Clostridium difficile infection differential diagnosis
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C. difficile Infection Microchapters |
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Differentiating Clostridium difficile infectionfrom other Diseases |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Yazan Daaboul, M.D.
Overview
Clostridium difficile infection must be differentiated from other diseases that cause acute inflammatory diarrhea, abdominal pain, fever, and ileus, including other causes of colitis (ischemic, collagenous, ulcerative), malabsorptive syndromes, diverticulitis, appendicitis, malignancies, drug-induced causes, and infections, such as salmonellosis, shigellosis, or gastrointestinal infections with Escherichia coli or Campylobacter jejuni.
Differential Diagnosis of Clostridium difficile Infection
Clostridium difficile infection must be differentiated from other diseases that cause acute inflammatory diarrhea, abdominal pain, fever, and ileus:
- Other causes of colitis
- Crohn's disease
- Diverticulitis
- Appendicitis
- Malabsorptive syndromes
- Malignancy, such as colon cancer
- Infections
- Bacterial infections
- Viral infections, including HIV
- Parasitis infections, such as amebiasis or giardiasis
- Fungal infections
- Mesenteric ischemia
- Thrombosis
- Drug-induced (e.g. cocaine, oral contraceptive, gold, isotretinoin, laxative abuse, allopurinol, antibiotics adverse effect, chemotherapy, NSAIDs)
- Allergic proctitis
- Graft vs. host disease (GVHD)
- Immunodeficiency syndromes
- Vasculitis
- Behcet disease
- Sarcoidosis
The table below lists common infectious pathogens that are known to cause acute inflammatory diarrhea:[1][2]
| Pathogen | Transmission | Clinical Manifestations | |||
|---|---|---|---|---|---|
| Fever | Nausea/Vomiting | Abdominal Pain | Bloody Stool | ||
| Salmonella | Foodborne transmission, community-acquired | ++ | + | ++ | + |
| Shigella | Community-acquired, person-to-person | ++ | ++ | ++ | + |
| Campylobacter | Community-acquired, ingestion of undercooked poultry | ++ | + | ++ | + |
| E. coli (EHEC or EIEC) | Foodborne transmission, ingestion of undercooked hamburger meat | ± | + | ++ | ++ |
| Yersinia | Community-aquired, foodborne transmission | ++ | + | ++ | + |
| Entamoeba histolytica | Travel to or emigration from tropical regions | + | ± | + | ± |
| Aeromonas | Ingestion of contaminated water | ++ | + | ++ | + |
| Plesiomonas | Ingestion of contaminated water or undercooked shellfish, travel to tropical regions | ± | ++ | + | + |
References
- ↑ Thielman NM, Guerrant RL (2004). "Clinical practice. Acute infectious diarrhea". N Engl J Med. 350 (1): 38–47. doi:10.1056/NEJMcp031534. PMID 14702426.
- ↑ Khan AM, Faruque AS, Hossain MS, Sattar S, Fuchs GJ, Salam MA (2004). "Plesiomonas shigelloides-associated diarrhoea in Bangladeshi children: a hospital-based surveillance study". J Trop Pediatr. 50 (6): 354–6. doi:10.1093/tropej/50.6.354. PMID 15537721.