Skip to main content

Abstract

Diarrhea is the second leading cause of death in children below 5 years of age worldwide. In developing countries, the mortality rate due to acute gastroenteritis is very high. In industrialized countries, the mortality rate is much lower but acute gastroenteritis still accounts for several hospitalizations in children below 5 years of age. Viruses are the most common etiologic agents, with Rotavirus and Norovirus being the most frequent pathogens. Rotaviruses have a predilection for young children, whereas Noroviruses affect people of all ages. Viral gastroenteritis is characterized by an abrupt appearance of vomiting and watery diarrhea, often accompanied by low-grade fever and abdominal pain, which is generally self-limited lasting no more than 5 days. Microbiological examination is not helpful in the majority of cases, and it is indicated only in specific circumstances such as immunocompromised patients for whom molecular biology has now become a rapid and sensitive method for diagnosis. The severity of acute gastroenteritis is reflected by the degree of dehydration, and treatment is focused on maintaining adequate hydration with oral rehydration solution. Feeding should be continued if possible. Intravenous rehydration is recommended in case of severe dehydration, failure of oral rehydration, and in the presence of complications. Active treatment of acute gastroenteritis with selected probiotics in adjunct to rehydration is effective in reducing the intensity and duration of symptoms. The incidence of viral diarrhea is consistently reduced by Rotavirus immunization.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 89.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 129.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Similar content being viewed by others

References

  1. Walker CL, Aryee MJ, Boschi-Pinto C, Black RE. Estimating diarrhea mortality among young children in low and middle income countries. PLoS One. 2012;7:e29151.

    Google Scholar 

  2. Liu L, Oza S, Hogan D, Chu Y, Perin J, Zhu J, et al. Global, regional, and national causes of under-5 mortality in 2000–15: an updated systematic analysis with implications for the sustainable development goals. Lancet. 2016;388:3027–35.

    Google Scholar 

  3. Boschi-Pinto C, Velebit L, Shibuya K. Estimating child mortality due to diarrhoea in developing countries. Bull World Health Organ. 2008;86:710–7.

    Google Scholar 

  4. GBD 2016 Diarrhoeal Disease Collaborators. Estimates of the global, regional, and national morbidity, mortality, and aetiologies of diarrhoea in 195 countries: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Infect Dis. 2018;18:1211–28.

    Google Scholar 

  5. Leshem E, Tate JE, Steiner CA, Curns AT, Lopman BA, Parashar UD. Acute gastroenteritis hospitalizations among US children following implementation of the Rotavirus vaccine. JAMA. 2015;313:2282–4.

    CAS  Google Scholar 

  6. Velázquez FR, Matson DO, Calva JJ, Guerrero L, Morrow AL, Carter-Campbell S, et al. Rotavirus infections in infants as protection against subsequent infections. N Engl J Med. 1996;335:1022–8.

    Google Scholar 

  7. Aliabadi N, Antoni S, Mwenda JM, Weldegebriel G, Biey JN, Cheikh D, Fahmy K, Teleb N, Ashmony HA, Ahmed H, Daniels DS. Global impact of Rotavirus vaccine introduction on rotavirus hospitalisations among children under 5 years of age, 2008–16: findings from the Global Rotavirus Surveillance Network. Lancet Glob Health. 2019;7:e893–903.

    Google Scholar 

  8. Forster J, Guarino A, Parez N, Moraga F, Román E, Mory O, et al. Rotavirus Study Group. Hospital-based surveillance to estimate the burden of Rotavirus gastroenteritis among European children younger than 5 years of age. Pediatrics. 2009;123:393–400.

    Google Scholar 

  9. Williams CJ, Lobanov A, Pebody RG. Estimated mortality and hospital admission due to Rotavirus infection in the WHO European region. Epidemiol Infect. 2009;137:607–16.

    CAS  Google Scholar 

  10. De Grazia S, Bonura F, Bonura C, Mangiaracina L, Filizzolo C, Martella V, Giammanco GM. Assessing the burden of viral co-infections in acute gastroenteritis in children: an eleven-year-long investigation. J Clin Virol. 2020;129:104513.

    Google Scholar 

  11. Fischer TK, Viboud C, Parashar U, et al. Hospitalizations and deaths from diarrhea and Rotavirus among children <5 years of age in the United States, 1993–2003. J Infect Dis. 2007;195:1117–25.

    Google Scholar 

  12. Leshem E, Tate JE, Steiner CA, Curns AT, Lopman BA, Parashar UD. National estimates of reductions in acute gastroenteritis-related hospitalizations and associated costs in US children after implementation of rotavirus vaccines. J Pediatric Infect Dis Soc. 2018;7:257–60.

