Traveler's diarrhea differential diagnosis
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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:
- Acute pancreatitis
- Adrenal insufficiency and Waterhouse-Friedrichsen syndrome
- Allergy (e.g. insect bite allergy or anaphylaxis)
- Appendicitis
- Bowel obstruction
- Celiac disease
- 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
- Lactose intolerance
- Lymphoma
- Mesenteric ischemia
- Necrotizing enterocolitis
- Ogilvie syndrome
- Peritonitis
- Pneumonia
- Poisoning and toxicity (e.g. carbon monoxide poisoning, organophosphate poisoning, digitoxin toxicity)
- Ruptured abdominal aortic aneurysm
- Spider bite
- Tropical sprue
- Volvulus
- Urinary tract infection
- Whipple disease
To view a comprehensive list of abdominal pain differential diagnoses, click here.
To view a comprehensive list of diarrhea differential diagnoses, click here.
References
- ↑ Thielman NM, Guerrant RL (2004). "Clinical practice. Acute infectious diarrhea". N Engl J Med. 350 (1): 38–47. doi:10.1056/NEJMcp031534. PMID 14702426.
- ↑ 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.