;" align="center" |Stool exam
| colspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" |'''CBC'''
! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Other lab findings
|-
! style="background:#4479BA; color: #FFFFFF;" align="center" |Acute
! style="background:#4479BA; color: #FFFFFF;" align="center" |Chronic
! style="background:#4479BA; color: #FFFFFF;" align="center" |Watery
! style="background:#4479BA; color: #FFFFFF;" align="center" |Bloody
! style="background:#4479BA; color: #FFFFFF;" align="center" |Fatty
! style="background:#4479BA; color: #FFFFFF;" align="center" |WBC
! style="background:#4479BA; color: #FFFFFF;" align="center" |RBC
! style="background:#4479BA; color: #FFFFFF;" align="center" |Ova/Parasite
! style="background:#4479BA; color: #FFFFFF;" align="center" |Osmotic gap
! style="background:#4479BA; color: #FFFFFF;" align="center" |Other
! style="background:#4479BA; color: #FFFFFF;" align="center" |WBC
! style="background:#4479BA; color: #FFFFFF;" align="center" |Hgb
! style="background:#4479BA; color: #FFFFFF;" align="center" |Plt
|-
! colspan="2" rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Cause
! colspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Duration
! colspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" |Diarrhea
! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Fever
! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Abdominal pain
! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Weight loss
! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |GI signs
! colspan="5" style="background:#4479BA; color: #FFFFFF;" align="center" |Stool exam
! colspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" |CBC
! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Other lab findings
! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Extra intestinal findings
! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Cause/Pathogenesis
! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Gold standard diagnosis
|-
! style="background:#4479BA; color: #FFFFFF;" align="center" |Acute
! style="background:#4479BA; color: #FFFFFF;" align="center" |Chronic
! style="background:#4479BA; color: #FFFFFF;" align="center" |Watery
! style="background:#4479BA; color: #FFFFFF;" align="center" |Bloody
! style="background:#4479BA; color: #FFFFFF;" align="center" |Fatty
! style="background:#4479BA; color: #FFFFFF;" align="center" |WBC
! style="background:#4479BA; color: #FFFFFF;" align="center" |RBC
! style="background:#4479BA; color: #FFFFFF;" align="center" |Ova/Parasite
! style="background:#4479BA; color: #FFFFFF;" align="center" |Osmotic gap
! style="background:#4479BA; color: #FFFFFF;" align="center" |Other
! style="background:#4479BA; color: #FFFFFF;" align="center" |WBC
! style="background:#4479BA; color: #FFFFFF;" align="center" |Hgb
! style="background:#4479BA; color: #FFFFFF;" align="center" |Plt
|-
|-
! style="background: #4479BA; padding: 5px 5px;" | {{fontcolor|#FFFFFF|Fever}}
! colspan="2" style="background:#DCDCDC;" align="center" | [[Campylobacteriosis]]
! style="background: #4479BA; padding: 5px 5px;" | {{fontcolor|#FFFFFF|Nausea/Vomiting}}
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
! style="background: #4479BA; padding: 5px 5px;" | {{fontcolor|#FFFFFF|Abdominal Pain}}
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |–
! style="background: #4479BA; padding: 5px 5px;" | {{fontcolor|#FFFFFF|Bloody Stool}}
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |–
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |–
| style="padding: 5px 5px; background: #F5F5F5;" align="Left" |
*Diffuse [[abdominal tenderness]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
*Positive [[stool culture]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Nl
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Nl
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Nl
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
*[[Toxic megacolon]]
*[[Sepsis]]
*[[Arthritis]]
*[[Endocarditis]] 
*[[Guillain-Barré syndrome|Guillain–Barré syndrome]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
*[[Campylobacter jejuni|''Campylobacter jejuni'']]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
*[[Stool culture]]
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold;" | ''[[Salmonella]]''
! colspan="2" style="background:#DCDCDC;" align="center" |[[Salmonellosis]]
| style="padding: 5px 5px; background: #F5F5F5;" | Foodborne transmission, community-acquired
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
! style="padding: 5px 5px; background: #F5F5F5;" | ++
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
