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Management of Acute Infectious Gastroenteritis in Children


avatar Abdollah Karimi 1 , * , avatar Roxana Mansour Ghanaie 1

1 Pediatric Infections Research Center, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran

How to Cite: Karimi A, Mansour Ghanaie R. Management of Acute Infectious Gastroenteritis in Children. J Compr Ped. 2014;5(1):e17823.
doi: 10.17795/compreped-17823.


Journal of Comprehensive Pediatrics: 5 (1); e17823
Published Online: February 25, 2014
Article Type: Editorial
Received: January 25, 2014
Accepted: February 27, 2014

1. Data Gathering

It means getting the history of food consumption, recent travel, presence of fever, tenesmus, bloody diarrhea, frequency of diarrhea and different aspects of epidemiology.

2. Duration

It means onset less than two weeks before the visit.

3. Date (Time of Consumed Food)

Less than six hours: consider toxin of Staphylococcus aurous and Bacillus cereus; onset between 8 - 14 hours: enterotoxin of Clostridium perfringens and B. cereus; onset between 16 - 48 hours: norovirus, Campylobacter, Escherichia coli, Salmonella, Shigella, and Vibrio parahaemolyticus.

4. Intravenous Hydration

IV therapy is indicated in unstable patients, presence of protracted vomiting, ileus, patients with obtundated mental status, signs and symptoms of shock or intussusception, or stool output of more than 10 cc/kg/h, and carbohydrate intolerance.

5. Associated Signs and Symptoms

Signs and symptoms such as fever, anemia and hemolysis (Yersinia, Campylobacter), hemolytic uremic syndromes (HUS: Enterohemorrhagic E. coli, EHEC 0159-H7 & 0104-H4, S. dysentery), erythema nodosum (Salmonella, Campylobacter, Yersinia) (9, 10), IgA nephropathy (Campylobacter), glomerulonephritis (Yersinia, Campylobacter, Shigella, Salmonella), reactive arthritis (Salmonella, Shigella, Campylobacter, Yersinia, C. difficile, Cryptosporidium) (11), rashes (enteroviruses, adenovirus, Yersinia, Salmonella, Listeria), loss of consciousness (Ekiri syndrome, Salmonella, Encephalopathy, shock) seizures (Salmonella, Shigella, Campylobacter, rotavirus (12), Rhinovirus (13), Listeria), Guillan-Barre syndrome (Campylobacter) could be associated with the disease.

6. Red Flags

Red flags are signs and symptoms of severe dehydration, shock, loss of consciousness, acute abdomen, toxic megacolon, presence of protracted vomiting, and oliguria.

7. Repeated RE-evaluation

Repeated re-evaluation is very important. These points should be considered: 1) Probable complications and/or differential diagnoses such as: toxic megacolon, hemolytic uremic syndrome (HUS), appendicitis, gastrointestinal obstruction, and intussusceptions. 2) Re-evaluation of the hydration level and electrolyte imbalance (monitoring the mental status, quality of pulse, heart rate, mucosa and skin dryness, breathing, capillary filling, thirsty, skin fold, and urine output).

8. Host Factors

Previous history or signs and symptoms of prematurity, failure to thrive, immune deficiency, and underlying diseases should be gained.

9. Exudative or Nonexudative Diarrhea and Electrolyte Correction

9.1. Probable Causes of Exudative Diarrhea

-Infectious: Shigella spp., Salmonella spp., Campylobacter spp., Bacillus anthracis, EHEC, C. difficile, Entamoeba histolytica, urosepsis (especially in infants), typhlitis.

-Noninfectious: intussusception, appendicitis, HUS, Kawasaki disease, milk allergy, Hirschsprung, bowel ischemia (9, 14).

9.2. Probable Causes of NonExudative Diarrhea

-Secretory; bacterial: V. cholera, Salmonella spp., Enterotoxicogenic (ETEC), Shigella spp.; viral: rotavirus, enterovirus, adenovirus, astrovirus, calicivirus, avian flu.

-Toxin; Food poisoning: S. aureus, C. perfringens, E. coli, V. cholera, V. parahaemolyticus, Chinese restaurant food.

