ACUTE

GASTROENTERITIS IN
CHILDREN
PGI Aniban

Nelson’s Textbook of Pediatrics, 20th ed.

 GASTROENTERITIS

Bacterial

infections of the gastrointestinal Viral

tract
Parasitic
FOOD BORNE

Most common manifestation: Systemic features:

✓ Vomiting ✓ Abdominal pain
 EPIDEMIOLOGY

9% of childhood deaths 2nd most common cause of

child deaths worldwide

preventive rotavirus vaccination

Decline in Diarrheal improved case management of

Mortality diarrhea

improved nutrition of infants and

 ETIOLOGY

Fecal-Oral Route

Ingestion of Contaminated Food/ Water

Associated with:
✓ Poverty
✓ Poor environmental
 ETIOLOGY

VIRUSES:
✓ Rotavirus-
✓

• most common viral agent

✓ Norovirus
✓

• Also the most common

• Food borne outbreaks BACTERIAL:
✓ Sapovirus ✓ Salmonella
✓ Adenovirus ✓ Clostridium perfringens
✓ Astrovirus ✓ Campylobacter
✓ Staphylococcus aureus
✓ E. coli
✓ Clostridium botulinum
 ETIOLOGY

FOOD SOURCES:
✓ Poultry

✓ Leafy vegetables

✓ Beef

✓ Fruits and nuts

✓ Vine-stalk vegetation
 PATHOGENESIS

PREFORMED TOXINS:
✓ S. aureus
✓ Bacillus Species
CYTOXIC TOXINS:
✓ Shigella
SECRETORY TOXINS:
✓ S.aureus
✓ Cholera
✓ V.parahemolyticus
✓ E. coli
✓ C.difficile
✓ Salmonella
✓ E.coli
✓ Shigella
✓ C.jejuni
 PATHOGENESIS

NON INFLAMMATORY
INFLAMMATORY

• Directly invade the intestine

• Produce cytotoxins
• Enterotoxin production- •

bacteria ✓ Fluid
• ✓ Protein
• Adherence or translocation- ✓ Cells (Rbc, Wbc)
bacteria
•

• Destruction of villus (surface

cells)- viruses
•
 PATHOGENESIS

ROTAVIRUS BACTERIAL
ENTEROTOXINS

Microvillus tips enterocyte intracellular signal

transduction

Enter cells by direct invasion/

calcium dependent endocytosis alterations in water and electrolyte
fluxes across enterocytes
 PATHOGENESIS

TOXIGENIC DIARRHEA INFLAMMATORY

Enterotoxin produced by Vibrio Shigella, Salmonella

cholera

Extensive histologic damage

Increase cAMP

Inhibit NaCl absorption

 PATHOGENESIS

ETEC SHIGELLA

superficial invasion of colonic

colonizes and adheres to mucosa
enterocytes via surface fimbriae
(pili)
invade through M cells located
over Peyer patches.

induces hyper secretion of

fluids and electrolytes
✓ Heat labile enterotoxin
✓ Heat stable enterotoxin
INCIDENCE OF DIARRHEA BY AGE STRATUM