Gastroenteritis differential diagnosis
|
Gastroenteritis Microchapters |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Differential diagnosis
It is important to consider infectious gastroenteritis as a diagnosis per exclusionem. A few loose stools and vomiting may be the result of systemic infection such as pneumonia, septicemia, urinary tract infection and even meningitis. Surgical conditions such as appendicitis, intussusception and, rarely, even Hirschsprung's disease may mislead the clinician.
Non-infectious causes to consider are poisoning with heavy metals (i.e. arsenic, cadmium), seafood (i.e. ciguatera, scombroid, toxic encephalopathic shellfish poisoning) or mushrooms (i.e. Amanita phalloides). Secretory tumours (i.e. carcinoid, medullary tumour of the thyroid, vasoactive intestinal peptide-secreting adenomas) and endocrine disorders (i.e. thyrotoxicosis and Addison's disease) are disorders that can cause diarrhea. Also, pancreatic insufficiency, short bowel syndrome, Whipple's disease, coeliac disease, and laxative abuse should be excluded as possibilities. Infectious gastroenteritis is caused by a wide variety of bacteria and viruses. For a list of bacteria causing gastroenteritis, see above. Viruses causing gastroenteritis include rotavirus, norovirus, adenovirus and astrovirus.
If gastroenteritis in a child is severe enough to require admission to a hospital, then it is important to distinguish between bacterial and viral infections. Bacteria, shigella and campylobacter, for example, and parasites like giardia can be treated with antibiotics, but viruses do not respond to antibiotics and infected children usually make a full recovery after a few days.[1] Children admitted to hospital with gastroenteritis routinely are tested for rotavirus A to gather surveillance data relevant to the epidemiological effects of rotavirus vaccination programs.[2][3] These children are routinely tested also for norovirus, which is extraordinarily infectious and requires special isolation procedures to avoid transmission to other patients. Other methods, electron microscopy and polyacrylamide gel electrophoresis, are used in research laboratories.[4][5]
References
- ↑ Haffejee IE (1991). "The pathophysiology, clinical features and management of rotavirus diarrhoea". Q. J. Med. 79 (288): 289–99. PMID 1649479.
- ↑ Patel MM, Tate JE, Selvarangan R; et al. (2007). "Routine laboratory testing data for surveillance of rotavirus hospitalizations to evaluate the impact of vaccination". Pediatr. Infect. Dis. J. 26 (10): 914–9. doi:10.1097/INF.0b013e31812e52fd. PMID 17901797.
- ↑ "The paediatric burden of rotavirus disease in Europe". Epidemiol. Infect. 134 (5): 908–16. 2006. doi:10.1017/S0950268806006091. PMID 16650331.
- ↑ Beards GM (1988). "Laboratory diagnosis of viral gastroenteritis". Eur. J. Clin. Microbiol. Infect. Dis. 7 (1): 11–3. PMID 3132369.
- ↑ Steel HM, Garnham S, Beards GM, Brown DW (1992). "Investigation of an outbreak of rotavirus infection in geriatric patients by serotyping and polyacrylamide gel electrophoresis (PAGE)". J. Med. Virol. 37 (2): 132–6. PMID 1321223.