-Heavy metal poisoning: arsenic, lead, iron.

-Others: conium (9, 14).

9.3. Electrolyte Correction

The electrolyte imbalance should be corrected properly.

10. Antibiotic-Associated Diarrhea, Treatment and Other Therapies

10.1. Antibiotic-Associated Diarrhea

It can occur with C. difficile or Non-C. difficile (klebsiella oxytoca: cytotoxic hemolytic colitis) (9).

10.2. Antibiotic Therapy and Other Supplements

In a few cases of bacterial or protozoan gastroenteritis, antibiotics are needed. These included Shigella spp., S. typhi, V. cholera, some ETEC and Shiga toxin-producing E. coli and selected cases of non-typhi Salmonella, E. histolytica, Giardia and Cryptosporidium. Zinc sulfate, vitamin A and probiotics can be beneficial especially in resource-limited countries. Breastfeeding, continuous and proper nutrition, and age-appropriate calorie-protein intake during the episode will reduce further severe episodes.



  • 1.

    O'Ryan M, Lucero Y, O'Ryan-Soriano MA, Ashkenazi S. An update on management of severe acute infectious gastroenteritis in children. Expert Rev Anti Infect Ther. 2010; 8 (6) : 671 -82 [DOI][PubMed]

  • 2.

    Burkhart DM. Management of acute gastroenteritis in children. Am Fam Physician. 1999; 60 (9) : 2555 -6 [PubMed]

  • 3.

    Hersh AL, Shapiro DJ, Pavia AT, Shah SS. Antibiotic prescribing in ambulatory pediatrics in the United States. Pediatrics. 2011; 128 (6) : 1053 -61 [DOI][PubMed]

  • 4.

    Bourgeois FT, Mandl KD, Valim C, Shannon MW. Pediatric adverse drug events in the outpatient setting: an 11-year national analysis. Pediatrics. 2009; 124 (4) : e744 -50 [DOI][PubMed]

  • 5.

    Shehab N, Patel PR, Srinivasan A, Budnitz DS. Emergency department visits for antibiotic-associated adverse events. Clin Infect Dis. 2008; 47 (6) : 735 -43 [DOI][PubMed]

  • 6.

    Cohen AL, Budnitz DS, Weidenbach KN, Jernigan DB, Schroeder TJ, Shehab N, et al. National surveillance of emergency department visits for outpatient adverse drug events in children and adolescents. J Pediatr. 2008; 152 (3) : 416 -21 [DOI][PubMed]

  • 7.

    Costelloe C, Metcalfe C, Lovering A, Mant D, Hay AD. Effect of antibiotic prescribing in primary care on antimicrobial resistance in individual patients: systematic review and meta-analysis. BMJ. 2010; 340 : c2096 [DOI][PubMed]

  • 8.

    Threat Report 2013. 2013;

  • 9.

    Fisher RG, Boyce TG, Moffet HL. Skin and Soft-Tissue Syndrome. 2005;

  • 10.

    Fisher RG, Boyce TG, Moffet HL. Gastrointestinal Syndromes. 2005;

  • 11.

    Collings S, Highton J. Cryptosporidium reactive arthritis. NZ Med J. 2004; 117 (1)

  • 12.

    Lynch M, Lee B, Azimi P, Gentsch J, Glaser C, Gilliam S, et al. Rotavirus and central nervous system symptoms: cause or contaminant? Case reports and review. Clin Infect Dis. 2001; 33 (7) : 932 -8 [DOI][PubMed]

  • 13.

    Calvo C, Garcia ML, Pozo F, Reyes N, Perez-Brena P, Casas I. Role of rhinovirus C in apparently life-threatening events in infants, Spain. Emerg Infect Dis. 2009; 15 (9) : 1506 -8 [DOI][PubMed]

  • 14.

    Ochoa TJ, Zambruni M, Chea-Woo E. Approach to Patients with Gastrointestinal Tract Infections and Food Poisoning. Feigin, Cherry, Demmler-Harrison, Kaplan, Feigin & Cherry's textbook of pediatric infectious diseases. 2014;

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