Edit concept Create issue ticket

Infantile Gastroenteritis

Infantile gastroenteritis is a common illness worldwide, causing significant morbidity and mortality, especially in developing countries. Its main characteristic is the presence of diarrhea, defined as stools more than 15g/kg for infants younger than 2 years and greater than 200 g for children and beyond that age and adults.


Presentation

Infantile gastroenteritis presentation widely varies depending on its etiology and severity. In viral gastroenteritis, most often caused by rotavirus, there is low fever, vomiting, and water-like stools. Most rotavirus patients are younger than 2 years [1]. Blood is absent in the fecal matter.

Severe abdominal pain and bloody diarrhea point to a bacterial etiology.

The existence of dehydration should be thoroughly assessed. Important clinical indicators are low blood pressure, tachycardia, thready pulse, significant weight loss, dry mucous membranes, and oliguria. The consciousness state may be decreased in severely affected infants.

The physician should inquire about the types of food the patient has ingested, which may point to a specific pathogen: dairy products may contain Staphylococcus, Campylobacter, Listeria or Salmonella species. Meat can be infected by Clostridium perfringens, Aeromonas, Staphylococcus and Salmonella or Campylobacter species, while seafood intake may lead to astrovirus, Vibrio, Aeromonas or Plesiomonas species infection. If symptoms occur sooner than 6 hours after ingestion, a preformed toxin, like those produced by Bacillus or Staphylococcus should be suspected. Nosocomial infection of various types has also been documented [2].

Aeromonas induces acute watery diarrhea or a more severe, cholera-like illness, with blood present in the stool [3]. Bacillus cereus causes precocious emetic syndrome that usually resolves within 24 hours [4] and watery diarrhea accompanied by severe cramps [5]. Campylobacter infection is characterized by a pre-diarrhea period, with fever, myalgia and abdominal pain [6]. Clostridium difficile may be complicated by pseudomembranous colitis [7]. Escherichia coli leads to enteritis that may progress to hemorrhagic colitis and hemolytic uremic syndrome [8]. Diarrhea usually lasts for 1 to 3 days and is accompanied by headache, dizziness, lymphadenopathy, rash and myalgia [9]. Nontyphoidal Salmonella infection is characterized by diarrhea that usually lasts less than a week, but may lead to extraintestinal complications, such as urinary tract infections, osteomyelitis or arthritis. Salmonella typhi is the etiological agent of typhoid fever, a condition with diarrhea, vomiting, anorexia, fever, headaches and rose spots. Bloody stools may be present both in Salmonella [10] and Shigella patients [11]. Cholera is described as afebrile, watery, painless diarrhea. A more severe form, cholera gravis may give rise to an immense liquid loss which rapidly progresses to severe dehydration and death [12]. Yersinia enterocolitica can be the causative agent of terminal ileitis and mesenteric lymphadenitis and may mimic appendicitis [13]. Complaints may persist up to one year in Yersinia infection [14]. The physician should inquire about associated symptoms of parasitic infections, like anal pruritus, that may be accompanied by diarrhea.

