Infectious gastroenteritis (subacute) (pediatrics): Clinical sciences

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Subacute infectious gastroenteritis refers to an infection of the stomach and intestines that lasts longer than 2 weeks. Gastrointestinal infections typically present with diarrhea after fecal-oral contact or ingestion of contaminated food or water. Most cases of subacute infectious gastroenteritis are caused by either bacteria or parasites.

Now, if a pediatric patient presents with a chief concern suggesting subacute infectious gastroenteritis, first perform an ABCDE assessment to determine if they’re unstable or stable.

If unstable, stabilize their airway, breathing, and circulation. Next, obtain IV access, start IV fluids, and put your patient on continuous vital sign monitoring. Finally, provide supplemental oxygen if needed, and consider starting antibiotics.

Now, let’s return to the ABCDE assessment and take a look at stable patients. Start by obtaining a focused history and physical examination.

History will reveal more than 14 days of diarrhea, possibly in combination with fever, malaise, anorexia, vomiting, and abdominal cramps. The patient might also report a known sick contact or recent travel, and some patients may report weight loss. Finally, the exam may reveal abdominal tenderness. This clinical picture is highly suggestive of subacute infectious gastroenteritis.

To look for the causative pathogen, collect a stool sample and order labs. Depending on the suspected pathogen, you may want to order a stool culture to identify bacterial pathogens; and a stool glutamate dehydrogenase, C. diff toxins A and B, and an nucleic acid amplification test, or NAAT, to look for Clostridioides difficile or C. diff. Additionally, send stool ova and parasites, Giardia and Cryptosporidium antigens, and a Cyclospora examination, to look for parasitic pathogens. First, let’s take a look at findings you’d expect to see in bacterial infection.

In this case, the stool culture might be positive; or C. diff tests like the stool glutamate dehydrogenase antigen test, C. diff toxins A and B, and the NAAT could be positive. Any one of these findings confirms bacterial infection. Let’s look at some common causes, starting with enteroaggregative Escherichia coli, or EAEC for short.

Sources

  1. "2017 Infectious Diseases Society of America Clinical Practice Guidelines for the Diagnosis and Management of Infectious Diarrhea. " Clinical Infectious Diseases. (2017;65(12):e45-e80. )
  2. "Acute gastroenteritis." Pediatr Rev. (2012;33(11):487-495. )
  3. "Gastroenteritis in Children [published correction appears in Am Fam Physician. 2019 Jun 15;99(12):732]. " Am Fam Physician (2019)
  4. "Nelson Textbook of Pediatrics. 21st ed. " Elsevier (2020)
  5. "Nelson Essentials of Pediatrics. 8th ed. " Elsevier (2023)