Acute diarrhea differential diagnosis

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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]

Overview

The differentials of acute diarrhea include Ischemic colitis, Lactose intolerance, Tropical sprue, Pseudomembranous enterocolitis, Campylobacteriosis, Salmonellosis, Shigellosis, Escherichia coli enteritis, Yersinia enterocolitica, Vibrio cholera, Aeromonas, Plesiomonas, Staphylococcus aureus, Bacillus cereus, Clostridium perfringens, Rotavirus, Norovirus, Adenovirus, Entamoeba histolytica, medications, Short bowel syndrome, Organophosphate poisoning, Radiation enteritis and Opium withdrawal.

Differential Diagnosis of Acute Diarrhea from other diseases

The following table outlines the major differential diagnoses of acute 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 phosphokinasePCR: 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
Ischemic colitis + + + + + + + + + Nl
Lactose intolerance + + + + Nl Nl Nl
  • Lactose tolerance test
  • Genetic testing
  • Reduction of lactase enzyme activity or inability to produce persistent lactase
  • Congenital lactase deficiency
  • Secondary lactose malabsorption
Tropical sprue + + + + + + + + Nl Nl Nl
  • Diagnosis of exclusion
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
Pseudomembranous enterocolitis + + ± + + ± + + Nl
 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
EPEC + + + + + + + + + Nl Nl Nl
EIEC + + + + + + + Nl Nl Nl
EHEC + + + + + + Nl
EAEC + + + + + + + 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
Yersinia enterocolitica + + + + + + + Nl Nl Nl
Vibrio cholera + + + + Nl Nl Nl
Aeromonas + + + + + + + + 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
Plesiomonas + + + + + + + Nl Nl Nl
Mycobacterium avium complex + + + + + + + + Nl Nl
Food poisoning + + ± + + ± + ± Nl Nl Nl
  • History of travel or ingestion of infected food
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
Norovirus + + + + Nl Nl Nl
  • Clinical diagnosis
Rotavirus + + + + Nl Nl Nl Nl
  • Stool immune–based assays
Echovirus + + + + Nl Nl Nl Nl
  • Clinical diagnosis
Adenovirus + + + + Nl
  • Viral antigen assay
Nl Nl Nl
  • Clinical diagnosis
CMV colitis + + + ± + + + Nl
  • Viral antigen assay
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
Entamoeba histolytica + + + + + + + + + Nl Nl Nl
  • Antigen testing
  • Serology 
Microsporidia + + + + + + Nl
  • Positive stool microscopy
Nl Nl Nl
  • Decreased CD4 count
  • Antigen detection assays
Isospora + + + + + + + + + + Nl Nl Nl
  • Detecting oocysts in the feces
VIPoma + + + + + + Nl Nl Nl
  • Primary secretory tumor
  • Blood VIP levels
  • Followed by imaging
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
Medications + + + ± ± + + ↑/↓ Nl Nl
  • Elevated plasma level of drug
  • Clinical evaluation after discontinuation of the drugs
Factitious diarrhea + + + + + ↑/↓ Nl Nl Nl
  • Clinical evaluation after discontinuation of the drugs
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
Organophosphate poisoning + + + + Nl Nl Nl Nl
  • Clinical diagnosis
Opium withdrawal + + + + Nl Nl Nl Nl
Short bowel syndrome + + + + + Nl Nl
Radiation enteritis + + + + + + + + + Nl Nl Nl

References

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