Viral GastroEnteritis (GE)

DEFINITION 

Viral gastroenteritis is an intestinal infection marked by watery diarrhea, abdominal cramps, nausea or vomiting, and sometimes fever. The most common way to develop viral gastroenteritis often called "stomach flu" is through contact with an infected person or by ingesting contaminated food or water. If you're otherwise healthy, you'll likely recover without complications. But for infants, older adults and people with compromised immune systems, viral gastroenteritis can be deadly. 

 There's no effective treatment for viral gastroenteritis, so prevention is key. In addition to avoiding food and water that may be contaminated, thorough and frequent hand-washings are your best defense. 

 SYMPTOMS 

Although it's commonly called stomach flu, gastroenteritis isn't the same as influenza. Real flu (influenza) affects only your respiratory system — your nose, throat and lungs. Gastroenteritis, on the other hand, attacks your intestines, causing signs and symptoms, such as: Watery, usually nonbloody diarrhea, bloody diarrhea usually means you have a different, more severe infection Abdominal cramps and pain Nausea, vomiting or both Occasional muscle aches or headache, Low-grade fever. Depending on the cause, viral gastroenteritis symptoms may appear within one to three days after you're infected and can range from mild to severe. Symptoms usually last just a day or two, but occasionally they may persist as long as 10 days. Because the symptoms are similar, it's easy to confuse viral diarrhea with diarrhea caused by bacteria, such as Clostridium difficile, salmonella and E. coli, or parasites, such as giardia. 

When to see a doctor 

If you're an adult, call your doctor if: You're not able to keep liquids down for 24 hours, You've been vomiting for more than two days, You're vomiting blood, You're dehydrated — signs of dehydration include excessive thirst, dry mouth, deep yellow urine or little or no urine, and severe weakness, dizziness or lightheadedness, You notice blood in your bowel movements, You have a fever above 104 F (40 C). 

For infants and children See your doctor right away if your child: Has a fever of 102 F (38.9 C) or higher Seems lethargic or very irritable Is in a lot of discomfort or pain, Has bloody diarrhea, Seems dehydrated — watch for signs of dehydration in sick infants and children by comparing how much they drink and urinate with how much is normal for them If you have an infant, remember that while spitting up may be an everyday occurrence for your baby, vomiting is not. Babies vomit for a variety of reasons, many of which may require medical attention. 

 Call your baby's doctor right away if your baby: Has vomiting that lasts more than several hours, Hasn't had a wet diaper in six hours, Has bloody stools or severe diarrhea, Has a sunken soft spot (fontanel) on the top of his or her head, Has a dry mouth or cries without tears Is unusually sleepy, drowsy or unresponsive. 

CAUSES 

You're most likely to contract viral gastroenteritis when you eat or drink contaminated food or water, or if you share utensils, towels or food with someone who's infected. A number of viruses can cause gastroenteritis, including:

Noroviruses. Both children and adults are affected by noroviruses, the most common cause of foodborne illness worldwide. Norovirus infection can sweep through families and communities. It's especially likely to spread among people in confined spaces. In most cases, you pick up the virus from contaminated food or water, although person-to-person transmission also is possible. 

Rotavirus. Worldwide, this is the most common cause of viral gastroenteritis in children, who are usually infected when they put their fingers or other objects contaminated with the virus into their mouths. The infection is most severe in infants and young children. Adults infected with rotavirus may not have symptoms, but can still spread the illness — of particular concern in institutional settings because infected adults unknowingly can pass the virus to others. A vaccine against viral gastroenteritis is available in some countries, and appears to be effective in preventing the infection. Some shellfish, especially raw or undercooked oysters, also can make you sick. Although contaminated drinking water is a cause of viral diarrhea, in many cases the virus is passed through the fecal-oral route — that is, someone with a virus handles food you eat without washing his or her hands after using the toilet. 

RISK FACTORS 

Gastroenteritis occurs all over the world, affecting people of every age, race and background. People who may be more susceptible to gastroenteritis include: 

 Young children. Children in child care centers or elementary schools may be especially vulnerable because it takes time for a child's immune system to mature. Older adults. Adult immune systems tend to become less efficient later in life. Older adults in nursing homes, in particular, are vulnerable because their immune systems weaken and they live in close contact with others who may pass along germs. Schoolchildren, churchgoers or dormitory residents. Anywhere that groups of people come together in close quarters can be an environment for an intestinal infection to get passed. Anyone with a weakened immune system. If your resistance to infection is low — for instance, if your immune system is compromised by HIV/AIDS, chemotherapy or another medical condition — you may be especially at risk. 