Pediatric Disorder
  • Rush was the most influential American physician of his day and a signer of the Declaration of Independence, and he lectured and published regarding pediatric disorders, including cholera infantum and diphtheria (11) .[nature.com]
Diarrhea
  • Bacillus cereus causes precocious emetic syndrome that usually resolves within 24 hours and watery diarrhea accompanied by severe cramps. Campylobacter infection is characterized by a pre-diarrhea period, with fever, myalgia and abdominal pain.[symptoma.com]
  • Diarrhea developed in five newborn rhesus monkeys (Macaca mulatta) inoculated orally on the first day of life with the human reovirus-like agent of infantile gastroenteritis.[ncbi.nlm.nih.gov]
  • January 2003 to June 2005, investigated the incidence and the clinical role of various enteric viruses responsible for infantile gastroenteritis in 632 Tunisian children presenting in dispensaries (380 children) or hospitalized (252 children) for acute diarrhea[ncbi.nlm.nih.gov]
  • Diarrhea began 15 to 30.5 h (mean 22.3 h) post-inoculation and lasted less than 24 h; three of the seven animals that developed diarrhea were also depressed or anorectic.[ncbi.nlm.nih.gov]
  • Part III examines the epidemiological relationship between malnutrition and chronic diarrhea in infants and children. Part IV focuses on the diagnosis and dietary and pharmacological management of chronic diarrhea.[books.google.de]
Vomiting
  • […] by the picture of vomiting and diarrhea, in addition to the appearance of the fever produced by the viral character of the infantile gastroenteritis.[parenthotline.net]
  • Most patients presented with high fever between the 2nd and 5th day, having started with diarrhoea or vomiting or both. 42% of the infants had upper respiratory tract symptoms.[ncbi.nlm.nih.gov]
  • The incubation period appeared to be 48-72 hours; and the onset was sudden, often with vomiting in the first 1-2 days of the illness.[ncbi.nlm.nih.gov]
  • […] of young children (6 months-12 years) that is especially widespread during winter, caused by strains of rotavirus (family Reoviridae); the incubation period is 2-4 days, with symptoms lasting 3-5 days, including abdominal pain, diarrhea, fever, and vomiting[medical-dictionary.thefreedictionary.com]
  • In viral gastroenteritis, most often caused by rotavirus, there is low fever, vomiting, and water-like stools. Most rotavirus patients are younger than 2 years. Blood is absent in the fecal matter.[symptoma.com]
Nausea
  • The symptoms that usually appear with the infantile gastroenteritis are similar to which occurs in adults with the same virus, that is, that our son can suffer nausea, vomiting, fever, dizziness, abdominal pain and episodes of diarrhea.[parenthotline.net]
  • Symptoms may include abdominal cramps or pain, bloody stools, loss of appetite and nausea and vomiting. Most forms of bacterial gastroenteritis should only last a couple of days and we advise you to avoid dehydration by drinking plenty of fluids.[myhealthportal.co.uk]
  • Case Report This outbreak occurred in riot police camp in Chungcheongbuk-do, with symptoms of diarrhea (100%), abdominal pain (100%), headache (80%), nausea (70%), and fever (30%) ( Table 1 ).[omicsonline.org]
  • Symptoms include diarrhoea, nausea and vomiting and abdominal cramps. [6] In general, the illnesses caused by bacterial pathogens are more serious, than those due to viruses (Sethi 1989). [21] Parasites These commonly result in gastroenteritis secondary[atmph.org]
  • Clinical symptoms include abdominal cramps, nausea, a high prevalence of vomiting, and diarrhea [ 22 ]. Most published estimates for noroviruses were consistent with an incubation period of 1 to 2 days (Table 1 ).[bmcinfectdis.biomedcentral.com]
Rice Water Stool
  • DIAGNOSIS : In endemic or epidemic areas, the working diagnosis of cholera is made based on the clinical presentation, especially the presence of "rice water" stools.[atsu.edu]

Workup

In cases where physical examination suggests a bacterial, protozoal or parasitic infection, laboratory tests are required in order to elucidate the etiology. In all situations where dehydration signs are observed, the physician should evaluate the gravity of the condition by ordering complete blood cell count, serum electrolytes, urea, and creatinine.

Clinical judgment indicates what tests may be necessary for a specific patient. Giardia lamblia is identified by enzyme immunoassay. Rapid antigen stool testing may highlight the presence of rotavirus, while polymerase chain reaction is used in calicivirus infection. Human astrovirus genotyping is possible in selected cases [15]. The stool should be examined for parasite ova and larvae [16], as well as leukocytes, that signify enteroinvasive infection. Bacterial cultures are extremely valuable [17] and should always be performed if the patient is febrile. Cultures for Campylobacter, Salmonella, and Shigella should be obtained if white or red blood cells are identified in the stool. Escherichia coli is identified if the stool is cultured on a specific environment such as a chromogenic media [18]. This is method valuable in Yersinia [19], Salmonella [20] and Vibrio [21] species, as well. A blood agar plate is useful for the detection of Aeromonas spp., Vibrio spp. and Plesiomonas spp. Campylobacter should be cultured on blood-free charcoal-cefoperazone-deoxycholate agar or Skirrow medium [22] or it can be identified using its characteristic Gram stain morphology. Antibiotic susceptibility testing is indicated in infants younger than 6 months or immunocompromised children, as well as those with prolonged evolution.

If the diarrhea is considered to be part of an ulcerative colitis or Crohn's disease, a colonoscopy may be indicated. This procedure sometimes visualizes pseudomembranes in Clostridium difficile infection. If this microorganism is identified, the physician should keep in mind and monitor the risk of developing toxic megacolon [23], intestinal perforation [24], renal failure or septic shock.

Complement Fixing Antibody
  • Sucrose gradient centrifugation of sera collected sequentially from four patients after infection detected 19S complement-fixing antibody up to 5 weeks, with highest titers at 1 week, after the onset of illness.[ncbi.nlm.nih.gov]

Treatment

  • Treatment of the whole sera with 2-mercaptoethanol decreased complement-fixing titers only up to 2 weeks after onset of illness.[ncbi.nlm.nih.gov]
  • We recommend 1 day of treatment with low-dose carbamazepine as the first-line treatment for BISMG. The unnecessary use of AEDs for BISMG should be avoided after the acute phase because seizures in BISMG rarely recur.[jstage.jst.go.jp]
  • Severe dehydration and electrolyte inbalance were uncommon; and with standard treatment the illness was uncomplicated, usually lasting 5-8 days.[ncbi.nlm.nih.gov]
  • In 8 patients with CwG due to norovirus, treatment with the anticonvulsant carbamazepine (serum level 5.4 /- 1.1 mg/dl) significantly shortened duration of seizures as compared to treatment with phenobarbital.[pediatricneurologybriefs.com]

