eMedicine Specialties > Pediatrics: General Medicine > Infectious Disease
Food Poisoning: Differential Diagnoses & Workup
Updated: Apr 9, 2009
- Overview
- Differential Diagnoses & Workup
- Treatment & Medication
- Follow-up
- Multimedia
Differential Diagnoses
Other Problems to Be Considered
In most food-borne diseases (FBDs), the differential diagnosis includes infection by various toxins or pathogens that can cause the same presentation (eg, diarrhea vs bloody diarrhea).
Large bowel enteritis (ie, dysentery) can mimic inflammatory bowel disease and intussusception.
A noteworthy diagnostic dilemma is botulism, in which the differential diagnosis includes Guillain-Barré syndrome, organophosphate ingestion, tick paralysis, brainstem tumor, poliomyelitis, and myasthenia gravis. In infant botulism, an additional possibility is Werdnig-Hoffman disease.
Workup
Laboratory Studies
- Stool culture is an expensive test with a very low yield and is indicated particularly if patients with food poisoning have bloody diarrhea, severe abdominal pain, or are immunocompromised. When the likely pathogen is a Campylobacter, Yersinia, or Vibrio species, or if Shigalike toxin-producing E coli (eg, E coli O157:H7) is suspected, the laboratory should be notified because special media or incubation conditions (high or low temperature) are required.
- Stool examination for parasites is indicated for GI tract illnesses that appear to have occurred after a long incubation period. Certain travel history, such as travel to tropical countries, camping, and drinking well or stream water should prompt consideration of parasitic food-borne illness.
- Blood cultures are performed for bacteremic food-borne diseases (FBDs).
- Serum electrolyte levels, BUN levels, creatinine levels, CBC count, and urinalysis are performed to assess hydration, renal function, and presence of hemolytic-uremic syndrome (HUS). Evidence of hemolysis and thrombocytopenia are present in patients with HUS.
- Toxin testing, serotyping, and molecular techniques are available only from large commercial and public health laboratories. They are generally ordered only as part of an epidemiologic investigation.
- Testing of food or vomitus for toxins may be offered by a poison control center or the local health authorities.
More on Food Poisoning |
| Overview: Food Poisoning |
 Differential Diagnoses & Workup: Food Poisoning |
| Treatment & Medication: Food Poisoning |
| Follow-up: Food Poisoning |
| Multimedia: Food Poisoning |
| References |
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References
Miller MA, Sentz J, Rabaa MA, Mintz ED. Global epidemiology of infections due to Shigella, Salmonella serotype Typhi, and enterotoxigenic Escherichia coli. Epidemiol Infect. Apr 2008;136(4):433-5. [Medline].
Koepke R, Sobel J, Arnon SS. Global occurrence of infant botulism, 1976-2006. Pediatrics. Jul 2008;122(1):e73-82. [Medline].
Noah N. Food poisoning from raw fruit and vegetables. Introduction. Epidemiol Infect. Mar 2009;137(3):305-6. [Medline].
American Medical Association; American Nurses Association-American Nurses Foundation; Centers for Disease Control and Prevention; Center for Food Safety and Applied Nutrition, Food and Drug Administration; Food Safety and Inspection Service, US Department of Agriculture. Diagnosis and management of foodborne illnesses: a primer for physicians and other health care professionals. MMWR Recomm Rep. Apr 16 2004;53:1-33. [Medline].
Niyogi SK. Increasing antimicrobial resistance--an emerging problem in the treatment of shigellosis. Clin Microbiol Infect. Dec 2007;13(12):1141-3. [Medline].
[Best Evidence] Michael M, Elliott EJ, Craig JC, Ridley G, Hodson EM. Interventions for hemolytic uremic syndrome and thrombotic thrombocytopenic purpura: a systematic review of randomized controlled trials. Am J Kidney Dis. Feb 2009;53(2):259-72. [Medline].
Batz MB, Doyle MP, Morris G, et al. Attributing illness to food. Emerg Infect Dis. Jul 2005;11(7):993-9. [Medline].
Friedman CR, Hoekstra RM, Samuel M, et al. Risk factors for sporadic Campylobacter infection in the United States: A case-control study in FoodNet sites. Clin Infect Dis. Apr 15 2004;38 Suppl 3:S285-96. [Medline].