! style="padding: 5px 5px; background: #F5F5F5;" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
! style="padding: 5px 5px; background: #F5F5F5;" | ++
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
! style="padding: 5px 5px; background: #F5F5F5;" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| style="padding: 5px 5px; background: #F5F5F5;" align="Left" |
*[[Abdominal distention]]
*Diffuse [[abdominal tenderness]]
*[[Hepatosplenomegaly]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
*Positive [[stool culture]]
*Positive serologic testing
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
*[[Hypokalemia]]
*[[Hypernatremia]]
*[[Hyponatremia]]
* [[Hypercalciuria]]
* [[Hypocitraturia]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* [[Post-infectious arthritis|Post–infectious arthritis]]
* [[Obtundation]]
* [[Bacteremia]]
* [[Pericarditis]]
* [[Pyelonephritis]]
*[[Brain abscess]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
*[[Salmonella|''Salmonella'']]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
*[[Stool culture]]
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold;" | ''[[Shigella]]''
! colspan="2" style="background:#DCDCDC;" align="center" |[[Shigellosis]]
| style="padding: 5px 5px; background: #F5F5F5;" | Community-acquired, person-to-person
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
! style="padding: 5px 5px; background: #F5F5F5;" | ++
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |–
! style="padding: 5px 5px; background: #F5F5F5;" | ++
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
! style="padding: 5px 5px; background: #F5F5F5;" | ++
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
! style="padding: 5px 5px; background: #F5F5F5;" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |–
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |–
| style="padding: 5px 5px; background: #F5F5F5;" align="Left" |
* [[Abdominal distention]]
* Hyperactive [[Stomach rumble|bowel sounds]]
* Diffuse [[abdominal tenderness]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
*Positive [[stool culture]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑/↓
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↓
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↓
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
*Elevated [[C-reactive protein|CRP]]
*Elevated [[Erythrocyte sedimentation rate|ESR]]
*[[Hyponatremia]]
* [[Hypoglycemia]]
* [[Azotemia]] 
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* [[Headache]]
* [[Lethargy]]
* [[Seizures]]
* [[Delirium]]
* [[Post-infectious arthritis|Post–infectious arthritis]]
* [[Myocarditis]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
*[[Shigella|''Shigella'']]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
*[[Stool culture]]
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold;" | ''[[Campylobacter]]''
! colspan="2" rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Cause
| style="padding: 5px 5px; background: #F5F5F5;" | Community-acquired, ingestion of undercooked poultry
! colspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Duration
! style="padding: 5px 5px; background: #F5F5F5;" | ++
! colspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" |Diarrhea
! style="padding: 5px 5px; background: #F5F5F5;" | +
! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Fever
! style="padding: 5px 5px; background: #F5F5F5;" | ++
! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Abdominal pain
! style="padding: 5px 5px; background: #F5F5F5;" | +
! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Weight loss
! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |GI signs
! colspan="5" style="background:#4479BA; color: #FFFFFF;" align="center" |Stool exam
! colspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" |CBC
! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Other lab findings
! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Extra intestinal findings
! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Cause/Pathogenesis
! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Gold standard diagnosis
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold;" | ''Escherichia coli''
! style="background:#4479BA; color: #FFFFFF;" align="center" |Acute
| style="padding: 5px 5px; background: #F5F5F5;" | Foodborne transmission, ingestion of undercooked hamburger meat
! style="background:#4479BA; color: #FFFFFF;" align="center" |Chronic
! style="padding: 5px 5px; background: #F5F5F5;" | -
! style="background:#4479BA; color: #FFFFFF;" align="center" |Watery
! style="padding: 5px 5px; background: #F5F5F5;" | +
! style="background:#4479BA; color: #FFFFFF;" align="center" |Bloody
! style="padding: 5px 5px; background: #F5F5F5;" | ++
