Summary
Definition
History and exam
Key diagnostic factors
- presence of risk factors
- diarrhoea
- nausea and vomiting
Other diagnostic factors
- abdominal pain
- bloating
- fever
- dehydration
- blood or mucus in stool
- profuse rice-water stool
- reactive arthritis
- skin rash
- difficulty swallowing
- diplopia
- slurred speech
- weakness
- hepatobiliary disease
- pulmonary symptoms
- other intestinal features
- manifestations of ectopic infection
Risk factors
- older people, children, and pregnant women
- chronic disease
- recent hx of travel
- immunocompromised state
- hx of contact with cases of food poisoning
- consumption of undercooked meat
- consumption of raw seafood
- consumption of homemade canned foods
- consumption of unpasteurised soft cheeses
- consumption of deli meats
- consumption of unpasteurised milk or juice
- consumption of raw eggs
- improper food handling and storage
- use of antacids
Diagnostic investigations
1st investigations to order
- stool microscopy for WBC and red blood cells (RBC)
- stool culture
- stool O+P
- FBC with differential
- serum creatinine and electrolytes
Investigations to consider
- stool/serum botulinum toxin detection test
- blood culture
- amylase and lipase
- LFTs
- hepatitis A IgM antibodies
- hepatitis E IgM antibodies
- acute abdominal series
- sigmoidoscopy/colonoscopy
- oesophagogastroduodenoscopy
- biopsy
- duodenal aspirate
Treatment algorithm
Contributors
Authors
Consultant Gastroenterologist
Department of Gastroenterology
John Radcliffe Hospital
Oxford
UK
Disclosures
PA is a consultant for Abbvie and an advisor to Bresmed Health Solutions, and has received travel expenses from NPS Pharmaceuticals (now Shire).
Consultant Gastroenterologist
Department of Gastroenterology
John Radcliffe Hospital
Oxford
UK
Disclosures
SK declares that he has no competing interests.
Dr Philip Allan and Dr Satish Keshav would like to gratefully acknowledge Dr Michael Bennish, Dr Willem J.S. de Villiers, and Dr Houssam E. Mardini, the previous contributors to this topic. MB has received funds, salary, and/or research funding greater than 6 figures USD.
Peer reviewers
Professor of Clinical Microbiology
Austrian Agency for Health and Food Safety (AGES)
Vienna
Austria
Disclosures
FA declares that he has no competing interests.
Department Head
Naval Health Research Center
San Diego
CA
Disclosures
NCC declares that she has no competing interests.
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