Hennessy TW, Marcus R, Deneen V, et al. Survey of physician diagnostic practices for patients with acute diarrhea: clinical and public health implications. Clin Infect Dis. Apr 15 2004;38 Suppl 3:S203-11. [Medline].
Herwaldt BL, Beach MJ. The return of Cyclospora in 1997: another outbreak of cyclosporiasis in North America associated with imported raspberries. Cyclospora Working Group. Ann Intern Med. Feb 2 1999;130(3):210-20. [Medline]. [Full Text].
Karch H, Tarr PI, Bielaszewska M. Enterohaemorrhagic Escherichia coli in human medicine. Int J Med Microbiol. Oct 2005;295(6-7):405-18. [Medline].
Kassenborg HD, Hedberg CW, Hoekstra M, et al. Farm visits and undercooked hamburgers as major risk factors for sporadic Escherichia coli O157:H7 infection: data from a case-control study in 5 FoodNet sites. Clin Infect Dis. Apr 15 2004;38 Suppl 3:S271-8. [Medline].
Mead PS, Griffin PM. Escherichia coli O157:H7. Lancet. Oct 10 1998;352(9135):1207-12. [Medline].
Mermin JH, Townes JM, Gerber M, et al. Typhoid fever in the United States, 1985-1994: changing risks of international travel and increasing antimicrobial resistance. Arch Intern Med. Mar 23 1998;158(6):633-8. [Medline].
Morgan MR, Fenwick GR. Natural foodborne toxicants. Lancet. Dec 15 1990;336(8729):1492-5. [Medline].
Schantz PM. The dangers of eating raw fish. N Engl J Med. Apr 27 1989;320(17):1143-5. [Medline].
Schlech WF 3rd. Listeria gastroenteritis--old syndrome, new pathogen. N Engl J Med. Jan 9 1997;336(2):130-2. [Medline].
Shapiro RL, Hatheway C, Swerdlow DL. Botulism in the United States: a clinical and epidemiologic review. Ann Intern Med. Aug 1 1998;129(3):221-8. [Medline]. [Full Text].
Swaminathan B, Gerner-Smidt P. The epidemiology of human listeriosis. Microbes Infect. Aug 2007;9(10):1236-43. [Medline].
Varma JK, Samuel MC, Marcus R, Hoekstra RM, Medus C, Segler S. Listeria monocytogenes infection from foods prepared in a commercial establishment: a case-control study of potential sources of sporadic illness in the United States. Clin Infect Dis. Feb 15 2007;44(4):521-8. [Medline].
Voetsch AC, Van Gilder TJ, Angulo FJ, et al. FoodNet estimate of the burden of illness caused by nontyphoidal Salmonella infections in the United States. Clin Infect Dis. Apr 15 2004;38 Suppl 3:S127-34. [Medline].
Wong CS, Jelacic S, Habeeb RL, et al. The risk of the hemolytic-uremic syndrome after antibiotic treatment of Escherichia coli O157:H7 infections. N Engl J Med. Jun 29 2000;342(26):1930-6. [Medline].
Further Reading
Keywords
food poisoning, food-borne disease, FBD, food-borne infection, food-borne illness, botulism, gastroenteritis, diarrhea, diagnosis, treatment, vomiting, Staphylococcus aureus toxin, food-borne bacterial infection, food-borne parasitic infection, food-borne viral infection, zoonosis, gastrointestinal disease, GI disease, seafood poisoning, plant poisoning, chemical poisoning, staphylococcal-toxin gastroenteritis, hepatitis A, trichinosis, toxoplasmosis, hemolytic-uremic syndrome, HUS, enterohemorrhagic Escherichia coli -induced diarrhea, cholera, toxin-mediated food poisoning, Salmonella infection, Listeria infection, bowel enteritis, Norwalklike virus, rotavirus, adenovirus, astrovirus, Yersinia enterocolitica, appendicitis, Yersinia pseudotuberculosis, dysentery, giardiasis, amebiasis, cryptosporidiosis, cyclosporiasis, cysticercosis, brucellosis, nausea, myalgias, lymphadenopathy, oliguria
