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Acute gastroenteritis: clinical features according to etiologic agents
F A Khuffash1, S K Sethi, A A Shaltout
1Department of Pediatrics, Faculty of Medicine, Kuwait University.
Insights
Salmonella infections cause prolonged diarrhea and severe complications in children, unlike rotavirus gastroenteritis. Prompt management, especially for malnourished children, is crucial to reduce mortality and morbidity.
Area of Science:
- Pediatrics
- Infectious Diseases
- Gastroenterology
Background:
- Gastroenteritis is a common childhood illness with varied etiologies.
- Understanding clinical differences between pathogens is vital for effective treatment.
Purpose of the Study:
- To compare clinical manifestations of gastroenteritis in hospitalized children based on causative agents.
- To identify risk factors and severity associated with specific pathogens.
Main Methods:
- Retrospective analysis of 595 children hospitalized with gastroenteritis.
- Categorization into etiological groups: rotavirus, Salmonella, E. coli, Campylobacter, Shigella, and mixed infections.
- Comparison of clinical outcomes including diarrhea duration, associated manifestations, malnutrition, and electrolyte imbalances.
Main Results:
- Salmonella infections resulted in the longest diarrhea duration (12.3-12.9 days) and highest frequency of associated manifestations, malnutrition, hyponatremia, and septicemia.
- Rotavirus and "no pathogen" groups had the shortest diarrhea duration (4.8-5.6 days).
- All four deaths occurred in Salmonella groups, highlighting its severity.
Conclusions:
- Salmonella gastroenteritis poses a significant clinical challenge, particularly in young, malnourished children in developing countries.
- Intensified management strategies and judicious antibiotic use are recommended to decrease mortality and morbidity.
- Rotavirus and E. coli infections were associated with milder clinical courses.
Abstract:
The clinical manifestations in 595 children hospitalized with gastroenteritis during a 15-month time frame were studied. They were divided into eight groups according to etiologic agent: rotavirus (203 patients); Salmonellae (98); Escherichia coli (55); Campylobacter (36); Shigella (22); combined rotavirus and salmonellae (44); combined rotavirus and other bacteria (26); and no pathogen (111). The mean duration of diarrhea was shortest in the rotavirus and "no pathogen" groups (4.8 and 5.6 days, respectively) and longest with pure and mixed salmonella infections (12.3 and 12.9 days, respectively). Associated manifestations were most frequent with salmonellae and least frequent with rotavirus and E. coli infections. Malnutrition also was most common with salmonellae and lowest with rotavirus and E. coli. There were no differences in the frequency of hypernatremia. Hyponatremia was most frequently encountered with salmonella (25% compared to 9% in the rest of the patients). Evidence of septicemia was found in 22 patients, 21 of whom were in the salmonella groups. The four deaths in this series (0.7%) also were in the salmonellae groups. The clinical severity of salmonella infection in developing countries, particularly in young and malnourished children, warrants attention to more intensive management. The selective use of antibiotics may help reduce the mortality and morbidity of gastroenteritis.