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Key Features

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  • Viruses are the most common cause of acute gastroenteritis

  • Rotavirus is the most common

  • Affects the small intestine, causing voluminous watery diarrhea without leukocytes or blood

  • Transmission is via the fecal-oral route

  • Virus can survive for hours on hands and for days on environmental surfaces

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Clinical Findings

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  • Rotavirus

    • Incubation period is 1–3 days

    • Symptoms are similar to other viral pathogens

    • Vomiting is the first symptom in 80–90% of patients

    • Low-grade fever and watery diarrhea develop in following 24 hours

    • Diarrhea usually lasts 4–8 days but may last longer in young infants or immunocompromised patient

    • Primarily affects infants between 3 and 15 months of age

    • Peak incidence is in winter

  • Enteric adenovirus infection

    • Symptoms are similar to those of rotavirus

    • Duration of illness may be longer

    • Not seasonal

  • Norovirus (also called The Norwalk agent)

    • Mainly causes vomiting

    • Can also cause diarrhea in older children and adults, usually in common source outbreaks

    • Duration of symptoms is short, usually 24–48 hours

  • Other potentially pathogenic viruses include

    • Astroviruses

    • Corona-like viruses

    • Other small round viruses

  • Cytomegalovirus

    • Rarely causes diarrhea in immunocompetent children

    • May cause erosive colitis or enteritis in immunocompromised persons

    • Cytomegalovirus enteritis is particularly common after solid-organ and bone marrow transplant and in the late stages of HIV infection

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Diagnosis

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  • Rotavirus

    • Cannot be definitively diagnosed on clinical grounds alone

    • Antigens can be identified in stool

    • Scanning electron microscopy can show virus

    • Additional laboratory testing is generally unnecessary

  • Other viral pathogens causing diarrhea in children can be identified in stool by

    • Electron microscopy

    • Viral culture

    • Enzyme-linked immunoassay

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Treatment

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  • Nonspecific and supportive

  • Replacement of fluid and electrolyte deficits, along with ongoing losses, especially in small infants is necessary

  • Use of clear liquids or hypocaloric (dilute formula) diets for more than 48 hours is not advisable

  • Early initiation of refeeding is recommended

  • Brief use of a lactose-free diet may be associated with a shorter period of diarrhea but is not critical to successful recovery in healthy infants

  • Reduced fat intake during recovery may decrease nausea and vomiting

  • Antidiarrheal medications

    • Ineffective (kaolin-pectin combinations)

    • In some circumstances can be dangerous (loperamide, tincture of opium, diphenoxylate with atropine)

  • Bismuth subsalicylate preparations

    • May reduce stool volume

    • However, not generally recommended, especially in young children due to the salicylate component and risk of Reye syndrome

  • Oral immunoglobulin or specific antiviral agents have occasionally been useful in limiting duration of disease in immunocompromised patients

  • Probiotics

    • Moderately effective in treating acute viral gastroenteritis in healthy children

    • Should be used with extreme caution, however, in immunocompromised, chronically debilitated, or seriously ill children

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