Gastroenteritis in Emergency Medicine Differential Diagnoses

  • Author: Arthur Diskin, MD; Chief Editor: Steven C Dronen, MD, FAAEM   more...
 
Updated: Mar 19, 2012
 
 

Differential Diagnoses

Proceed to Workup
 
 
Contributor Information and Disclosures
Author

Arthur Diskin, MD  Vice-President, Global Chief Medical Officer, Royal Caribbean Cruise Lines; Voluntary Associate Professor, University of Miami, Leonard M Miller School of Medicine

Arthur Diskin, MD is a member of the following medical societies: American College of Emergency Physicians

Disclosure: Royal Caribbean Cruise Lines Salary Employment

Specialty Editor Board

Michelle Ervin, MD  Chair, Department of Emergency Medicine, Howard University Hospital

Michelle Ervin, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, National Medical Association, and Society for Academic Emergency Medicine

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

Eugene Hardin, MD, FAAEM, FACEP  Former Chair and Associate Professor, Department of Emergency Medicine, Charles Drew University of Medicine and Science; Former Chair, Department of Emergency Medicine, Martin Luther King Jr/Drew Medical Center

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Steven C Dronen, MD, FAAEM  Chair, Department of Emergency Medicine, LeConte Medical Center

Steven C Dronen, MD, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

References

  1. Centers for Disease Control and Prevention. Vessel Sanitation Program: Cruise Ship Outbreak Updates. Available at http://www.cdc.gov/nceh/vsp/surv/GIlist.htm.

  2. Centers for Disease Control and Prevention. Vessel Sanitation Program: Cruise Ship Inspection. Available at http://wwwn.cdc.gov/InspectionQueryTool/Forms/InspectionSearch.aspx.

  3. Centers for Disease Control and Prevention. Investigation Update: Outbreak of Salmonella Typhimurium Infections, 2008-2009. Available at http://www.cdc.gov/salmonella/typhimurium/update.html.

  4. Rasko DA, Webster DR, Sahl JW, et al. Origins of the E. coli strain causing an outbreak of hemolytic-uremic syndrome in Germany. N Engl J Med. Aug 25 2011;365(8):709-17. [Medline]. [Full Text].

  5. Farthing M, Lindberg G, Dite P, et al. World Gastroenterology Organisation practice guideline: Acute diarrhea. World Gastroenterology Organisation. Available at http://www.worldgastroenterology.org/acute-diarrhea-in-adults.html. Accessed September 2011.

  6. CDC research shows outbreaks linked to imported foods increasing. Available at http://www.cdc.gov/media/releases/2012/p0314_foodborne.html. Accessed March 14, 2012.

  7. Belliot G, Lavaux A, Souihel D, Agnello D, Pothier P. Use of murine norovirus as a surrogate to evaluate resistance of human norovirus to disinfectants. Appl Environ Microbiol. May 2008;74(10):3315-8. [Medline]. [Full Text].

  8. [Best Evidence] Ruiz-Palacios GM, Perez-Schael I, Velazquez FR, et al. Safety and efficacy of an attenuated vaccine against severe rotavirus gastroenteritis. N Engl J Med. Jan 5 2006;354(1):11-22. [Medline].

  9. DuPont HL, Jiang ZD, Okhuysen PC, Ericsson CD, de la Cabada FJ, Ke S, et al. A randomized, double-blind, placebo-controlled trial of rifaximin to prevent travelers' diarrhea. Ann Intern Med. May 17 2005;142(10):805-12. [Medline].

  10. Caeiro JP, DuPont HL. Management of travellers' diarrhoea. Drugs. Jul 1998;56(1):73-81. [Medline].

  11. Centers for Disease Control and Prevention. Outbreaks of gastroenteritis associated with noroviruses on cruise ships--United States, 2002. MMWR Morb Mortal Wkly Rep. Dec 13 2002;51(49):1112-5. [Medline]. [Full Text].

  12. Heymann DL. Control of communicable diseases manual. 19th ed. Washington, DC: American Public Health Association; 2008:258-260, 534-539.