! style="background:#4479BA; color: #FFFFFF;" align="center" |Fatty
! style="padding: 5px 5px; background: #F5F5F5;" | + (EHEC or EIEC), - (ETEC, EAEC, EPEC)
! style="background:#4479BA; color: #FFFFFF;" align="center" |WBC
! style="background:#4479BA; color: #FFFFFF;" align="center" |RBC
! style="background:#4479BA; color: #FFFFFF;" align="center" |Ova/Parasite
! style="background:#4479BA; color: #FFFFFF;" align="center" |Osmotic gap
! style="background:#4479BA; color: #FFFFFF;" align="center" |Other
! style="background:#4479BA; color: #FFFFFF;" align="center" |WBC
! style="background:#4479BA; color: #FFFFFF;" align="center" |Hgb
! style="background:#4479BA; color: #FFFFFF;" align="center" |Plt
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold;" | ''[[Clostridium difficile]]''
! rowspan="3" style="background:#DCDCDC;" align="center" |[[Escherichia coli enteritis]]
| style="padding: 5px 5px; background: #F5F5F5;" | Nosocomial spread, antibiotic use
| style="background:#DCDCDC;" align="center" |[[ETEC|'''ETEC''']]
! style="padding: 5px 5px; background: #F5F5F5;" | +
([[Traveler's diarrhea]])
! style="padding: 5px 5px; background: #F5F5F5;" | ±
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
! style="padding: 5px 5px; background: #F5F5F5;" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
! style="padding: 5px 5px; background: #F5F5F5;" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| style="padding: 5px 5px; background: #F5F5F5;" align="Left" |
*Diffuse [[abdominal tenderness]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |–
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
*Positive [[stool culture]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Nl
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Nl
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |–
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |–
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
*[[Escherichia coli|''Enterotoxigenic escherichia coli'']]
*[[Enterotoxin|Enterotoxins]]:
**Heat–labile [[enterotoxin]] (LT)
**Heat–stable [[enterotoxin]] (ST)
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
*[[Stool culture]]
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold;" | ''[[Yersinia]]''
| style="background:#DCDCDC;" align="center" |[[EIEC|'''EIEC''']]
| style="padding: 5px 5px; background: #F5F5F5;" | Community-acquired, foodborne transmission
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
! style="padding: 5px 5px; background: #F5F5F5;" | ++
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |–
! style="padding: 5px 5px; background: #F5F5F5;" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
! style="padding: 5px 5px; background: #F5F5F5;" | ++
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
! style="padding: 5px 5px; background: #F5F5F5;" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |–
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |–
| style="padding: 5px 5px; background: #F5F5F5;" align="Left" |
*Diffuse [[abdominal tenderness]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
*Positive [[stool culture]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Nl
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Nl
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |–
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |–
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
*[[Escherichia coli enteritis|''Enteroinvasive E. coli'']]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
*[[Hybridization probe|DNA probe]]
*[[Stool culture]]
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold;" | ''[[Entamoeba histolytica]]''
| style="background:#DCDCDC;" align="center" |[[EAEC|'''EAEC''']]
| style="padding: 5px 5px; background: #F5F5F5;" | Travel to or emigration from tropical regions
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
! style="padding: 5px 5px; background: #F5F5F5;" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
! style="padding: 5px 5px; background: #F5F5F5;" | ±
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
! style="padding: 5px 5px; background: #F5F5F5;" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
! style="padding: 5px 5px; background: #F5F5F5;" | ±
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| style="padding: 5px 5px; background: #F5F5F5;" align="Left" |
*Diffuse [[abdominal tenderness]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
*Positive [[stool culture]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↓
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↓
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |–
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
