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Gastrointestinal infections account for a large burden of morbidity and mortality in children worldwide. In developing countries, gastrointestinal infections are the second leading cause of death in children, resulting in an estimated 2 to 3 million fatalities annually.1 The incidence of diarrhea peaks between 6 and 12 months of age, with an annual incidence of 4.8 episodes per child.2 In the United States, acute diarrhea leads to more than 1.5 million outpatient visits, 200,000 hospitalizations, and 300 deaths among children per year.2

Table 236-1 lists the common gastrointestinal pathogens in children and the common syndromes they cause. This chapter will focus on common gastrointestinal infections in the pediatric population, including acute watery diarrhea, acute inflammatory diarrhea. Specific infections causing esophagitis are discussed in Chapter 394; and those causing gastritis or peptic ulcer disease in Chapter 409.

Table 236-1. Gastrointestinal Infections in Children: Common Pathogens and Commonly Associated Clinical Syndromes


Acute watery diarrhea is a ubiquitous symptom in childhood. Good global data on the etiology of diarrhea is lacking, but worldwide, rotavirus is the most common etiologic agent of acute gastroenteritis in children.3 Rotavirus is seasonal in temperate climates, with peak incidence occurring in late winter, but shows no seasonal pattern in the tropics. The highest incidence of rotavirus infection occurs in children ages 6 months to 2 years. Rotavirus is spread via the fecal-oral route and can be acquired nosocomially. The incubation period for rotavirus is 1 to 3 days.

Other important viral causes of acute watery diarrhea in the United States include adenovirus and norovirus. Adenovirus gastroenteritis is predominantly caused by types 40 and 41 in children younger than 2. Adenovirus ...

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