Clostridium difficile infection differential diagnosis

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

Indeterminate colitis

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
Pathogen	Transmission	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.

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[pmid14702426-1] Thielman NM, Guerrant RL (2004). “Clinical practice. Acute infectious diarrhea”. N Engl J Med. 350 (1): 38–47. doi:10.1056/NEJMcp031534. PMID 14702426.

[pmid15537721-2] 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.

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