*Chronic infection in [[Immunodeficiency|immunocompromised]] patients
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
*[[Escherichia coli enteritis|''Enteroaggregative E. coli'']]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
*[[Stool culture]]
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold;" | ''[[Aeromonas]]''
! colspan="2" style="background:#DCDCDC;" align="center" |[[Yersinia enterocolitica]]
| style="padding: 5px 5px; background: #F5F5F5;" | Ingestion of contaminated water
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
! style="padding: 5px 5px; background: #F5F5F5;" | ++
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
! style="padding: 5px 5px; background: #F5F5F5;" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
! style="padding: 5px 5px; background: #F5F5F5;" | ++
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
! style="padding: 5px 5px; background: #F5F5F5;" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| style="padding: 5px 5px; background: #F5F5F5;" align="Left" |
* [[Abdominal distention]]
* Hyperactive [[Stomach rumble|bowel sounds]]
* Diffuse [[abdominal tenderness]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
*Positive [[stool culture]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |–
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
*[[Bacteremia]]
*[[Reactive arthritis]]
*[[Glomerulonephritis]]
*[[Endocarditis]]
*[[Erythema nodosum]]
*[[Abscess]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
*[[Yersinia enterocolitica|''Yersinia enterocolitica'']]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
*[[Stool culture]]
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold;" | ''[[Plesiomonas]]''
! colspan="2" rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Cause
| style="padding: 5px 5px; background: #F5F5F5;" | Ingestion of contaminated water or undercooked shellfish, travel to tropical regions
! colspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Duration
! style="padding: 5px 5px; background: #F5F5F5;" | ±
! colspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" |Diarrhea
! style="padding: 5px 5px; background: #F5F5F5;" | ++
! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Fever
! style="padding: 5px 5px; background: #F5F5F5;" | +
! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Abdominal pain
! style="padding: 5px 5px; background: #F5F5F5;" | +
! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Weight loss
! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |GI signs
! colspan="5" style="background:#4479BA; color: #FFFFFF;" align="center" |Stool exam
! colspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" |CBC
! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Other lab findings
! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Extra intestinal findings
! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Cause/Pathogenesis
! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Gold standard diagnosis
|-
! style="background:#4479BA; color: #FFFFFF;" align="center" |Acute
! style="background:#4479BA; color: #FFFFFF;" align="center" |Chronic
! style="background:#4479BA; color: #FFFFFF;" align="center" |Watery
! style="background:#4479BA; color: #FFFFFF;" align="center" |Bloody
! style="background:#4479BA; color: #FFFFFF;" align="center" |Fatty
! style="background:#4479BA; color: #FFFFFF;" align="center" |WBC
! style="background:#4479BA; color: #FFFFFF;" align="center" |RBC
! style="background:#4479BA; color: #FFFFFF;" align="center" |Ova/Parasite
! style="background:#4479BA; color: #FFFFFF;" align="center" |Osmotic gap
! style="background:#4479BA; color: #FFFFFF;" align="center" |Other
! style="background:#4479BA; color: #FFFFFF;" align="center" |WBC
! style="background:#4479BA; color: #FFFFFF;" align="center" |Hgb
! style="background:#4479BA; color: #FFFFFF;" align="center" |Plt
|-
! colspan="2" style="background:#DCDCDC;" align="center" |[[Vibrio cholerae|Vibrio cholera]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| style="padding: 5px 5px; background: #F5F5F5;" align="Left" |
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |–
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
*Positive [[stool culture]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Nl
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Nl
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
*[[Azotemia]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
*Severe [[dehydration]]
*Decreased [[Turgor|skin turgor]]
*[[Oliguria]]
*[[Renal insufficiency|Renal failure]]
*[[Cramp|Muscle cramps]]
*[[Seizure]]
*[[Somnolence]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