Prognosis

  • The prognosis is good. doi: 10.3969/j.issn.1672-6731.2014.03.019 Keywords Gastroenteritis; Seizures, febrile; Encephalitis, viral; Child[cjcnn.org]
  • The interictal EEG is normal, response to anticonvulsants is variable, often poor, but the prognosis is favorable. The entity is reported mainly in Asia, and outbreaks are rare in the US and Europe.[pediatricneurologybriefs.com]
  • They are characterized by brief generalized seizure or seizures in cluster, normal laboratory findings and good prognosis. We believe that individualized approach is needed in the management of rotavirus gastroenteritis with afebrile convulsion.[kjp.or.kr]
  • Prognosis Acute viral gastroenteritis is generally self-limited and has a good prognosis. [1] Morbidity/mortality Severe cases are seen in the elderly, infant, and immunosuppressed populations, including transplant patients. [ 1 ] Rotavirus infantile[emedicine.medscape.com]

Etiology

  • Severe abdominal pain and bloody diarrhea point to a bacterial etiology. The existence of dehydration should be thoroughly assessed.[symptoma.com]
  • This finding should provide additional evidence for the etiologic role of calicivirus in acute infantile gastroenteritis.[ncbi.nlm.nih.gov]
  • The difficulties in assessing the value of chemotherapeutic agents in such a disease as infantile gastroenteritis, of varied and as yet not thoroughly understood etiology, are not unexpected.[jamanetwork.com]
  • Etiology of community-acquired pediatric viral diarrhea: a prospective longitudinal study in hospitals, emergency departments, pediatric practices and child care centers during the winter rotavirus outbreak, 1997 to 1998 .[cambridge.org]
  • The concussed data on various etiological agents of gastroenteritis was limited in the journals. This article is an attempt to put forth the varied etiology of gastroenteritis as a disease.[atmph.org]

Epidemiology

  • Serological studies of a diagnostic but not epidemiological nature may also be performed with equal facility by this same test scheme using highly purified IGV antigen derived from stool.[ncbi.nlm.nih.gov]
  • Epidemiology and Infection 2007 . doi:10.1017/S0950268807008151.[cambridge.org]
  • Epidemiology and clinical features of rotavirus and norovirus infection among children in Ji'nan, China. Virol J, 2013; 10(1): 302. Chen CJ, Lartey B,A gbemabiese C, Armah G et al. The Epidemiology of Noroviruses in Ghana.[ejmm.edu.eg]
  • This book provides overviews and updates on current issues relating to basic research, clinical diagnosis, immunology, epidemiology, treatment and prevention of infections with gastroenteritis viruses.[books.google.de]
Sex distribution
Age distribution

Pathophysiology

  • Pathophysiology Viral spread from person to person occurs by fecal-oral transmission of contaminated food and water. Some viruses, like noroviruses, may be transmitted by an airborne route.[emedicine.medscape.com]
  • Howe (1942) for studies of the pathophysiology of poliomyelitis, Hattie Alexander (1943) for studies related to treatment of H. influenzae infections, Horace Hodes (1946) for studies of the transmission of Japanese B encephalitis, Paul Harper (1946) for[nature.com]

Prevention

  • Special attention is given to the prevention and treatment of these diseases found in developing countries as well as the latest findings about new antimicrobial agents, gram-negative infections and their management, and recommendations for immunization[books.google.de]
  • This book provides overviews and updates on current issues relating to basic research, clinical diagnosis, immunology, epidemiology, treatment and prevention of infections with gastroenteritis viruses.[books.google.de]
  • To cure infantile gastroenteritis will require that the children drink plenty of fluids to prevent dehydration and vomiting, as well as provide anti thermal to reduce fever.[parenthotline.net]