    Google Scholar 

  13. Burnett E, Jonesteller CL, Tate JE, Yen C, Parashar UD. Global impact of rotavirus vaccination on childhood hospitalizations and mortality from diarrhea. J Infect Dis. 2017;215:1666–72.

    Google Scholar 

  14. Guarino A, Bruzzese E. Viral Diarrhea. Springer International Publishing Switzerland 2016. Giandalini S. et al. (eds). Textbook of Pediatrics Gastroenterology, Hepatology and Nutrition. pp 159–69.

    Google Scholar 

  15. Xiong L-J, Zhou M-Y, He X-Q, Wu Y, Xie X-L. The role of human coronavirus infection in pediatric acute gastroenteritis. Pediatr Infect Dis J. 2020;39:645–9.

    Google Scholar 

  16. Istrate C, Hagbom M, Vikström E, Magnusson KE, Svensson L. Rotavirus infection increases intestinal motility but not permeability at the onset of diarrhoea. J Virol. 2014;88:3161–9.

    Google Scholar 

  17. De Marco G, Bracale I, Buccigrossi V, Bruzzese E, Canani RB, Polito G, et al. Rotavirus induces a biphasic enterotoxic and cytotoxic response in human-derived intestinal enterocytes, which is inhibited by human immunoglobulins. J Infect Dis. 2009;200:813–9.

    Google Scholar 

  18. Camilleri M, Nullens S, Nelsen T. Enteroendocrine and neuronal mechanisms in pathophysiology of acute infectious diarrhea. Dig Dis Sci. 2012;57(1):19–27. https://doi.org/10.1007/s10620-011-1939-9.

    Article  CAS  Google Scholar 

  19. Crawford SE, Ramani S, Tate JE, et al. Rotavirus infection. Nat Rev Dis Primers. 2017;3:17083. https://doi.org/10.1038/nrdp.2017.83.

    Article  Google Scholar 

  20. Guarino A, Ashkenazi S, Gendrel D, Lo Vecchio A, Shamir R, Szajewska H. European Society for Pediatric Gastroenterology Hepatology and Nutrition European Society for Pediatric Infectious Diseases evidence-based guidelines for the management of acute gastroenteritis in children in Europe: update 2014. J Pediatr Gastroenterol Nutr. 2014;59:132–52.

    Google Scholar 

  21. Patteau G, Stheneur C, Chevallier B, Parez N. Benign afebrile seizures in Rotavirus gastroenteritis. Arch Pediatr. 2010;17:1527–30.

    CAS  Google Scholar 

  22. Kim BR, Choi GE, Kim YO, Kim MJ, Song ES, Woo YJ. Incidence and characteristics of Norovirus-associated benign convulsions with mild gastroenteritis, in comparison with Rotavirus ones. Brain and Development. 2018;40:699–706.

    Google Scholar 

  23. Shai S, Perez-Becker R, von König CH, von Kries R, Heininger U, Forster J, et al. Rotavirus disease in Germany—a prospective survey of very severe cases. Pediatr Infect Dis J. 2013;32:e62–7.

    Google Scholar 

  24. Lopman BA, Bresee JS. Viral gastroenteritis. In: Principles and practice of pediatric infectious diseases. Philadelphia: Elsevier; 2018. p. 383–387.e3.

    Google Scholar 

  25. Garza DR, Dutilh BE. From cultured to uncultured genome sequences: metagenomics and modeling microbial ecosystems. Cell Mol Life Sci. 2015;72:4287–308.

    CAS  Google Scholar 

  26. Martinez-Hernandez F, Fornas O, Gomez ML, Bolduc B, de La Cruz Peña MJ, Martínez JM, et al. Single-virus genomics reveals hidden cosmopolitan and abundant viruses. Nat Commun. 2017;8:15892.

    CAS  Google Scholar 

  27. Briese T, Kapoor A, Mishra N, Jain K, Kumar A, Jabado OJ, et al. Virome capture sequencing enables sensitive viral diagnosis and comprehensive virome analysis. MBio. 2015:e1491–15.

    Google Scholar 

  28. Tate JE, Mijatovic-Rustempasic S, Tam KI, et al. Comparison of 2 assays for diagnosing Rotavirus and evaluating vaccine effectiveness in children with gastroenteritis. Emerg Infect Dis. 2013;19:1245–52.