*[[Cholera toxin]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
*[[Stool culture]]
|-
! colspan="2" style="background:#DCDCDC;" align="center" |[[Aeromonas]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| style="padding: 5px 5px; background: #F5F5F5;" align="Left" |
* [[Abdominal distention]]
* Hyperactive [[Stomach rumble|bowel sounds]]
* Diffuse [[abdominal tenderness]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
*Positive [[stool culture]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |–
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
*Wound [[infection]]
*[[Bacteremia]]
*[[Hemolytic-uremic syndrome|Hemolytic uremic syndrome]] 
*[[Meningitis]]
*[[Ocular]] infection
*[[Pneumonia]] 
*[[Urinary tract infection]]
*[[Osteomyelitis]]
*[[Peritonitis]]
*[[Acute cholecystitis]]
*[[Opportunistic infection|Opportunistic infections]] in [[Immunodeficiency|immunocompromised]] patients
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
*''[[Aeromonas]]'' virulence factors including [[Endotoxin|endotoxins]], [[Hemolysin|hemolysins]], [[Enterotoxin|enterotoxins]], and adherence factors
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
*[[Blood culture]]
*Wound [[Culture collection|culture]]
|-
! colspan="2" style="background:#DCDCDC;" align="center" |[[Norovirus]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| style="padding: 5px 5px; background: #F5F5F5;" align="Left" |
*[[Abdominal distension|Abdominal distention]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
*Positive stool reverse–transcriptase [[polymerase chain reaction]] (RT–PCR)
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↓
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |–
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
*[[Myalgia]]
*[[Headache]] 
*[[Seizure]] 
*[[Encephalopathy]] 
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
*[[Norovirus|''Norovirus'']]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
*Clinical diagnosis
|-
! colspan="2" style="background:#DCDCDC;" align="center" |[[Rotavirus]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| style="padding: 5px 5px; background: #F5F5F5;" align="Left" |
* Hyperactive [[Stomach rumble|bowel sounds]]
* Diffuse [[abdominal tenderness]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |–
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
*Elevated [[blood urea nitrogen]]
*[[Hyperchloremic acidosis]]
*[[Hypocalcemia]] 
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
*[[Necrotizing enterocolitis]]
*[[Intussusception]] 
*[[Biliary atresia]]
*[[Central nervous system]] involvement
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
*[[Rotavirus|''Rotavirus'']]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
*Stool immune–based assays
|-
! colspan="2" rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Cause
! colspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Duration
! colspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" |Diarrhea
! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Fever
! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Abdominal pain
! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Weight loss
! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |GI signs
! colspan="5" style="background:#4479BA; color: #FFFFFF;" align="center" |Stool exam
! colspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" |CBC
! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Other lab findings
! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Extra intestinal findings
! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Cause/Pathogenesis
! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Gold standard diagnosis
|-
! style="background:#4479BA; color: #FFFFFF;" align="center" |Acute
! style="background:#4479BA; color: #FFFFFF;" align="center" |Chronic
! style="background:#4479BA; color: #FFFFFF;" align="center" |Watery
! style="background:#4479BA; color: #FFFFFF;" align="center" |Bloody
! style="background:#4479BA; color: #FFFFFF;" align="center" |Fatty
! style="background:#4479BA; color: #FFFFFF;" align="center" |WBC
! style="background:#4479BA; color: #FFFFFF;" align="center" |RBC
! style="background:#4479BA; color: #FFFFFF;" align="center" |Ova/Parasite
! style="background:#4479BA; color: #FFFFFF;" align="center" |Osmotic gap
! style="background:#4479BA; color: #FFFFFF;" align="center" |Other
! style="background:#4479BA; color: #FFFFFF;" align="center" |WBC
! style="background:#4479BA; color: #FFFFFF;" align="center" |Hgb
! style="background:#4479BA; color: #FFFFFF;" align="center" |Plt
|-
! colspan="2" style="background:#DCDCDC;" align="center" |[[Entamoeba histolytica]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |–