  13. Dolin R. Noroviruses--challenges to control. N Engl J Med. Sep 13 2007;357(11):1072-3. [Medline].

  14. DuPont HL. Clinical practice. Bacterial diarrhea. N Engl J Med. Oct 15 2009;361(16):1560-9. [Medline].

  15. [Guideline] DuPont HL. Guidelines on acute infectious diarrhea in adults. The Practice Parameters Committee of the American College of Gastroenterology. Am J Gastroenterol. Nov 1997;92(11):1962-75. [Medline].

  16. Glass RI, Parashar UD, Estes MK. Norovirus gastroenteritis. N Engl J Med. Oct 29 2009;361(18):1776-85. [Medline].

  17. Gonenne J, Pardi DS. Clostridium difficile: an update. Compr Ther. Fall-Winter 2004;30(3):134-40. [Medline].

  18. [Guideline] Guerrant RL, Van Gilder T, Steiner TS, Thielman NM, Slutsker L, Tauxe RV, et al. Practice guidelines for the management of infectious diarrhea. Clin Infect Dis. Feb 1 2001;32(3):331-51. [Medline].

  19. Health Protection Agency Centre for Infections. Guidance for the Management of Norovirus Infection in Cruise Ships - Norovirus Working Group. Available at http://www.hpa.org.uk/publications/2007/cruiseliners/cruiseliners.pdf.

  20. Hom J. Do probiotics reduce the duration and symptoms of acute infectious diarrhea?. Ann Emerg Med. November 2011;58:445-446.

  21. Musher DM, Musher BL. Contagious acute gastrointestinal infections. N Engl J Med. Dec 2 2004;351(23):2417-27. [Medline].

  22. Seamens CM, Schwartz G. Food-borne illness: differential diagnosis and targeted management. Emerg Med Rep. 1998;19:120-131.

  23. Teitelbaum JE. Probiotics and the treatment of infectious diarrhea. Pediatr Infect Dis J. Mar 2005;24(3):267-8. [Medline].

  24. Thielman NM, Guerrant RL. Clinical practice. Acute infectious diarrhea. N Engl J Med. Jan 1 2004;350(1):38-47. [Medline].

  25. Widdowson MA, Glass R, Monroe S, Beard RS, Bateman JW, Lurie P, et al. Probable transmission of norovirus on an airplane. JAMA. Apr 20 2005;293(15):1859-60. [Medline].

 
Previous
Next
 
Hektoen enteric agar with Escherichia coli colonies. Different growth media are necessary for identifying different enteric pathogens, suppressing the growth of nonpathogens, and allowing for chemical reactions to assist in identification. The appearance results from the organism's ability to ferment lactose placed in the medium. This results in the production of acid, which lowers the pH and causes a change in the pH indicator placed in the medium. Salmonella and Shigella organisms do not ferment lactose.
Example of Salmonella on Hektoen enteric agar. The medium also contains ferric ammonium citrate, which indicates the production of hydrogen sulfide by the appearance of a black precipitate.
The MacConkey medium is commonly used and differentiates lactose fermenters, which produce acid, decrease the pH, and cause the neutral red indicator to give the colonies a pink-to-red color.
The Christensen method is used to determine if an organism produces the enzyme urease (Yersinia) or not (Salmonella, Shigella, Vibrio). Hydrolysis of urea produces ammonia and carbon dioxide, alkalinizing the medium and turning the phenol red from light orange to magenta (pink).
Often, a combination of methods may be used for identification. The tube on the left is triple sugar iron (TSI) agar. The alkaline slant and acid butt (K/A) indicates an organism that ferments glucose only (not lactose or sucrose). The middle tube is indole positive, as indicated by the pink ring, and indicates the organism's ability to split tryptophan to form indole. The tube on the right is urease negative. Taken together, these tests indicate the organism is likely Shigella.
Gram stain may be helpful in identifying an etiologic agent. This stain shows gram-negative bacilli, which could be Salmonella or Shigella with 2 polymorphonucleocyte cells (PMNs).
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.