Review Question - QID 106907

This patient's presentation is consistent with bacterial or viral food poisoning. ETEC causes watery, not bloody, diarrhea.

While nearly all viruses cause watery diarrhea, bacterial infections can manifest with either watery or bloody diarrhea. The differential diagnosis of bloody diarrhea should include S. enteriditis, S. dysenteriae, C. jejuni, Y. enterocolitica, enterohemorrhagic E. coli (EHEC), and C. difficile. While bacterial induced diarrhea is usually associated with meat, dairy, and other foods, viral-induced diarrhea is caused by fecal-oral transmission.

Barr and Smith discuss acute diarrheal illnesses. They note that most cases of diarrhea are caused by viruses, and stool cultures are not recommended for work-up. Treatment is focused on rehydration, and antimotility agents can be used for symptom management in watery diarrhea, but not bloody diarrhea.

Dupont discusses acute infectious diarrhea in immunocompetent adults. He notes that 83% of deaths from diarrheal diseases in the United States occur in adults over 65 years. Most lethal cases occur due to C. difficile or norovirus.

Illustration A shows a colonoscopy depicting C. difficile colitis (also known as pseudomembranous colitis).

Incorrect Answers:
Answer 1: S. dysenteriae causes bloody diarrhea and is transmitted by fecal-oral contamination.
Answer 2: S. enteriditis causes bloody diarrhea and is transmitted through chicken products.
Answer 4: EHEC causes bloody diarrhea and is transmitted transmitted through undercooked meat and fecal-oral contamination.
Answer 5: Y. enterocolitica causes bloody diarrhea and is transmitted through milk, pork, and pet feces.