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |–
| style="padding: 5px 5px; background: #F5F5F5;" align="Left" |
*[[Abdominal distension|Abdominal distention]]
*Diffuse [[Tenderness (medicine)|abdominal tenderness]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |–
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |–
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
*[[Liver abscess]]
*Pleuropulmonary infection
*[[Cardiac]] [[infection]]
*[[Brain abscess]]
*[[Skin and soft-tissue infections|Cutaneous infection]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
*[[Entamoeba histolytica|''Entamoeba histolytica'']]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
*Antigen testing
*Serology 
|-
! colspan="2" style="background:#DCDCDC;" align="center" |[[Giardia lamblia|Giardia]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |–
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |–
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="Left" |
*[[Abdominal distension|Abdominal distention]]
*Diffuse [[Tenderness (medicine)|abdominal tenderness]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |–
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |–
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |–
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Nl
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Nl
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Nl
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |–
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
*[[Malabsorption]]
*[[Urticaria]]
*[[Depression]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
*''[[Giardia lamblia]]''
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
*Antigen detection assays
|-
! colspan="2" style="background:#DCDCDC;" align="center" |[[Cryptosporidium]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | –
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |–
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |–
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |–
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="Left" |
*[[Abdominal distension|Abdominal distention]]
*Diffuse [[Tenderness (medicine)|abdominal tenderness]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |–
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |–
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Nl
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
*Positive stool microscopy
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Nl
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Nl
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Nl
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
*Elevated [[alkaline phosphatase]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
*Chronic, life–threatening illness in [[Immunodeficiency|immunocompromised]] patients
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
*[[Cryptosporidium|''Cryptosporidium'']]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
*Polymerase chain reaction
|- }
|}
|}


===Non-infectious Differential Diagnoses===
==References==
The following are the non-infectious differential diagnoses of ''E. coli enteritis'':
{{Reflist|2}}
*[[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 ==
{{reflist|2}}
{{WH}}
{{WS}}
[[Category:Gastroenterology]]
[[Category:Foodborne illnesses]]
[[Category:Water-borne diseases]]
[[Category:Infectious disease]]
[[Category:Emergency medicine]]
[[Category:Disease]]
 
[[Category:Needs content]]

Latest revision as of 17:13, 11 April 2018

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sadaf Sharfaei M.D.[2], Seyedmahdi Pahlavani, M.D. [3]

Traveler's Diarrhea Differential Diagnosis

The following table outlines the major differential diagnoses of traveler's diarrhea.[1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30]

Abbreviations: GI: Gastrointestinal, CBC: Complete blood count, WBC: White blood cell, RBC: Red blood cell, Plt: Platelet, Hgb: Hemoglobin, ESR: Erythrocyte sedimentation rate, CRP: C–reactive protein, IgE: Immunoglobulin E, IgA: Immunoglobulin A, ETEC: Escherichia coli enteritis, EPEC: Enteropathogenic Escherichia coli, EIEC: Enteroinvasive Escherichia coli, EHEC: Enterohemorrhagic Escherichia coli, EAEC: Enteroaggregative Escherichia coli, Nl: Normal, ASCA: Anti saccharomyces cerevisiae antibodies, ANCA: Anti–neutrophil cytoplasmic antibody, DNA: Deoxyribonucleic acid, CFTR: Cystic fibrosis transmembrane conductance regulator, SLC10A2: Solute carrier family 10 member 2, SeHCAT: Selenium homocholic acid taurine or tauroselcholic acid, IEL: Intraepithelial lymphocytes, MRCP: Magnetic resonance cholangiopancreatography, ANA: Antinuclear antibodies, AMA: Anti-mitochondrial antibody, LDH: Lactate dehydrogenase, CPK: Creatine phosphokinase, PCR: Polymerase chain reaction, ELISA: Enzyme–linked immunosorbent assay, LT: Heat–labile enterotoxin, ST: Heat–stable enterotoxin, RT-PCR: Reverse–transcriptase polymerase chain reaction, CD4: Cluster of differentiation 4, HIV: Human immunodeficiency virus, RUQ: Right-upper quadrant, VIP: Vasoactive intestinal peptide, GI: Gastrointestinal, FAP: Familial adenomatous polyposis, HNPCC: Hereditary nonpolyposis colorectal cancer, MTP: Microsomal triglyceride transfer protein, Scl‑70: Anti–topoisomerase I, TSH: Thyroid-stimulating hormone, T4: Thyroxine, T3: Triiodothyronine, DTR: Deep tendon reflex, RNA: Ribonucleic acid

Cause Clinical manifestation Lab findings Extra intestinal findings Cause/Pathogenesis Gold standard diagnosis
Symptoms GI signs
Duration Diarrhea Fever Abdominal pain Weight loss
Stool exam CBC Other lab findings
Acute Chronic Watery Bloody Fatty WBC RBC Ova/Parasite Osmotic gap Other WBC Hgb Plt
Cause Duration Diarrhea Fever Abdominal pain Weight loss GI signs Stool exam CBC Other lab findings Extra intestinal findings Cause/Pathogenesis Gold standard diagnosis
Acute Chronic Watery Bloody Fatty WBC RBC Ova/Parasite Osmotic gap Other WBC Hgb Plt
 Campylobacteriosis + – + + – + + – + + – Nl ↑ Nl Nl Nl
Salmonellosis + + + + – + + – + + – Nl ↑ Nl ↑
Shigellosis + – + + – + + – + + – Nl ↑/↓ ↓ ↓
Cause Duration Diarrhea Fever Abdominal pain Weight loss GI signs Stool exam CBC Other lab findings Extra intestinal findings Cause/Pathogenesis Gold standard diagnosis
Acute Chronic Watery Bloody Fatty WBC RBC Ova/Parasite Osmotic gap Other WBC Hgb Plt
Escherichia coli enteritis ETEC

(Traveler's diarrhea)

+ – + – – + – – + – – Nl ↑ Nl Nl – –
EIEC + – + + – + + – + + – Nl ↑ Nl Nl – –
EAEC + + + + – – + – + + – Nl ↑ ↓ ↓ –
Yersinia enterocolitica + – + + – + + – + + – Nl ↑ Nl Nl –
Cause Duration Diarrhea Fever Abdominal pain Weight loss GI signs Stool exam CBC Other lab findings Extra intestinal findings Cause/Pathogenesis Gold standard diagnosis
Acute Chronic Watery Bloody Fatty WBC RBC Ova/Parasite Osmotic gap Other WBC Hgb Plt
Vibrio cholera + – + – – – + – + – – Nl ↑ Nl Nl
Aeromonas + + + + – + + – + + – Nl ↑ Nl Nl –
Norovirus + – + – – + + – – – – Nl ↓ Nl Nl –
  • Clinical diagnosis
Rotavirus + – + – – + – – + – – Nl – Nl Nl Nl
  • Stool immune–based assays
Cause Duration Diarrhea Fever Abdominal pain Weight loss GI signs Stool exam CBC Other lab findings Extra intestinal findings Cause/Pathogenesis Gold standard diagnosis
Acute Chronic Watery Bloody Fatty WBC RBC Ova/Parasite Osmotic gap Other WBC Hgb Plt
Entamoeba histolytica + + + + – + + – + + + Nl – ↑ Nl Nl –
  • Antigen testing
  • Serology 
Giardia – + + – + – + + – – + Nl – Nl Nl Nl –
  • Antigen detection assays
Cryptosporidium – + + – – – + + – – + Nl
  • Positive stool microscopy
 Nl Nl Nl
  • Polymerase chain reaction

References

  1. ↑ Casburn-Jones, Anna C; Farthing, Michael Jg (2004). "Traveler's diarrhea". Journal of Gastroenterology and Hepatology. 19 (6): 610–618. doi:10.1111/j.1440-1746.2003.03287.x. ISSN 0815-9319.
  2. ↑ Kamat, Deepak; Mathur, Ambika (2006). "Prevention and Management of Travelers' Diarrhea". Disease-a-Month. 52 (7): 289–302. doi:10.1016/j.disamonth.2006.08.003. ISSN 0011-5029.
  3. ↑ Pfeiffer, Margaret L.; DuPont, Herbert L.; Ochoa, Theresa J. (2012). "The patient presenting with acute dysentery – A systematic review". Journal of Infection. 64 (4): 374–386. doi:10.1016/j.jinf.2012.01.006. ISSN 0163-4453.
  4. ↑ Barr W, Smith A (2014). "Acute diarrhea". Am Fam Physician. 89 (3): 180–9. PMID 24506120.
  5. ↑ Amil Dias J (2017). "Celiac Disease: What Do We Know in 2017?". GE Port J Gastroenterol. 24 (6): 275–278. doi:10.1159/000479881. PMID 29255768.
  6. ↑ Kotloff KL, Riddle MS, Platts-Mills JA, Pavlinac P, Zaidi A (2017). "Shigellosis". Lancet. doi:10.1016/S0140-6736(17)33296-8. PMID 29254859. Vancouver style error: initials (help)
  7. ↑ Yamamoto-Furusho, J.K.; Bosques-Padilla, F.; de-Paula, J.; Galiano, M.T.; Ibañez, P.; Juliao, F.; Kotze, P.G.; Rocha, J.L.; Steinwurz, F.; Veitia, G.; Zaltman, C. (2017). "Diagnóstico y tratamiento de la enfermedad inflamatoria intestinal: Primer Consenso Latinoamericano de la Pan American Crohn's and Colitis Organisation". Revista de Gastroenterología de México. 82 (1): 46–84. doi:10.1016/j.rgmx.2016.07.003. ISSN 0375-0906.
  8. ↑ Borbély, Yves M; Osterwalder, Alice; Kröll, Dino; Nett, Philipp C; Inglin, Roman A (2017). "Diarrhea after bariatric procedures: Diagnosis and therapy". World Journal of Gastroenterology. 23 (26): 4689. doi:10.3748/wjg.v23.i26.4689. ISSN 1007-9327.