    Google Scholar 

  29. Guarino A, Lo Vecchio A, Berni Canani R. Chronic diarrhoea in children. Best Pract Res Clin Gastroenterol. 2012;26:649–61.

    Google Scholar 

  30. Page N, Esona M, Armah G, Nyangao J, Mwenda J, Sebunya T, et al. Emergence and characterization of serotype G9 Rotavirus strains from Africa. J Infect Dis. 2010;202:S55–63.

    Google Scholar 

  31. Seheri M, Nemarude L, Peenze I, Netshifhefhe L, Nyaga MM, Ngobeni HG, et al. Update of Rotavirus strains circulating in Africa from 2007 through 2011. Pediatr Infect Dis J. 2014;33:S76–84.

    Google Scholar 

  32. Mwenda JM, Tate JE, Steele AD, Parashar UD. Preparing for the scale-up of Rotavirus vaccine introduction in Africa: establishing surveillance platforms to monitor disease burden and vaccine impact. Pediatr Infect Dis J. 2014;33:S1–5.

    Google Scholar 

  33. Linhares AD, Verstraeten T, Wolleswinkel-van den Bosch J, Clemens R, Breuer T. Rotavirus serotype G9 is associated with more-severe disease in Latin America. Clin Infect Dis. 2006;43:312–4.

    Google Scholar 

  34. Bruijning-Verhagen P, Quach C, Bonten M. Nosocomial Rotavirus infections: a meta-analysis. Pediatrics. 2012;129:e1011–9.

    Google Scholar 

  35. Ogilvie I, Khoury H, Goetghebeur MM, El Khoury AC, Giaquinto C. Burden of community-acquired and nosocomial Rotavirus gastroenteritis in the pediatric population of Western Europe: a scoping review. BMC Infect Dis. 2012;12:62.

    Google Scholar 

  36. Festini F, Cocchi P, Mambretti D, Tagliabue B, Carotti M, Ciofi D, Biermann KP, et al. Nosocomial Rotavirus gastroenteritis in pediatric patients: a multi-center prospective cohort study. BMC Infect Dis. 2010;10:235.

    Google Scholar 

  37. Shah MP, Hall AJ. Norovirus illnesses in children and adolescents. Infect Dis Clin N Am. 2018;32:103–18.

    Google Scholar 

  38. Widdowson MA, Monroe SS, Glass RI. Are Noroviruses emerging? Emerg Infect Dis. 2005;11:735–7.

    Google Scholar 

  39. Elftman MD, Gonzalez-Hernandez MB, Kamada N, Perkins C, Henderson KS, Núñez G, et al. Multiple effects of dendritic cell depletion on murine norovirus infection. J Gen Virol. 2013;94:1761–8.

    CAS  Google Scholar 

  40. Kim YG, Park JH, Reimer T, Baker DP, Kawai T, Kumar H, et al. Viral infection augments Nod1/2 signaling to potentiate lethality associated with secondary bacterial infections. Cell Host Microbe. 2011;9:496–507.

    CAS  Google Scholar 

  41. McFadden N, Bailey D, Carrara G, Benson A, Chaudhry Y, Shortland A, Heeney J, et al. Norovirus regulation of the innate immune response and apoptosis occurs via the product of the alternative open reading frame 4. PLoS Pathog. 2011;7:e1002413.

    CAS  Google Scholar 

  42. Nelson AM, Walk ST, Taube S, Taniuchi M, Houpt ER, Wobus CE, et al. Disruption of the human gut microbiota following Norovirus infection. PLoS One. 2012;7:e48224.

    CAS  Google Scholar 

  43. Buccigrossi V, Nicastro E, Guarino A. Functions of intestinal microflora in children. Curr Opin Gastroenterol. 2013;29:31–8.

    Google Scholar 

  44. Bartsch SM, O’Shea KJ, Lee BY. The clinical and economic burden of Norovirus gastroenteritis in the United States [published online ahead of print, 2020 Jul 16]. J Infect Dis. 2020:jiaa292. https://doi.org/10.1093/infdis/jiaa292.

  45. Burke RM, Mattison CP, Pindyck T, Dahl RM, Rudd J, Bi D, Curns AT, Parashar U, Hall AJ. The burden of Norovirus in the United States, as estimated based on administrative data: updates for medically attended illness and mortality, 2001–2015. Clin Infect Dis. 2020:ciaa438.

    Google Scholar 

  46. Halasa N, Piya B, Stewart LS, et al. The changing landscape of pediatric viral enteropathogens in the post-rotavirus vaccine era. Clin Infect Dis. 2020:ciaa100.

