Gastroenteritis Viruses

Viral Gastroenteritis (Stomach Flu)

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The epidemiology and clinical manifestations vary greatly depending on the subtype:. Enterohemorrhagic E. It produces Shiga toxin, which causes bloody diarrhea hemorrhagic colitis. Thus, these subtypes are sometimes termed Shiga toxin—producing E.

Undercooked ground beef, unpasteurized milk and juice, and contaminated water are possible sources. Person-to-person transmission is common in the day care setting. Outbreaks associated with exposure to water in recreational settings eg, pools, lakes, water parks have also been reported. Enterotoxigenic E. Enteropathogenic E. Once a common cause of diarrhea outbreaks in nurseries, this subtype is now rare. Enteroinvasive E. It is rare in the US. Enteroaggregative E. As with some of the other subtypes, it is more common in the developing world and can be a cause of traveler's diarrhea.

Each of these E. Sometimes more than one organism is detected simultaneously, the clinical significance of which is unclear. In the past, Clostridium difficile infection occurred almost exclusively in hospitalized patients receiving antibiotics. With the emergence of the hypervirulent NAP1 strain in the US in the late s, many community-associated cases are now occurring. Several other bacteria cause gastroenteritis, but most are uncommon in the US. It is transmitted by undercooked pork, unpasteurized milk, or contaminated water.

Listeria can rarely cause food-borne gastroenteritis but more often causes bloodstream infection or meningitis in pregnant women, neonates see Neonatal Listeriosis , or the elderly. Aeromonas is acquired from swimming in or drinking contaminated fresh or brackish water. Plesiomonas shigelloides can cause diarrhea in patients who have eaten raw shellfish or traveled to tropical regions of the developing world. Certain intestinal parasites, notably Giardia intestinalis G. Giardiasis occurs in every region of the US and throughout the world.

The infection can become chronic and cause a malabsorption syndrome. It is usually acquired via person-to-person transmission often in day care centers or from contaminated water. Cryptosporidium parvum causes watery diarrhea sometimes accompanied by abdominal cramps, nausea, and vomiting. In healthy people, the illness is self-limited, lasting about 2 weeks.

In immunocompromised patients, illness may be severe and prolonged, causing substantial electrolyte and fluid loss. Cryptosporidium is usually acquired through contaminated water.

Viral gastroenteritis (stomach flu)

It is not easily killed by chlorine and is the most common cause of recreational waterborne illness in the US, accounting for about three fourths of outbreaks. Other parasites that can cause symptoms similar to those of cryptosporidiosis include Cyclospora cayetanensis and, in immunocompromised patients, Cystoisospora Isospora belli and a collection of organisms referred to as microsporidia eg, Enterocytozoon bieneusi , Encephalitozoon intestinalis.

Entamoeba histolytica see Amebiasis is a common cause of subacute bloody diarrhea in the developing world but is rare in the US. The character and severity of symptoms of gastroenteritis vary.

Gastroenteritis - Gastrointestinal Disorders - MSD Manual Professional Edition

Generally, onset is sudden, with anorexia, nausea, vomiting, abdominal cramps, and diarrhea with or without blood and mucus. Malaise, myalgias, and prostration may occur. The abdomen may be distended and mildly tender; in severe cases, muscle guarding may be present. Gas-distended intestinal loops may be palpable.

Hyperactive bowel sounds are present on auscultation even without diarrhea an important differential feature from paralytic ileus, in which bowel sounds are absent or decreased. Persistent vomiting and diarrhea can result in intravascular fluid depletion with hypotension and tachycardia. In severe cases, shock, with vascular collapse and oliguric renal failure, occurs. If vomiting is the main cause of fluid loss, metabolic alkalosis with hypochloremia can occur. If diarrhea is more prominent, metabolic acidosis is more likely.

Both vomiting and diarrhea can cause hypokalemia. Hyponatremia may develop, particularly if hypotonic fluids are used in replacement therapy. In viral infections, watery diarrhea is the most common symptom; stools rarely contain mucus or blood. Rotavirus gastroenteritis in infants and young children may last 5 to 7 days.

