Case history
Case history
A 37-year-old woman presents to the accident and emergency department with a 2-hour history of abdominal cramps and severe vomiting, which came on a few hours after eating at a family picnic. A few other family members have similar symptoms and are waiting to be seen.
Other presentations
Gastroenteritis commonly presents with vomiting as a primary symptom (other symptoms may be present); common causes are preformed toxins (Staphylococcus aureus or Bacillus cereus), viruses (rotavirus and/or norovirus), and mushroom and heavy metal ingestion.[2] Noninflammatory diarrhea presents as acute and watery without fever or dysentery; it can be caused by virtually all enteric pathogens. Inflammatory diarrhea may present with a fever and there may be blood in the stool; it can be caused by invasive pathogens. Parasitic infections are more likely to cause persistent diarrhea than bacterial causes.[3] Systemic illness typically is associated with fever, weakness, arthralgia or arthritis, jaundice, and skin changes. Neurologic manifestations may encompass paresthesia, metallic taste, visual disturbances, hallucinations, confusion, respiratory depression or distress, bronchospasm, and cranial nerve palsies. Neurologic symptoms may be caused by botulism, noninfectious agents (including pesticides and mushrooms), and Campylobacter jejuni (Guillain-Barre syndrome). Ingestion of poisonous wild mushrooms may present with sudden onset of severe nausea and vomiting, diarrhea, and confusion.[4] Features of trematodiasis include hepatobiliary symptoms (e.g, abdominal pain, jaundice, right upper quadrant pain), pulmonary symptoms (e.g., chronic cough, chest pain, dyspnea, hemoptysis), or intestinal symptoms (e.g., mucosal ulceration, malnutrition).[5]
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