    Google Scholar 

  47. D’Amico F, Baumgart DC, Danese S, Peyrin-Biroulet L. Diarrhea during COVID-19 infection: pathogenesis, epidemiology, prevention, and management. Clin Gastroenterol Hepatol. 2020;18(8):1663–72.

    Google Scholar 

  48. Pan L, Mu M, Ren HG et al. Clinical characteristics of COVID-19 patients with digestive symptoms in Hubei, China: a descriptive, cross-sectional, multicenter study. Am J Gastroenterol. 2020;115(5):766–73. Published online March 18, 2020.

    Google Scholar 

  49. Fang D, Ma JD, Guan JL, et al. Manifestations of digestive system in hospitalized patients with novel coronavirus pneumonia in Wuhan, China: a single-center, descriptive study. Chin J Dig. 2020;40.

    Google Scholar 

  50. Zhang JJ, Dong X, Cao YY, Yuan YD, Yang YB, Yan YQ, Akdis CA. Gao YD clinical characteristics of 140 patients infected with SARS-CoV-2 in Wuhan, China. Allergy. 2020;75:1730–41. https://doi.org/10.1111/all.14238. Epub 2020 Feb 27.

    Article  CAS  Google Scholar 

  51. An P, Chen HB, Jiang XD, et al. The clinical features of 2019 will be coronavirus root presented gastrointestinal symptoms but without fever onset. Lancet. 2020;52:1076–9.

    Google Scholar 

  52. Musa S. Hepatic and gastrointestinal involvement in coronavirus disease 2019 (COVID-19): what do we know till now? Arab J Gastroenterol. 2020;21:3–8.

    Google Scholar 

  53. Bailey B, Gravel J, Goldman RD, Friedman JN, Parkin PC. External validation of the clinical dehydration scale for children with acute gastroenteritis. Acad Emerg Med. 2010;17:583–8.

    Google Scholar 

  54. Buccigrossi V, Vecchio AL, Bruzzese E, Russo C, Marano A, Terranova S, et al. Potency of oral rehydration solution in inducing fluid absorption is related to glucose concentration. Sci Rep. 2020;10:7803.

    Google Scholar 

  55. MacGillivray S, Fahey T, McGuire W. Lactose avoidance for young children with acute diarrhoea. Cochrane Database Syst Rev. 2013;10:CD005433.

    Google Scholar 

  56. Gaffey MF, Wazny K, Bassani DG, Bhutta ZA. Dietary management of childhood diarrhea in low- and middle-income countries: a systematic review. BMC Public Health. 2013;13(Suppl 3):S17.

    Google Scholar 

  57. Bruzzese E, Lo Vecchio A, Guarino A. Hospital management of children with acute gastroenteritis. Curr Opin Gastroenterol. 2013;29:23–30.

    Google Scholar 

  58. Vecchio AL, Dias JA, Berkley JA, Boey C, Cohen MB, Cruchet S, Liguoro I, Lindo ES, Sandhu B, Sherman P, Shimizu T. Comparison of recommendations in clinical practice guidelines for acute gastroenteritis in children. J Pediatr Gastroenterol Nutr. 2016;63:226–35.

    Google Scholar 

  59. Szajewska H, Skórka A, Ruszczyński M, Gieruszczak-Białek D. Meta-analysis: lactobacillus GG for treating acute gastroenteritis in children—updated analysis of randomised controlled trials. Aliment Pharmacol Ther. 2013;38:467–76.

    CAS  Google Scholar 

  60. Szajewska H, Skórka A, Dylag M. Meta-analysis: Saccharomyces boulardii for treating acute diarrhoea in children. Aliment Pharmacol Ther. 2007;25:257–64.

    CAS  Google Scholar 

  61. Guarino A, Lo Vecchio A, Canani RB. Probiotics as prevention and treatment for diarrhea. Curr Opin Gastroenterol. 2009;25:18–23.

    Google Scholar 

  62. Guandalini S. Probiotics for prevention and treatment of diarrhea. J Clin Gastroenterol. 2011;45:S149–53.

    Google Scholar 

  63. Schnadower D, Tarr PI, Casper TC, Gorelick MH, Dean JM, O’Connell KJ, Mahajan P, Levine AC, Bhatt SR, Roskind CG, Powell EC, Rogers AJ, Vance C, Sapien RE, Olsen CS, Metheney M, Dickey VP, Hall‐Moore C, Freedman SB. Lactobacillus rhamnosus GG versus placebo for acute gastroenteritis in children. N Engl J Med. 2018;379:2002–2014.

