Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content +++ Key Features ++ 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 +++ Clinical Findings ++ 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 +++ Diagnosis ++ 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 +++ Treatment ++ 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 Your Access profile is currently affiliated with [InstitutionA] and is in the process of switching affiliations to [InstitutionB]. Please select how you would like to proceed. Keep the current affiliation with [InstitutionA] and continue with the Access profile sign in process Switch affiliation to [InstitutionB] and continue with the Access profile sign in process Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Error: Incorrect UserName or Password Username Error: Please enter User Name Password Error: Please enter Password Sign in Forgot Password? Forgot Username? Download the Access App: iOS | Android Sign in via OpenAthens Sign in via Shibboleth You already have access! Please proceed to your institution's subscription. Create a free profile for additional features.