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 changes
- 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 history of travel
- immunocompromised state
- history 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
- gastric acid suppression
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
- serum lipase or amylase
- LFTs
- hepatitis A IgM antibodies
- hepatitis E IgM antibodies
- acute abdominal series
- sigmoidoscopy/colonoscopy
- oesophagogastroduodenoscopy
- biopsy
- duodenal aspirate
- polymerase chain reaction (PCR) of stool
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.
Differentials
- Acute viral syndromes
- Crohn's disease
- Ulcerative colitis
More DifferentialsGuidelines
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