ACUTE

GASTROENTE
RITIS

Gastroenteritis
Denotes infections of the
gastrointestinal
Infectionorirritationofthedigestive
tract,
particularlythestomachandintestin
e
Bacterial, viral, or parasitic
pathogens

EPIDEMIOLOGY
In Indias more than 2.3 million annual deaths
among children, about 334000 are attributable
to diarrhoeal diseases.
Rotavirus is the leading cause of severe
diarrhoea in children in developed and
developing countries.
Studies estimate that 90000153000 children
die from rotavirus infection in India each year
Introduction of vaccines is expected to reduce
child mortality by decreasing the incidence of
severe diarrhoea and the frequency of death

Clinical manifestations

Diarrhea
Vomiting
Abdominal pain
Fever
Weight loss

MODE OF
INFECTION

ETIOLOGY
In the United states, rotavirus and the
noroviruses are the most common viral
agents
Food-borne outbreaks of bacterial diarrhea
in the United states are most commonly
due to Salmonella, E. Coli, Clostridium
Botulinum,clostridium Perfringens, and
Staphylococcus Aureus
Waterborne outbreaks are often due to
Cryptosporidium species (most common),
C. jejuni , noroviruses,Shigella species,
Giardia , E. coli O157:H7, Plesiomonas

BACTERIA
L

Bacillus anthracis
Bacillus cereus
Brucella abortus,
B. melitensis,
and B. suis
Campylobacter
jejuni
Clostridium
botulinum:
Clostridium
perfringens toxin
Enterohemorrhag
ic Escherichia coli
(EHEC)
Enterotoxigenic
E. coli (ETEC
Listeria
monocytogenes
Salmonella spp.
Shigella spp.
Staphylococcus
aureus (
Vibrio cholerae
(toxin)
Vibrio
parahaemolyticu
s

VIRAL

Hepatitis A
Caliciviruses
(including
norovirses and
sapoviruses)
Rotavirus
Other viral
agents
(astroviruses,
adenoviruses,
parvoviruses)

PARASITIC NONINFECTI
OUS

Angiostrongylus
cantonensis
Cryptosporidium
Cyclospora
cayetanensis
Entamoeba
histolytica
Giardia lamblia
Toxoplasma
gondii
Trichinella spiralis

Antimony
Arsenic
Cadmium
Copper
Mercury
Mushroom toxins,
Nitrite poisoning
Pesticides
(organophosphate
s or carbamates)
Puffer fish
(tetrodotoxin)
Scombroid
(histamine)
Shellfish toxins
Sodium fluoride
Thallium
Tin
Vomitoxin
Zinc

RISK FACTORS FOR

GASTROENTERITIS

Environmental contamination
Increased exposure to enteropathogens.
Young age
Immunodeficiency
Measles
Malnutrition
Lack of exclusive or predominant
breast-feeding.

COMPLICATIONS
Dehydration
Prolongation of the diarrheal
episodes, with consequent secondary
infections
Micronutrient deficiencies (iron, zinc).
In developing countries and hivinfected populations, associated
bacteremias are well-recognized

Clinical Evaluation of Diarrhea

The evaluation of a child with acute diarrhea includes:
Assess the degree of dehydration and acidosis and
provide rapid resuscitation and rehydration with oral
or intravenous fluids as required
Obtain appropriate contact, travel, or exposure
history. information on exposure to contacts with
similar symptoms, intake of contaminated foods or
water, child-care center attendance, recent travel of
patient or contact with a person who traveled to a
diarrhea-endemic area, and use of antimicrobial
agents.

Stool Examination
Microscopic examination of the stool
and cultures can yield important
information on the etiology of
diarrhea.
Stool specimens should be examined
for mucus, blood, and leukocytes.
Fecal leukocytes indicate bacterial
invasion of colonic mucosa

 Obtained stool as early in the course

of disease
Specimens might need to be
transported in special media.
The yield and diagnosis of bacterial
diarrhea is improved by using
molecular diagnostic

TREATMENT

Oral rehydration therapy

Enteral feeding and diet selection
Zinc supplementation
Additional therapies such as
probiotics.

Antibiotic Therapy
Reduce the duration and severity of
diarrhea
Prevent complications

PREVENTION
Promotion of exclusive breast-feeding
Improved complementary feeding
practices
Rotavirus immunization
Improved water and sanitary
facilities
Promotion of personal and domestic
hygiene
Improved case management of
diarrhea

REFERENCES
NELSON TEXTBOOK OF PEDIATRICS ,
20TH EDITION
DAVIDSONS PRINCIPAL & PRACTICE
OF MEDICINE
Bulletin of WHO : Rotavirus mortality
in India: estimates based on a
nationally representative survey of
diarrhoeal deaths
PICTURES : INTERNET COURTESY