Differential Diagnosis for Cholera-like Diarrhea with Bone and Joint Involvement

• Single most likely diagnosis:
  • Shigella: This organism is known to cause severe diarrhea, which can be cholera-like in its presentation. Additionally, Shigella infections can lead to complications such as reactive arthritis, which affects the bones and joints, occurring in about 1-3% of cases but can be considered in the context of the question as it mentions a significant percentage of patients having bone and joint effects.
• Other Likely diagnoses:
  • Salmonella: Salmonella infections can cause gastroenteritis that might resemble cholera in severity, including diarrhea. Furthermore, Salmonella can lead to reactive arthritis, particularly in individuals with the HLA-B27 genotype, which could explain the bone and joint involvement in a subset of patients.
  • Clostridium difficile: While primarily known for causing antibiotic-associated diarrhea, Clostridium difficile infection can lead to severe diarrhea. However, its direct association with bone and joint involvement is less common compared to the other pathogens listed, though it could potentially lead to reactive arthritis in rare cases.
• Do Not Miss diagnoses:
  • Vibrio cholerae: Although the question asks for an organism causing "cholera-like" diarrhea, Vibrio cholerae, the causative agent of cholera, should not be overlooked. Cholera can lead to severe dehydration and, in rare cases, might be associated with secondary infections that could affect the bones and joints.
  • Campylobacter: Campylobacter infections are a common cause of gastroenteritis and can be associated with reactive arthritis, which would explain the bone and joint involvement. It's a significant pathogen to consider due to its potential for severe complications.
• Rare diagnoses:
  • Yersinia enterocolitica: This bacterium can cause a range of gastrointestinal symptoms, including diarrhea, and is known to trigger reactive arthritis, especially in individuals with certain genetic predispositions. However, it is less commonly encountered than the other pathogens listed.
  • Other enteric pathogens: Other bacteria, viruses, and parasites can cause severe gastrointestinal symptoms and, in rare instances, might lead to bone and joint involvement through mechanisms like reactive arthritis. Examples include certain strains of E. coli, rotavirus, and giardiasis, among others.