Infants diarrhea

Rotavirus. Rotavims causes infant diarrhea, a disease which has major socio-economic impact. In developing countries it is the major cause of death in infants worldwide, causing up to 870,000 deaths per year. In the United States, diarrhea is stiU a primary cause of physician visits and hospitalization, although the mortaUty rate is relatively low. Studies have estimated a substantial cost benefit for a vaccination program in the United States (67—69). Two membrane proteins (VP4 and VP7) of the vims have been identified as protective epitopes and most vaccine development programs are based on these two proteins as antigens. Both Hve attenuated vaccines and subunit vaccines are being developed (68). 

Levine, M. M., and Edelman, R. (1984). Enteropathogenic Escherichia coli of classic serotypes associated with infant diarrhea Epidemiology and pathogenesis. Epidemiol. Rev. 6,31-51. 

The issues of starvation and malnutrition are raised again in Chapter 8, where foods rich in energy but poor in protein are discussed. Malnutrition is discussed under Sodium, Potassium, and Water in Chapter 10, w here the problem of infant diarrhea is outlined. This problem often occurs with weaning in underdeveloped countries, when pathogenic bacteria and parasites are inadvertently introduced into the infant s diet. The problem is compounded when basic supplies, such as firewood for boiling drinking water, are missing. Malnutrition and infection are also discussed under Vitamin A in Chapter. ... 

DIARRHEA. The passage of loose, watery bowel movements will occur occasionally in almost all infants. However, infant diarrhea should be treated promptly according to a pediatrician s recommendations so that dehydration does not occur. 

Diagnosis and alleviation of the cause, if possible, is of primary importance. Often, however, this is not possible and therapy is used to alleviate the inconvenience and pain of diarrhea. These compounds usually only mask the underlying factors producing the problem. Diarrhea may cause significant dehydration and loss of electrolytes and is a particularly serious problem in infants. Antidiarrheals do not usually prevent the loss of fluids and electrolytes into the large bowel and, although these may prevent frequent defecation, often the serious imbalance of body electrolytes and fluids is not significantly affected. 

Cryptosporidiosis, an intestinal infection caused by protozoa of C ptosporidium species is a taxonomicaHy related disease (12). The disease affects animals, such as calves, lambs, and chickens, and infects humans woddwide, especially infants and children in developing countries. Symptoms range from mild self-limiting diarrhea and abdominal pain to a potentially fatal extreme diarrhea that results in weight loss and poor nutritional absorption. 

No more than 5.0% samples total coliform-positive in a month, (For water systems that collect fewer than 40 routine samples per month, no more than one sample can be total coliform-positive). Every sample that has total coliforms must be analyzed for fecal coliforms. There may not be any fecal coliforms or E. coli. Fecal coliform and E. coli are bacteria whose presence indicates that the water may be contaminated with human or animal wastes. Disease-causing microbes (pathogens) in these wastes can cause diarrhea, cramps, nausea, headaches, or other symptoms. These pathogens may pose a special health risk for infants, young children, and people with severely compromised immune systems. 

Penicillins should be used cautiously in patients witii renal disease, pregnancy (Pregnancy Category C), lactation (may cause diarrhea or candidiasis in die infant), and in tiiose witii a history of allergies. Any indication of sensitivity is reason for caution. The drug is also used witii caution in patients witii asthma, renal disease, bleeding disorders, and gastrointestinal disease. 

All infants developed deviant neurobehavioral symptoms within the first 24 hours of life. Most commonly, the neonates were found to have symptoms of irritability, tremors, and hypertonicity. Bizarre eye movements and staring spells were seen in 25 percent of infants. Poor sucking, lethargy, diarrhea, and facial twitching, symptoms commonly associated with prenatal opiate exposure, were seen infrequently in these PCP-addicted infants. 

Clinical experience with the infants exposed primarily to PCP pre-natally is remarkably close to Wilson et al. These neonates are difficult to console, have alternating periods of lethargy and irritability, and are unable to control the tremors of their extremities when unswaddled. Vasomotor instability, diarrhea, and voracious sucking movements are infrequently seen in the PCP-exposed infants who were followed. Chasnoff et al. (1983) compared these behaviors in infants exposed prenatally to PCP to those of adults who have acute intoxication. 

When diarrhea is severe and oral intake is limited, dehydration can occur, particularly in the elderly and infants. 

Most cases of diarrhea in adults are mild and resolve quickly. Infants and children (especially under 3 years of age) are highly susceptible to the dehydrating effect of diarrhea, and its occurrence in this age group should be taken seriously. 

Patients with diarrhea should be questioned about the onset of symptoms, recent travel, diet, source of water, and medication use. Other important considerations include duration and severity of the diarrhea along with an accounting of the presence of associated abdominal pain or vomiting, blood in the stool, stool consistency, stool appearance, stool frequency, and weight loss. Although most cases of diarrhea are self-limited, infants, children, elderly persons, and immunocompromised patients are at risk for increased morbidity. 

Most healthy adults with diarrhea do not develop dehydration or other complications and can be treated symptomatically by self medication. When diarrhea is severe and oral intake is limited, dehydration can occur, particularly in the elderly and infants. Other complications of diarrhea resulting from fluid loss include electrolyte disturbances, metabolic acidosis, and cardiovascular collapse. 

Gl Tract Esophageal web stricture or stenosis in the upper to middle third of the esophagus01 Exocrine Pancreatic insufficiency Anorexia Nausea Vomiting Diarrhea Weight loss Failure to thrive (infants and children)... 

Infante RM, Ericsson CD, Jiang ZD, Ke S, Steffen R, Riopel L, Sack DA, DuPont HL Enteroaggregative Escherichia coli diarrhea in travelers Response to rifaximin therapy. Clin Gastroenterol Hepatol 2004 2 135-138. 

Antibiotics have no effect on the duration of fever or diarrhea, and their frequent use increases the likelihood of resistance and the duration of fecal shedding. Antibiotics should be used in neonates or infants younger than 6 months, patients with primary or secondary immunodeficiency, severely symptomatic patients with fever and bloody diarrhea, and patients after splenectomy. 

As a result of limited oral intake due to coughing combined with fever, vomiting, and diarrhea, infants are frequently dehydrated. 

Rotavirus — the most common cause of severe diarrhea in infanfs, with approximately 125 million cases worldwide per year and 600,000 deaths — vaccines have been linked with intussusceptions (a problem with the intestine in which one portion of the bowel slides into the next) at a rate of between 1 in 5000 and 1 in 11,000 infants. The only rotavirus vaccine approved in the United States, RotaShield (Wyeth-Ayerst), was withdrawn from market on October 22, 1999, about 1 year after licensure. 

Clausen, C. R., and Christie, D. L. (1982). Chronic diarrhea in infants caused by adherent enteropathogenic Escherichia coli. J. Pediatr. 100, 358-361. 

Morrow, A. L., Ruiz-Palados, G. M., Jiang, X., and Newburg, D. S. (2005). Human-milk glycans that inhibit pathogen binding protect breast-feeding infants against infectious diarrhea. /. Nutr. 135,1304—1307. 

---