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[Acute infectious diarrhea in children]
A Guarino1, F Albano, R Berni Canani
1Dipartimento di Pediatria, Università degli Studi Federico II, Napoli.
Insights
Infantile acute gastroenteritis remains a significant global health issue. Advances in understanding its mechanisms and host-pathogen interactions are improving diagnosis and reducing antibiotic use.
Area of Science:
- Pediatric Gastroenterology
- Infectious Diseases
- Immunology
Context:
- Infantile acute gastroenteritis presents a substantial burden, causing high mortality in developing nations and significant healthcare costs in industrialized countries.
- Pathophysiological insights have differentiated diarrhea into secretory and osmotic pathways.
- Host-pathogen interactions involve complex microbial strategies to evade host defenses, including the gut-associated lymphoreticular tissue (GALT).
Purpose:
- To review the pathophysiology, epidemiology, and natural history of infantile acute gastroenteritis.
- To highlight advancements in diagnostic approaches and therapeutic strategies.
- To address challenges posed by the HIV pandemic in managing intestinal infections.
Summary:
- Understanding the distinct secretory and osmotic diarrhea mechanisms and sophisticated host-microorganism interactions is crucial.
- Epidemiological data and natural history inform rational diagnostics, reducing medical costs.
- Novel therapies, including probiotics and passive immunotherapy, are decreasing reliance on antibiotics.
Impact:
- Improved diagnostic strategies lead to significant reductions in healthcare expenditures.
- Novel therapeutic approaches, such as probiotics and passive immunotherapy, offer alternatives to widespread antibiotic use.
- The HIV pandemic necessitates rapid development of effective responses to intestinal infections.
Abstract:
Infantile acute gastroenteritis is still a frequent problem particularly in younger children, with high mortality rate in developing countries and high impact on health costs in industrialized countries. The increased knowledge on its pathophysiology has led to the definition of two distinct mechanisms of diarrhea: the secretory and the osmotic pathway. Investigation on the host-microorganism interaction revealed a complex scenario with sophisticated mechanisms developed by microorganisms during evolution to overcome the host defense system. The latter includes immune and non immune coordinated components, with a major role played by the GALT (gut associated lymphoreticular tissue). Knowledge of epidemiology and of the natural history of intestinal infections has led to rational diagnostic approach with substantial cut of medical costs. Novel therapeutic strategies have been made available with the use of probiotics and of passive immunotherapy together with a dramatic reduction of antibiotic treatment. HIV pandemy raises major problems which need rapid responses.