Acute Gastroenteritis in Infants and Young Children

Acute Gastroenteritis (AGE) is a common pediatric illness .In the Middle East region, AGE persists as the second major cause of pediatric mortality and morbidity following acute lower respiratory tract infections^3,4Acute gastroenteritis (AGE) in children is considered one of the most common causes of visits to health centers, one of the most frequent reason of hospitalization and the third leading cause of death related to infectious diseases worldwide^5,6.The incidence of diarrhea ranges from 0.5 to 2 episodes per child per year in children <3 years in Europe⁸. On average, children below 3 years of age in developing countries experience 3 episodes of diarrhea each year⁷.Rotavirus (RV)is the leading cause of AGE in infants and young children and the major contributor to hospitalization for diarrhea in countries that have no RV vaccines in their national immunization schedules^9,10,11. With the continuing decline in cases of RV-associated AGE, since the implementation of routine childhood vaccination against RV, norovirus (NoV) infection has become the most common cause of medically treated AGE ^12,13.In 2012, a study conducted in two locations in Egypt over 2112 children to determine the causes of acute diarrhea in children younger than 5-years seeking treatment. Bacteria were identified as a sole pathogen in 20%, RV in 14% and Cryptosporidium in 5% of the cases. Adenovirus (AdV), astrovirus (AsV), NoV and G. lamblia were detected as the sole pathogen in 2%, 3%, 9% and 7% of the cases, respectively. E. histolytica was never detected as the sole pathogen¹⁴.The most common enteric infections in the 0-12 months age group were NoV, RV, enterotoxigenic E.coli  (ETEC), AsV, Campylobacter spp. and AdV. When identified, Shigella was more commonly identified during the second year after birth (13-24 months). The rates of infection for Cryptosporidium spp. and G. lamblia were similar among children of both age groups¹⁴.High fever (>40 ̊C), overt fecal blood, abdominal pain, and central nervous system involvement each suggests a bacterial pathogen. Vomiting and respiratory symptoms are associated with a viral etiology⁷.Many diarrheal deaths are caused by dehydration⁸. It would be helpful to have a common tool to evaluate dehydration. The Clinical Dehydration Scale (CDS) is easy to use in the assessment of dehydration⁷.Dehydration from AGE of any etiology and at any age, except when it is severe, can be safely and effectively treated in over 90% of cases by Oral Rehydration Salts (ORS) solution⁸.For prevention of recurrent AGE, exclusive breastfeeding until age six months, and continued breastfeeding with complementary foods until two years of age is considered an important aspect in prevention⁷.Contact and standard precautions including  (hand hygiene, personal protective equipment, soiled patient-care equipment, environmental control including textiles, laundry and adequate patient placement)⁸.