Infectious Diarrhea: The Daily PANCE Blueprint
A 20-year-old presents to your clinic with the abrupt onset of intense nausea, repeated vomiting, crampy abdominal pain, and some watery diarrhea. Her symptoms began about 3 hours after she ate potato salad at a church picnic this afternoon. She is afebrile, and her vitals are otherwise unremarkable. Which of the following is most likely causing her symptoms?
A. Salmonella species
B. Campylobacter jejuni
C. Escherichia coli
D. Shigella species
E. Staphylococcus aureus
Answer and topic summary
The answer is E. Staphylococcus aureus
Acute gastroenteritis (AGE) is defined by acute diarrhea and/or vomiting which typically lasts <14 days. Viral illnesses (like norovirus) account for 75–90% of AGE in developed countries. The most common bacterial causes of AGE in the US include Salmonella species, Campylobacter jejuni, Escherichia coli, and Shigella species. Other bacteria include Staphylococcus aureus, Listeria, and Yersinia. Clinical features: sudden onset of diarrhea and/or vomiting, crampy abdominal pain. Routine testing is not recommended for mild disease. Treatment is generally supportive (rehydration) in average cases. In this patient, a vomiting-predominant illness that starts within about 1 to 8 hours of eating a food like potato salad, without fever, points to S. aureus preformed enterotoxin. Salmonella has a longer incubation period (6 to 72 hours) and usually causes fever and diarrhea.
View blueprint lesson
Smarty PANCE Content Blueprint Review:
Covered under ⇒ PANCE Blueprint GI and Nutrition ⇒
Also covered as part of the Emergency Medicine EOR topic list
