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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
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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.
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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.
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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. ...