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Norovirus typically causes acute onset of vomiting, abdominal cramps, and diarrhea, with symptoms lasting only 1 to 2 days. In children, vomiting is more prominent than diarrhea, whereas in adults, diarrhea usually predominates. Patients may also have fever, headache, and myalgias. The hallmark of adenovirus gastroenteritis is diarrhea lasting 1 to 2 weeks. Affected infants and children may have mild vomiting that typically starts 1 to 2 days after the onset of diarrhea. Respiratory symptoms may be present. Symptoms are generally mild but can last longer than with other viral causes of gastroenteritis.

Fever is absent or low grade. The spectrum of illness with C. Bacteria that produce an enterotoxin eg, S.

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Parasitic infections typically cause subacute or chronic diarrhea. Most cause nonbloody diarrhea; an exception is E. Fatigue and weight loss are common when diarrhea is persistent. Other gastrointestinal disorders that cause similar symptoms eg, appendicitis , cholecystitis , ulcerative colitis must be excluded see also evaluation of diarrhea.

Findings suggestive of gastroenteritis include copious, watery diarrhea; ingestion of potentially contaminated food particularly during a known outbreak , untreated surface water, or a known gastrointestinal irritant; recent travel; or contact with certain animals or similarly ill people.

Hemolytic-uremic syndrome may follow as evidenced by renal failure and hemolytic anemia. However, about one fourth of patients with community-associated C. Stool testing is guided by clinical findings and the organisms that are suspected based on patient history and epidemiologic factors eg, immunosuppression, exposure to a known outbreak, recent travel, recent antibiotic use. Cases are typically stratified into.

Multiplex polymerase chain reaction platforms that can identify causative organisms in each of these categories are being used more often. However, this testing is expensive, and because the categories are distinguishable clinically, it is usually more cost-effective to test for specific microorganisms depending on the type and duration of diarrhea. In addition, polymerase chain reaction testing does not allow for antibiotic susceptibility testing. Acute watery diarrhea is probably viral and testing is not indicated unless the diarrhea persists. Although rotavirus and enteric adenovirus infections can be diagnosed using commercially available rapid assays that detect viral antigen in the stool, these assays are rarely indicated.

Subacute and chronic watery diarrhea require testing for parasitic causes, typically with microscopic stool examination for ova and parasites. There is no specific treatment for viral gastroenteritis except rest and drinking plenty of fluids. Most people will recover without complications. However, viral gastroenteritis can be serious infants, people with suppressed immune systems and the elderly. People caring for those with gastroenteritis should wash hands thoroughly with soap and running water after any contact with the sick person.

Cleaning soiled surfaces and clothing reduces further spread of the virus. Outbreaks of viral gastroenteritis increase in winter and are common within families and group settings including nursing homes, hospitals, childcare centres, and schools.

1. The Known: Pathogenic Viruses in the Gastrointestinal Tract

Doctors and hospitals are required to notify their local public health unit whenever there are at least two cases of gastroenteritis that are linked. A to Z Feedback Contact us Emergency information.

Home Infectious diseases Fact sheets Viral gastroenteritis fact sheet. Fact sheets Currently selected Control guidelines. Gastroenteritis is commonly caused by viral infections resulting in vomiting and diarrhoea. The viruses are easily spread from person to person. Thorough washing of hands with soap and running water are vital to prevent spread. Last updated: 27 July What is viral gastroenteritis? Human torovirus: A new nosocomial gastrointestinal pathogen. Gubbay J. The role of torovirus in nosocomial viral gastroenteritis at a large tertiary pediatric centre.

Ludert J. Identification of viruses with bi- and trisegmented double-stranded RNA genome in faeces of children with gastroenteritis. Malik Y. Epidemiology, phylogeny, and evolution of emerging enteric picobirnaviruses of animal origin and their relationship to human strains. Virome analysis during a hospital diarrhoea outbreak. Banyai K. Sequence heterogeneity among human picobirnaviruses detected in a gastroenteritis outbreak.

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