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Table 1. Stool Characteristics and Sources

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

Table 2. Symptoms and Their Characteristics

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

Table 3. Common Bacteria and Optimum Culture Media

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.

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Author

Jennifer Lynn Bonheur, MD Attending Gastroenterologist

Jennifer Lynn Bonheur, MD is a member of the following medical societies: American Gastroenterological Association, American Society for Gastrointestinal Endoscopy, New York Academy of Sciences, New York Society for Gastrointestinal Endoscopy, Sigma Xi, The Scientific Research Honor Society

Disclosure: Nothing to disclose.

Coauthor(s)

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.

Chief Editor

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.

Acknowledgements

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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