Infectious
Enteritis:
Pathophysiology
and
Management
D.
Grant
Gall
Department
of
Paediatrics
and
Medicine
Faculty
of
Medicine
University
of
Calgary
Calgary,
Alberta,
Canada
Infectious
enteritis
remains
an
important
worldwide
health
problem
with
over
three
million
deaths
per
year
in
children
under
the
age
of
five.
The
presentation
will
focus
on
the
reasons
for
the
susceptibility
of
young
children
to
infection,
provide
an
overview
of
the
infectious
agents
responsible,
review
newer
concepts
of
pathophysiology
and
finally
review
management.
A
number
of
factors
are
responsible
for
the
increased
susceptibility
of
young
children.
These
include
immaturity
of
the
immune
system
and
other
defense
mechanisms
such
as
gut
motility
and
gastric
function.
Not
only
are
children
more
susceptible
to
infection
but
also
suffer
increased
morbidity
and
mortality
largely
due
to
the
potential
for
acute
loss
of
fluid
and
electrolytes
and
the
impact
of
nutritional
deprivation.
Viral
agents
account
for
the
majority
of
cases
of
infectious
enteritis
but
bacterial
agents
remain
important
etiologic
factors.
In
designing
management
strategies
it
is
important
to
understand
the
underlying
pathophysiology
of
the
disease
process.
Agents
such
as
cholera
cause
disease
by
inducing
active
chloride
secretion.
In
contrast,
most
other
infectious
agents
induce
diarrhea
by
interfering
with
brush
border
integrity
and
function,
thereby
diminishing
absorptive
capacity.
Because
of
the
nature
of
these
infections
acute
therapy
remains
largely
supportive
with
provision
of
water
and
electrolytes,
nutritional
support
and
limited
use
of
medications.
Oral
dehydration
solutions
are
the
mainstay
of
acute
therapy.
Provision
of
adequate
nutrition
is
an
important
component
of
treatment.
The
strategy
of
early
re-feeding
is
a
dramatic
departure
from
the
long-standing
tradition
of
"gut
rest"
in
diarrhea
ceases.
Breast
feeding
should
be
continued
and
in
artificially
fed
infants
and
children
the
regular
formula
or
diet
should
be
resumed
within
24
hours.
The
prescribing
of
anti-emetics,
anti-motility
and
anti-diarrheal
agents
for
the
treatment
of
acute
infectious
diarrhea
is
seldom
beneficial.
Antibiotics
should
only
be
used
when
specifically
indicated.
The
long-term
goal
is
prevention.
There
are
ongoing
efforts
to
develop
vaccines,
for
example,
against
cholera
and
rotavirus,
but
to
date
these
efforts
have
not
proven
totally
efficacious.
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