  9. ↑ Crawford, Sue E.; Ramani, Sasirekha; Tate, Jacqueline E.; Parashar, Umesh D.; Svensson, Lennart; Hagbom, Marie; Franco, Manuel A.; Greenberg, Harry B.; O'Ryan, Miguel; Kang, Gagandeep; Desselberger, Ulrich; Estes, Mary K. (2017). "Rotavirus infection". Nature Reviews Disease Primers. 3: 17083. doi:10.1038/nrdp.2017.83. ISSN 2056-676X.
  10. ↑ Kist M (2000). "[Chronic diarrhea: value of microbiology in diagnosis]". Praxis (Bern 1994) (in German). 89 (39): 1559–65. PMID 11068510.
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  13. ↑ Wahnschaffe, Ulrich; Ignatius, Ralf; Loddenkemper, Christoph; Liesenfeld, Oliver; Muehlen, Marion; Jelinek, Thomas; Burchard, Gerd Dieter; Weinke, Thomas; Harms, Gundel; Stein, Harald; Zeitz, Martin; Ullrich, Reiner; Schneider, Thomas (2009). "Diagnostic value of endoscopy for the diagnosis of giardiasis and other intestinal diseases in patients with persistent diarrhea from tropical or subtropical areas". Scandinavian Journal of Gastroenterology. 42 (3): 391–396. doi:10.1080/00365520600881193. ISSN 0036-5521.
  14. ↑ Mena Bares LM, Carmona Asenjo E, García Sánchez MV, Moreno Ortega E, Maza Muret FR, Guiote Moreno MV, Santos Bueno AM, Iglesias Flores E, Benítez Cantero JM, Vallejo Casas JA (2017). "75SeHCAT scan in bile acid malabsorption in chronic diarrhoea". Rev Esp Med Nucl Imagen Mol. 36 (1): 37–47. doi:10.1016/j.remn.2016.08.005. PMID 27765536.
  15. ↑ Gibson RJ, Stringer AM (2009). "Chemotherapy-induced diarrhoea". Curr Opin Support Palliat Care. 3 (1): 31–5. doi:10.1097/SPC.0b013e32832531bb. PMID 19365159.
  16. ↑ Abraham BP, Sellin JH (2012). "Drug-induced, factitious, & idiopathic diarrhoea". Best Pract Res Clin Gastroenterol. 26 (5): 633–48. doi:10.1016/j.bpg.2012.11.007. PMID 23384808.
  17. ↑ Reintam Blaser A, Deane AM, Fruhwald S (2015). "Diarrhoea in the critically ill". Curr Opin Crit Care. 21 (2): 142–53. doi:10.1097/MCC.0000000000000188. PMID 25692805.
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  19. ↑ Schiller LR (2012). "Definitions, pathophysiology, and evaluation of chronic diarrhoea". Best Pract Res Clin Gastroenterol. 26 (5): 551–62. doi:10.1016/j.bpg.2012.11.011. PMID 23384801.
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  21. ↑ Silverberg MS, Satsangi J, Ahmad T, Arnott ID, Bernstein CN, Brant SR; et al. (2005). "Toward an integrated clinical, molecular and serological classification of inflammatory bowel disease: report of a Working Party of the 2005 Montreal World Congress of Gastroenterology". Can J Gastroenterol. 19 Suppl A: 5A–36A. PMID 16151544.
  22. ↑ Sauter GH, Moussavian AC, Meyer G, Steitz HO, Parhofer KG, Jüngst D (2002). "Bowel habits and bile acid malabsorption in the months after cholecystectomy". Am J Gastroenterol. 97 (7): 1732–5. doi:10.1111/j.1572-0241.2002.05779.x. PMID 12135027.
  23. ↑ Maiuri L, Raia V, Potter J, Swallow D, Ho MW, Fiocca R; et al. (1991). "Mosaic pattern of lactase expression by villous enterocytes in human adult-type hypolactasia". Gastroenterology. 100 (2): 359–69. PMID 1702075.
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  30. ↑ BLACK-SCHAFFER B (1949). "The tinctoral demonstration of a glycoprotein in Whipple's disease". Proc Soc Exp Biol Med. 72 (1): 225–7. PMID 15391722.
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