    Google Scholar 

  64. Pérez-Gaxiola G, Cuello-García CA, Florez ID, Pérez-Pico VM. Smectite for acute infectious diarrhoea in children (review). Cochrane Database Syst Rev. 2018;4:CD011526.

    Google Scholar 

  65. Lehert P, Cheron G, Calatayud GA, Cézard JP, Castrellón PG, Garcia JM, et al. Racecadotril for childhood gastroenteritis: an individual patient data meta-analysis. Dig Liver Dis. 2011;43:707–13.

    CAS  Google Scholar 

  66. Liang Y, Zhang L, Zeng L, Gordon M, Wen J, Cochrane Infectious Diseases. Racecadotril for acute diarrhoea in children. Cochrane Database Syst Rev. 2019;2019:CD009359.

    Google Scholar 

  67. Black R, Fontaine O, Lamberti L, Bhan M, Huicho L, El Arifeen S, Masanja H, Walker CF, Mengestu TK, Pearson L, Young M, Orobaton N, Chu Y, Jackson B, Bateman M, Walker N, Merson M. Drivers of the reduction in childhood diarrhea mortality 1980–2015 and interventions to eliminate preventable diarrhea deaths by 2030. J Glob Health. 2019;9:020801.

    Google Scholar 

  68. Tomasik E, Ziółkowska E, Kołodziej M, Szajewska H. Systematic review with meta-analysis: ondansetron for vomiting in children with acute gastroenteritis. Aliment Pharmacol Ther. 2016;44:438–46.

    CAS  Google Scholar 

  69. Guarino A, Canani RB, Russo S, et al. Oral immunoglobulins for treatment of acute Rotaviral gastroenteritis. Pediatrics. 1994;93:12–6.

    CAS  Google Scholar 

  70. Guarino A, Russo S, Castaldo A, Spagnuolo MI, Tarallo L, Rubino A. Passive immunotherapy for Rotavirus-induced diarrhoea in children with HIV infection. AIDS. 1996;10:1176–8.

    CAS  Google Scholar 

  71. Alexander E, Hommeida S, Stephens MC, Manini ML, Absah I. The role of oral administration of immunoglobulin in managing diarrheal illness in immunocompromised children. Paediatr Drugs. 2020;22:331–4.

    Google Scholar 

  72. Ruiz-Palacios GM, Perez-Schael I, Velazquez FR, Abate H, Breuer T, Clemens SC, et al. Human Rotavirus Vaccine Study Group. Safety and efficacy of an attenuated vaccine against severe Rotavirus gastroenteritis. N Engl J Med. 2006;354:11–22.

    CAS  Google Scholar 

  73. Vesikari T, Matson DO, Dennehy P, Van Damme P, Santosham M, Rodriguez Z, et al. Rotavirus Efficacy and Safety Trial (REST) Study Team. Safety and efficacy of a pentavalent human–bovine (WC3) reassortant Rotavirus vaccine. N Engl J Med. 2006;354:23–33.

    CAS  Google Scholar 

  74. Pereira P, Vetter V, Standaert B, Benninghoff B. Fifteen years of experience with the oral live-attenuated human Rotavirus vaccine: reflections on lessons learned [published online ahead of print, 2020 Jul 30]. Expert Rev Vaccines. 2020;19(8):755–69.

    Google Scholar 

  75. Lo Vecchio A, Liguoro I, Dias JA, Berkley JA, Boey C, Cohen MB, Cruchet S, Salazar-Lindo E, Podder S, Sandhu B, Sherman PM, Shimizu T, Guarino A. Rotavirus immunization: global coverage and local barriers for implementation. Vaccine. 2017;35:1637–44.

    Google Scholar 

  76. Guarino A, Aguilar J, Berkley J, et al. Acute gastroenteritis in children of the world: what needs to be done? J Pediatr Gastroenterol Nutr. 2020;70:694–701.

    Google Scholar 

  77. Cortes-Penfield NW, Ramani S, Estes MK, Atmar RL. Prospects and challenges in the development of a Norovirus vaccine. Clin Ther. 2017;39:1537–49.

    CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Alfredo Guarino .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2022 The Author(s), under exclusive license to Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Guarino, A., Bruzzese, E. (2022). Viral Diarrhea. In: Guandalini, S., Dhawan, A. (eds) Textbook of Pediatric Gastroenterology, Hepatology and Nutrition. Springer, Cham. https://doi.org/10.1007/978-3-030-80068-0_14

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-80068-0_14

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-80067-3

  • Online ISBN: 978-3-030-80068-0

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics