eMedicine Specialties > Gastroenterology > Intestine

Gastroenteritis, Viral: Differential Diagnoses & Workup

Author: Michael Vincent F Tablang, MD, Resident Physician, Department of Internal Medicine, University of Connecticut Health Center
Coauthor(s): Michael J Grupka, MD, Fellow, Department of Gastroenterology-Hepatology, University of Connecticut School of Medicine; George Y Wu, MD, PhD, Professor, Department of Medicine, Director, Hepatology Section, Herman Lopata Chair in Hepatitis Research, University of Connecticut School of Medicine
Contributor Information and Disclosures

Updated: Nov 12, 2008

Differential Diagnoses

Amebiasis
Giardiasis
Appendicitis
Intra-abdominal Sepsis
Campylobacter Infections
Salmonellosis
Clostridium Difficile Colitis
Shigellosis
Escherichia Coli Infections
Food Poisoning
Gastroenteritis, Bacterial

Workup

Laboratory Studies

  • General laboratory evaluation
    • In most cases that fit the clinical features of viral gastroenteritis, lab tests are not indicated.
    • If bacterial or protozoal infection is suspected, stool studies for occult blood, WBC count, microscopy for protozoa, Clostridium difficile toxin, Giardia lamblia by enzyme immunoassay (EIA), or bacterial culture may be indicated.
    • Consider investigating patients with low-grade fever, nausea, vomiting, abdominal pain, and extreme dehydration by evaluating serum electrolytes, urea, creatinine, amylase, CBC count, and abdominal imaging studies.
  • Diagnosis of rotavirus infection
    • Rapid antigen testing of the stool, either by EIA (>98% sensitivity and specificity) or latex agglutination tests (less sensitive and specific as compared to EIA), is used to aid in the diagnosis of rotavirus infection.
    • Expect antirotavirus antibodies (ie, immunoglobulin M, immunoglobulin A) to be excreted in the stool after the first day of illness. Antibody tests can remain positive for 10 days after primary infection and longer after reinfection; therefore, they can be used as an adjunct to diagnosis.
  • Diagnosis of calicivirus infection
    • In epidemics, save stool and emesis specimens for evaluation by public health officials. Polymerase chain reaction is valuable in both the outbreak setting and the sporadic case setting.
    • Researchers have cloned several of the caliciviruses and placed the genome in a baculovirus that produces unlimited amounts of recombinant calicivirus capsid protein. Enzyme immunoassays for serum antibody and stool antigen have been developed using this antigen source.
    • A modification to the polymerase chain reaction has allowed many of the different strains of caliciviruses to be recognized with just a few primers (broadly reactive reverse-transcription polymerase chain reaction). These primers are directed at a region of the genome that is common to many of the strains of calicivirus. This has been an important tool for identifying caliciviruses as the most common cause of epidemic viral gastroenteritis.
    • Fecal viral concentration of norovirus correlates with duration of illness.  As in most viral infections, active viral replication determines clinical disease.  High fecal viral concentrations suggest the need for both aggressive fluid replacement and stringent infection control measures.5

More on Gastroenteritis, Viral

Overview: Gastroenteritis, Viral
Differential Diagnoses & Workup: Gastroenteritis, Viral
Treatment & Medication: Gastroenteritis, Viral
Follow-up: Gastroenteritis, Viral
References
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References

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Further Reading

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Keywords

viral gastroenteritis, rotavirus, rotaviruses, stomach flu, diarrhea, dysentery, watery diarrhea, nausea, intestinal flu, infectious diarrhea, traveler's diarrhea, food poisoning, caliciviruses, astroviruses, adenoviruses, Norovirus, Norwalk-like virus, Norwalk virus, Sapovirus, Sapporo-like virus, sporadic infantile viral gastroenteritis, sporadic adult viral gastroenteritis, Clostridium difficile, Giardia lamblia

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Contributor Information and Disclosures

Author

Michael Vincent F Tablang, MD, Resident Physician, Department of Internal Medicine, University of Connecticut Health Center
Michael Vincent F Tablang, MD is a member of the following medical societies: American College of Physicians
Disclosure: Nothing to disclose.

Coauthor(s)

Michael J Grupka, MD, Fellow, Department of Gastroenterology-Hepatology, University of Connecticut School of Medicine
Disclosure: Nothing to disclose.

George Y Wu, MD, PhD, Professor, Department of Medicine, Director, Hepatology Section, Herman Lopata Chair in Hepatitis Research, University of Connecticut School of Medicine
George Y Wu, MD, PhD is a member of the following medical societies: American Association for the Study of Liver Diseases, American Gastroenterological Association, American Medical Association, American Society for Clinical Investigation, and Association of American Physicians
Disclosure: Humana Press Consulting fee Consulting; Novartis Consulting fee Review panel membership

Medical Editor

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.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Noel Williams, MD, Professor Emeritus, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada; Professor, Department of Internal Medicine, Division of Gastroenterology, University of Alberta, Edmonton, Alberta, Canada
Noel Williams, MD is a member of the following medical societies: Royal College of Physicians and Surgeons of Canada
Disclosure: Nothing to disclose.

CME Editor

Alex J Mechaber, MD, FACP, Associate Dean for Undergraduate Medical Education, Associate Professor of Medicine, University of Miami Miller School of Medicine
Alex J Mechaber, MD, FACP is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, and Society of General Internal Medicine
Disclosure: Nothing to disclose.

Chief Editor

Julian Katz, MD, Clinical Professor of Medicine, Drexel University College of Medicine; Consulting Staff, Department of Medicine, Section of Gastroenterology and Hepatology, Hospital of the Medical College of Pennsylvania
Julian Katz, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Geriatrics Society, American Medical Association, American Society for Gastrointestinal Endoscopy, American Society of Law Medicine and Ethics, American Trauma Society, Association of American Medical Colleges, and Physicians for Social Responsibility
Disclosure: Nothing to disclose.

 
 
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