Each gastrointestinal virus has a season when it's most active. If you live in the Northern Hemisphere, for instance, you're more likely to have rotavirus or norovirus infections between October and April. 

COMPLICATIONS 

The main complication of viral gastroenteritis is dehydration — a severe loss of water and essential salts and minerals. If you're healthy and drink enough to replace fluids you lose from vomiting and diarrhea, dehydration shouldn't be a problem. Infants, older adults and people with suppressed immune systems may become severely dehydrated when they lose more fluids than they can replace. Hospitalization might be needed so that lost fluids can be replaced intravenously. Dehydration can be fatal, but rarely. 

PREPARING FOR YOUR APPOINTMENT 

If you or your child needs to see a doctor, you'll likely see your primary care provider first. If there are questions about the diagnosis, your doctor may refer you to an infectious disease specialist. What you can do is Preparing a list of questions will help you make the most of your time with your doctor. Some questions you might want to ask your or your child's doctor include: What's the likely cause of the symptoms? Are there other possible causes? Is there a need for tests? What's the best treatment approach? Are there any alternatives? Is there a need to take medicine? What can I do at home to ease the symptoms? 

What to expect from your doctor, Some questions the doctor may ask include: When did symptoms begin? Have the symptoms been continuous, or do they come and go? How severe are the symptoms? What, if anything, seems to improve symptoms? What, if anything, appears to worsen symptoms? Have you been in contact with anyone with similar symptoms? 

What you can do in the meantime Drink plenty of fluids. Stick with bland foods to reduce stress on your digestive system. If your child is sick, follow the same approach — offer plenty of fluids and bland food. If you're breast-feeding or using formula, continue to feed your child as usual. Ask your child's doctor if giving your child an oral rehydration solution, available without a prescription at pharmacies, would help. 

TESTS AND DIAGNOSIS 

Your doctor will likely diagnose gastroenteritis based on symptoms, a physical exam and sometimes on the presence of similar cases in your community. A rapid stool test can detect rotavirus or norovirus, but there are no quick tests for other viruses that cause gastroenteritis. In some cases, your doctor may have you submit a stool sample to rule out a possible bacterial or parasitic infection.  

TREATMENTS AND DRUGS 

There's often no specific medical treatment for viral gastroenteritis. Antibiotics aren't effective against viruses, and overusing them can contribute to the development of antibiotic-resistant strains of bacteria. Treatment initially consists of self-care measures. 

 LIFESTYLE AND HOME REMEDIES 

The best way to prevent the spread of intestinal infections is to follow these precautions: 

 Get your child vaccinated. A vaccine against gastroenteritis caused by the rotavirus is available in some countries, Given to children in the first year of life, the vaccine appears to be effective in preventing severe symptoms of this illness. 

Wash your hands thoroughly. And make sure your children do too. If your children are older, teach them to wash their hands, especially after using the toilet. It's best to use warm water and soap and to rub hands vigorously for at least 20 seconds, remembering to wash around cuticles, beneath fingernails and in the creases of the hands. Then rinse thoroughly. 

Carry towelettes and hand sanitizer for times when soap and water aren't available. Use separate personal items around your home. 

Avoid sharing eating utensils, glasses and plates. 

Use separate towels in the bathroom. 

Keep your distance. Avoid close contact with anyone who has the virus, if possible. Disinfect hard surfaces. If someone in your home has viral gastroenteritis, disinfect hard surfaces, such as counters, faucets and doorknobs, with a mixture of two cups of bleach to one gallon of water. 

Check out your child care center. Make sure the center has separate rooms for changing diapers and preparing or serving food. The room with the diaper-changing table should have a sink as well as a sanitary way to dispose of diapers. 

Take precautions when traveling, When you're traveling in other countries, you can become sick from contaminated food or water. You may be able to reduce your risk by following these tips - Drink only well-sealed bottled or carbonated water. Avoid ice cubes, because they may be made from contaminated water. Use bottled water to brush your teeth. Avoid raw food — including peeled fruits, raw vegetables and salads — that has been touched by human hands. Avoid undercooked meat and fish.