Summary
Definition
History and exam
Key diagnostic factors
- diarrhea
- nausea and vomiting
Other diagnostic factors
- abdominal pain
- bloating
- fever
- dehydration
- blood or mucus in stool
- profuse rice-water stool
- reactive arthritis
- skin manifestations
- ear, nose, and throat manifestations
- hepatosplenomegaly
- neurologic manifestations
- hepatobiliary disease
- pulmonary symptoms
- other intestinal features
- manifestations of ectopic infection
Risk factors
- older people and pregnant women
- chronic disease
- recent history of travel
- immunocompromised state
- history of contact with other people with food poisoning
- consumption of undercooked meat
- consumption of raw seafood
- consumption of homemade canned foods
- consumption of unpasteurized soft cheeses
- consumption of deli meats
- consumption of unpasteurized milk or juice
- consumption of raw eggs
- improper food handling and storage
- gastric acid suppression
Diagnostic tests
1st tests to order
- stool microscopy for WBC and red blood cells (RBC)
- stool culture
- stool ova and parasite (O&P) test
- polymerase chain reaction (PCR) of stool
- CBC with differential
- basic metabolic panel
- C-reactive protein
Tests to consider
- botulinum toxin detection test
- blood culture
- serum lipase or amylase
- LFTs
- hepatitis A IgM antibodies
- hepatitis E IgM antibodies
- acute abdominal series
- sigmoidoscopy/colonoscopy
- esophagogastroduodenoscopy
- biopsy
- string test (entero-test)
- duodenal aspirate
Treatment algorithm
mild-to-moderate disease
severe disease
suspected foodborne botulism
known infecting organism
Contributors
Authors
Philip Allan, MBBS, DPhil, FRCP
Consultant Gastroenterologist
Department of Gastroenterology
John Radcliffe Hospital
Oxford
UK
Disclosures
PA has consulted for Takeda (Shire) and BaxterHealthcare. PA has received travel, accommodation, and conference fees from Takeda (Shire).
Acknowledgements
Dr Philip Allan would like to gratefully acknowledge Dr Satish Keshav, Dr Michael Bennish, Dr Willem J.S. de Villiers, and Dr Houssam E. Mardini, the previous contributors to this topic. Unfortunately, we have been made aware that Dr Satish Keshav has passed away.
Disclosures
MB received funds, salary, and/or research funding greater than 6 figures USD. MB declares that he has no other competing interests. WJSDV and HEM declare that they have no competing interests.
Peer reviewers
Franz Allerberger, MD, MPH
Professor of Clinical Microbiology
Austrian Agency for Health and Food Safety (AGES)
Vienna
Austria
Disclosures
FA declares that he has no competing interests.
Nancy Crum-Cianflone, MD, MPH
Department Head
Naval Health Research Center
San Diego
CA
Disclosures
NCC declares that she has no competing interests.
References
Key articles
American Medical Association, American Nurses Association/American Nurses Foundation, Centers for Disease Control and Prevention, et al. Diagnosis and management of foodborne illnesses: a primer for physicians and other health care professionals. MMWR Recomm Rep. 2004 Apr 16;53(RR-4):1-33.Full text Abstract
World Health Organization. Foodborne disease outbreaks: guidelines for investigation and control. 2008 [internet publication].Full text
Public Health England. UK Standards for microbiology investigations S 7: gastroenteritis. Oct 2020 [internet publication].Full text
Centers for Disease Control and Prevention. Food safety. Aug 2023 [internet publication].Full text
Shane AL, Mody RK, Crump JA, et al. 2017 Infectious Diseases Society of America clinical practice guidelines for the diagnosis and management of infectious diarrhea. Clin Infect Dis. 2017 Nov 29;65(12):e45-80.Full text Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
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