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Sections Bacterial Gastroenteritis
- Overview
- Presentation
- DDx
- Workup
- Treatment
- Medication
- Tables
- References
Diagnostic Considerations
Conditions to consider in the differential diagnosis of bacterial gastroenteritis include the following:
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Colovesical fistula
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Cholera
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Diverticulitis
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Food allergies
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Food poisoning
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Gardnerella
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Viral gastroenteritis
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Giardiasis
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Isosporiasis
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Lower gastrointestinal bleeding
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Meckel diverticulum
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Microsporidiosis
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Salmonellosis
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Shigellosis
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Short-bowel syndrome
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Ulcerative colitis
Differential Diagnoses
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Guandalini S, Pensabene L, Zikri MA, et al. Lactobacillus GG administered in oral rehydration solution to children with acute diarrhea: a multicenter European trial. J Pediatr Gastroenterol Nutr. 2000 Jan. 30(1):54-60. [Medline].
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Duggan C, Nurko S. "Feeding the gut": the scientific basis for continued enteral nutrition during acute diarrhea. J Pediatr. 1997 Dec. 131(6):801-8. [Medline].
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Salminen S, Isolauri E, Onnela T. Gut flora in normal and disordered states. Chemotherapy. 1995. 41 suppl 1:5-15. [Medline].
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Marks MI. Infectious diarrhea: introduction and commentary. Pediatr Ann. 1994 Oct. 23(10):526-7. [Medline].
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Liebelt EL. Clinical and laboratory evaluation and management of children with vomiting, diarrhea, and dehydration. Curr Opin Pediatr. 1998 Oct. 10(5):461-9. [Medline].
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Hamer DH, Gorbach SL. Infectious diarrhea and bacterial food poisoning. Feldman M, Scharschmidt BF, Sleisenger MH, eds. Sleisinger and Fordtran’s Gastrointestinaland Liver Disease. 6th ed. Philadelphia, Pa: WB Saunders; 1998. 1594-1632.
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Xu F, Gonzalez-Escalona N, Haendiges J, et al. Vibrio parahaemolyticus sequence type 631, an emerging foodborne pathogen in North America. J Clin Microbiol. 2016 Dec 14. [Medline].
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Cadle RM, Mansouri MD, Logan N, Kudva DR, Musher DM. Association of proton-pump inhibitors with outcomes in Clostridium difficile colitis. Am J Health Syst Pharm. 2007 Nov 15. 64(22):2359-63. [Medline].
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Wei L, Ratnayake L, Phillips G, et al. Acid suppression medications and bacterial gastroenteritis: a population-based cohort study. Br J Clin Pharmacol. 2017 Jan 5. 27 (1):40-51. [Medline].
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Steffen R, Collard F, Tornieporth N, et al. Epidemiology, etiology, and impact of traveler's diarrhea in Jamaica. JAMA. 1999 Mar 3. 281(9):811-7. [Medline]. [Full Text].
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Streit JM, Jones RN, Toleman MA, Stratchounski LS, Fritsche TR. Prevalence and antimicrobial susceptibility patterns among gastroenteritis-causing pathogens recovered in Europe and Latin America and Salmonella isolates recovered from bloodstream infections in North America and Latin America: report from the SENTRY Antimicrobial Surveillance Program (2003). Int J Antimicrob Agents. 2006 May. 27(5):367-75. [Medline].
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Vital Signs: Preventing Clostridium difficile Infections. MMWR Morb Mortal Wkly Rep. 2012 Mar 9. 61:157-62. [Medline].
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World Health Organization. Cholera: fact sheet no. 107. November 2008. Available at http://www.who.int/mediacentre/factsheets/fs107/en/. Accessed: February 19, 2009.
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May FJ, Polkinghorne BG, Fearnley EJ. Epidemiology of bacterial toxin-mediated foodborne gastroenteritis outbreaks in Australia, 2001 to 2013. Commun Dis Intell Q Rep. 2016 Dec 24. 40 (4):E460-E469. [Medline].
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Lee LA, Gerber AR, Lonsway DR, et al. Yersinia enterocolitica O:3 infections in infants and children, associated with the household preparation of chitterlings. N Engl J Med. 1990 Apr 5. 322(14):984-7. [Medline].
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Centers for Disease Control and Prevention. Yersinia enterocolitica. October 25, 2005. Available at http://www.cdc.gov/ncidod/dbmd/diseaseinfo/yersinia_g.htm. Accessed: February 18, 2009.
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Centers for Disease Control and Prevention (CDC). Deaths from gastroenteritis double. Available at http://www.cdc.gov/media/releases/2012/p0314_gastroenteritis.html.
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Garcia Rodriguez LA, Ruigomez A, Panes J. Acute gastroenteritis is followed by an increased risk of inflammatory bowel disease. Gastroenterology. 2006 May. 130(6):1588-94. [Medline].
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Calbo E, Freixas N, Xercavins M, et al. Foodborne nosocomial outbreak of SHV1 and CTX-M-15-producing Klebsiella pneumoniae: epidemiology and control. Clin Infect Dis. 2011 Mar. 52(6):743-9. [Medline].
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Biswas JS, Al-Ali A, Rajput P, Smith D, Goldenberg SD. A parallel diagnostic accuracy study of three molecular panels for the detection of bacterial gastroenteritis. Eur J Clin Microbiol Infect Dis. 2014 Nov. 33 (11):2075-81. [Medline].
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Humphries RM, Linscott AJ. Laboratory diagnosis of bacterial gastroenteritis. Clin Microbiol Rev. 2015 Jan. 28 (1):3-31. [Medline].
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World Health Organization. Drug-resistant Salmonella: fact sheet no. 139. Revised April 2005. Available at http://www.who.int/mediacentre/factsheets/fs139/en/. Accessed: February 19, 2009.
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Sullivan PB. Nutritional management of acute diarrhea. Nutrition. 1998 Oct. 14(10):758-62. [Medline].
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Brooks M. FDA clears novel test for infectious gastroenteritis. Medscape Medical News. January 15, 2013. Available at http://www.medscape.com/viewarticle/777671. Accessed: February 9, 2013.
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Tables
| Stool Characteristics | Small Bowel | Large Bowel |
| Appearance | Watery | Mucus and/or blood |
| Volume | Large | Small |
| Frequency | Increased | Increased |
| Blood | Possibly heme-positive but never gross blood | Possibly grossly bloody |
| pH | Possibly < 5.5 | >5.5 |
| Reducing substances | Possibly positive | Negative |
| White blood cell (WBC) count | <5/high-power field (HPF) | Possibly >10/HPF |
| Serum WBC count | Normal | Possible leukocytosis, bandemia |
| Organisms |
Preformed toxins:
Bacillus species, Staphylococcus aureus |
Invasive bacteria:
E coli and Shigella, Salmonella, Campylobacter, Yersinia, Aeromonas, and Plesiomonas species |
|
Toxic bacteria:
E coli, cholera, C perfringens, Vibrio species, Listeria monocytogenes |
Toxic bacteria:
C difficile |
|
|
Other causes:
rotavirus, adenovirus, calicivirus, astrovirus, Norwalk virus, and Giardia and Cryptosporidium species |
Other causes:
Entamoeba species |
| Organism | Incubation | Duration | Vomiting | Fever | Abdominal Pain |
| Aeromonas species | None | 0-2 weeks | +/- | +/- | No |
| Bacillus species | 1-16 hours | 1-2 days | Yes | No | Yes |
| Campylobacter species | 2-4 days | 5-7 days | No | Yes | Yes |
| C difficile | Variable | Variable | No | Few | Few |
| C perfringens | 0-1 | 1 day | Mild | No | Yes |
| Enterohemorrhagic E coli | 1-8 days | 3-6 days | No | +/- | Yes |
| Enterotoxigenic E coli | 1-3 days | 3-5 days | Yes | Low | Yes |
| Listeria species | 20 hours | 2 days | Few | Yes | +/- |
| Plesiomonas species | None | 0-2 weeks | +/- | +/- | +/- |
| Salmonella species | 0-3 days | 2-7 days | Yes | Yes | Yes |
| Shigella species | 0-2 days | 2-7 days | No | High | Yes |
| S aureus | 2-6 hours | 1 day | Yes | No | Yes |
| Vibrio species | 0-1 days | 5-7 days | Yes | No | Yes |
| Y enterocolitica | 0-6 | 1-46 days | Yes | Yes | Yes |
| Organism | Detection Method | Microbiologic Characteristics |
| Aeromonas species | Blood agar | Oxidase-positive, flagellated GNB |
| Bacillus species | Blood agar | Facultatively aerobic, spore-forming GPR; beta hemolytic; reduces nitrates; ferments carbohydrates |