References

Article

  1. Sánchez-Fauquier A, Wilhelmi I, Colomina J, Cubero E, Roman E. Diversity of group A human rotavirus types circulating over a 4-year period in Madrid, Spain. J Clin Microbiol. 2004;42:1609-1613
  2. Calbo E, Freixas N, Xercavins M, et al. Foodborne nosocomial outbreak of SHV1 and CTX-M-15-producing Klebsiella pneumoniae: epidemiology and control. Clin Infect Dis. 2011;52(6):743-9.
  3. Janda J, Abbott L. The genus Aeromonas: taxonomy, pathogenicity, and infection. Clin Microbiol Rev. 2010;23:35–73.
  4. Ehling-Schulz M, Fricker M, Scherer S. Bacillus cereus, the causative agent of an emetic type of food-borne illness. Mol Nutr Food Res. 2004;48:479–487.
  5. Stenfors Arnesen L, Fagerlund A, Granum P. From soil to gut: Bacillus cereus and its food poisoning toxins. FEMS Microbiol Rev. 2008;32:579–606.
  6. Fernandez-Cruz A, Munoz P, Mohedano R, et al. Campylobacter bacteremia: clinical characteristics, incidence, and outcome over 23 years. Medicine. 2010;89:319–330.
  7. Dallal R, Harbrecht B, Boujoukas A, et al. Fulminant Clostridium difficile: an underappreciated and increasing cause of death and complications. Ann Surg. 2002;235:363–372.
  8. Rohde H, Qin J, Cui Y, et al. Open-source genomic analysis of Shiga-toxin-producing E. coli O104:H4. N Engl J Med. 2011;365:718–724.
  9. Tarr P, Gordon C, Chandler W. Shiga-toxin-producing Escherichia coli and haemolytic uraemic syndrome. Lancet. 2005;365:1073–1086.
  10. Parry C, Hien T, Dougan G, et al. Typhoid fever. N Engl J Med. 2002;347:1770–1782.
  11. von Seidlein L, Kim D, Ali M, et al. A multicentre study of Shigella diarrhoea in six Asian countries: disease burden, clinical manifestations, and microbiology. PLoS Med. 2006;3(9):e353.
  12. Harris J, LaRocque R, Qadri F, et al. Cholera. Lancet. 2012;379:2466–2476.
  13. Ong K, Gould L, Chen D, et al. Changing epidemiology of Yersinia enterocolitica infections: markedly decreased rates in young black children, Foodborne Diseases Active Surveillance Network (FoodNet), 1996-2009. Clin Infect Dis. 2012;54(5):S385–S390
  14. Rosner B, Werber D, Hohle M, et al. Clinical aspects and self-reported symptoms of sequelae of Yersinia enterocolitica infections in a population-based study, Germany 2009-2010. BMC Infect Dis. 2013;13:236.
  15. Cardoso D, Fiaccadori F, Souza M, et al. Detection and genotyping of astroviruses from children with acute gastroenteritis from Goiânia, Goiás, Brazil. Med Sci Monit. 2002;8: 624-628.
  16. La Via W. Parasitic gastroenteritis.Pediatr Ann. 1994;23(10):556-60.
  17. Humphries R, Linscott A. Laboratory diagnosis of bacterial gastroenteritis. Clin Microbiol Rev. 2015;28(1):3-31.
  18. Church D, Emshey D, Semeniuk H, et al. Evaluation of BBL CHROMagar O157 versus sorbitol-MacConkey medium for routine detection of Escherichia coli O157 in a centralized regional clinical microbiology laboratory. J Clin Microbiol. 2007;45:3098–3100.
  19. Renaud N, Lecci L, Courcol R, et al. CHRO Magar Yersinia, a new chromogenic agar for screening of potentially pathogenic Yersinia enterocolitica isolates in stools. J Clin Microbiol. 2013;51:1184–1187.
  20. Maddocks S, Olma T, , Chen S. Comparison of CHROMagar Salmonella medium and xylose-lysine-desoxycholate and Salmonella-Shigella agars for isolation of Salmonella strains from stool samples. J Clin Microbiol. 2002;40:2999–3003.
  21. Eddabra R, Piemont Y, Scheftel J. Evaluation of a new chromogenic medium, chromID Vibrio, for the isolation and presumptive identification of Vibrio cholerae and Vibrio parahaemolyticus from human clinical specimens. Eur J Clin Microbiol Infect Dis. 2011;30:733–737.
  22. Endtz H, Ruijs G, Zwinderman A, et al. Comparison of six media, including a semisolid agar, for the isolation of various Campylobacter species from stool specimens. J Clin Microbiol. 1991;29:1007–1010.
  23. Earhart M. The identification and treatment of toxic megacolon secondary to pseudomembranous colitis. Dimens Crit Care Nurs. 2008;27:249–254.
  24. Hall J, Berger D. Outcome of colectomy for Clostridium difficile colitis: a plea for early surgical management. Am J Surg. 2008;196:384–388.

Ask Question

5000 Characters left Format the text using: # Heading, **bold**, _italic_. HTML code is not allowed.
By publishing this question you agree to the TOS and Privacy policy.
• Use a precise title for your question.
• Ask a specific question and provide age, sex, symptoms, type and duration of treatment.
• Respect your own and other people's privacy, never post full names or contact information.
• Inappropriate questions will be deleted.
• In urgent cases contact a physician, visit a hospital or call an emergency service!
Last updated: 2018-06-21 21:35