| Campylobacter species | Skirrow agar | Rapidly motile, curved GNR; Campylobacter jejuni 90% of infections, Campylobacter coli 5% of infections |
| C difficile | CCFE agar, EIA for toxin, LA for protein | Anaerobic, spore-forming GPR; toxin-mediated diarrhea; produces pseudomembranous colitis |
| C perfringens | None available | Anaerobic, spore-forming GPR; toxin-mediated diarrhea |
| E coli | MacConkey, EMB, or SM agar | Lactose-producing GNR |
| Listeria species | Blood agar | Flagellated GPB |
| Plesiomonas species | Blood agar | Oxidase-positive GNR |
| Salmonella species | Blood, MacConkey, EMB, XLD, or HE agar | Nonlactose, non–H2S-producing GNR |
| Shigella species | Blood, MacConkey, EMB, XLD, or HE agar | Nonlactose and H2S-producing GNR; verotoxin (neurotoxin) |
| Staphylococcus species | Blood agar | Heat-stable, preformed toxin-mediated GPC |
| Vibrio species | Blood or TCBS agar | Oxidase-positive, motile, curved GNB |
| Y enterocolitica | CIN agar | Nonlactose-producing, oval GNR |
| CCFE = cycloserine-cefoxitin-fructose-egg; CIN = cefsulodin-irgasan-novobiocin; EIA= enzyme immunoassay; EMB = e-methylene blue; GNB = gram-negative bacillus; GNR = gram-negative rod; GPB = gram-positive bacillus; GPC = gram-positive cocci; GPR = gram-positive rod; H2S = hydrogen sulfide; HE = Hektoen enteric; LA = latex agglutination; SM = Sorbitol-MacConkey; TCBS = thiosulfate-citrate-bile-sucrose; XLD = xylose-lysine-deoxycholate. |
Jennifer Lynn Bonheur, MD Attending Physician, Division of Gastroenterology, Lenox Hill Hospital
Jennifer Lynn Bonheur, MD is a member of the following medical societies: American Gastroenterological Association, American Society for Gastrointestinal Endoscopy, New York Society for Gastrointestinal Endoscopy, New York Academy of Sciences, Sigma Xi
Disclosure: Nothing to disclose.
Mukul Arya, MD Associate Professor of Internal Medicine, Weill Cornell Medical College; Assistant Director of Therapeutic Endoscopy, Department of Gastroenterology and Internal Medicine, Wyckoff Heights Medical Center
Mukul Arya, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Medical Association, American Society for Gastrointestinal Endoscopy
Disclosure: Nothing to disclose.
M Akram Tamer, MD Professor, Program Director, Department of Pediatrics, University of Miami, Leonard M Miller School of Medicine
M Akram Tamer, MD is a member of the following medical societies: American Medical Association, Florida Medical Association
Disclosure: Nothing to disclose.
BS Anand, MD Professor, Department of Internal Medicine, Division of Gastroenterology, Baylor College of Medicine
BS Anand, MD is a member of the following medical societies: American Association for the Study of Liver Diseases, American College of Gastroenterology, American Gastroenterological Association, American Society for Gastrointestinal Endoscopy
Disclosure: Nothing to disclose.
Simmy Bank, MD Chair, Professor, Department of Internal Medicine, Division of Gastroenterology, Long Island Jewish Hospital, Albert Einstein College of Medicine
Disclosure: Nothing to disclose.
Richard E Frye, MD, PhD Assistant Professor, Departments of Pediatrics and Neurology, University of Texas Medical School at Houston
Richard E Frye, MD, PhD is a member of the following medical societies: American Academy of Neurology, American Academy of Pediatrics, Child Neurology Society, and International Neuropsychological Society
Disclosure: Nothing to disclose.
John Gunn Lee, MD Director of Pancreaticobiliary Service, Associate Professor, Department of Internal Medicine, Division of Gastroenterology, University of California at Irvine School of Medicine
John Gunn Lee, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, and American Society for Gastrointestinal Endoscopy
Disclosure: Nothing to disclose.
Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference
Disclosure: Medscape Salary Employment
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Sections Bacterial Gastroenteritis
- Overview
- Presentation
- DDx
- Workup
- Treatment
- Medication
- Tables
- References
