Infantile gastroenteritis is a common illness worldwide, causing significant morbidity and mortality, especially in developing countries. Its main characteristic is the presence of diarrhea, defined as stools more than 15g/kg for infants younger than 2 years and greater than 200 g for children and beyond that age and adults.
Presentation
Infantile gastroenteritis presentation widely varies depending on its etiology and severity. In viral gastroenteritis, most often caused by rotavirus, there is low fever, vomiting, and water-like stools. Most rotavirus patients are younger than 2 years [1]. Blood is absent in the fecal matter.
Severe abdominal pain and bloody diarrhea point to a bacterial etiology.
The existence of dehydration should be thoroughly assessed. Important clinical indicators are low blood pressure, tachycardia, thready pulse, significant weight loss, dry mucous membranes, and oliguria. The consciousness state may be decreased in severely affected infants.
The physician should inquire about the types of food the patient has ingested, which may point to a specific pathogen: dairy products may contain Staphylococcus, Campylobacter, Listeria or Salmonella species. Meat can be infected by Clostridium perfringens, Aeromonas, Staphylococcus and Salmonella or Campylobacter species, while seafood intake may lead to astrovirus, Vibrio, Aeromonas or Plesiomonas species infection. If symptoms occur sooner than 6 hours after ingestion, a preformed toxin, like those produced by Bacillus or Staphylococcus should be suspected. Nosocomial infection of various types has also been documented [2].
Aeromonas induces acute watery diarrhea or a more severe, cholera-like illness, with blood present in the stool [3]. Bacillus cereus causes precocious emetic syndrome that usually resolves within 24 hours [4] and watery diarrhea accompanied by severe cramps [5]. Campylobacter infection is characterized by a pre-diarrhea period, with fever, myalgia and abdominal pain [6]. Clostridium difficile may be complicated by pseudomembranous colitis [7]. Escherichia coli leads to enteritis that may progress to hemorrhagic colitis and hemolytic uremic syndrome [8]. Diarrhea usually lasts for 1 to 3 days and is accompanied by headache, dizziness, lymphadenopathy, rash and myalgia [9]. Nontyphoidal Salmonella infection is characterized by diarrhea that usually lasts less than a week, but may lead to extraintestinal complications, such as urinary tract infections, osteomyelitis or arthritis. Salmonella typhi is the etiological agent of typhoid fever, a condition with diarrhea, vomiting, anorexia, fever, headaches and rose spots. Bloody stools may be present both in Salmonella [10] and Shigella patients [11]. Cholera is described as afebrile, watery, painless diarrhea. A more severe form, cholera gravis may give rise to an immense liquid loss which rapidly progresses to severe dehydration and death [12]. Yersinia enterocolitica can be the causative agent of terminal ileitis and mesenteric lymphadenitis and may mimic appendicitis [13]. Complaints may persist up to one year in Yersinia infection [14]. The physician should inquire about associated symptoms of parasitic infections, like anal pruritus, that may be accompanied by diarrhea.
Entire Body System
- Pain
Additionally, abdominal pain can be referred pain, which can complicate the clinical picture even further. [nursing.com]
[…] endemic viral gastroenteritis of young children (6 months-12 years) that is especially widespread during winter, caused by strains of rotavirus (family Reoviridae); the incubation period is 2-4 days, with symptoms lasting 3-5 days, including abdominal pain [medical-dictionary.thefreedictionary.com]
Diagnosis Acute Pain Outcomes Patient will report a decrease of pain. [rnpedia.com]
The symptoms that usually appear with the infantile gastroenteritis are similar to which occurs in adults with the same virus, that is, that our son can suffer nausea, vomiting, fever, dizziness, abdominal pain and episodes of diarrhea. [parenthotline.net]
- Inflammation
It is inflammation of the stomach mucosa and bowel mucosa. It is an irritation and inflammation of the whole digestive tract of our children. [parenthotline.net]
Allergic inflammation in the skin and gastrointestinal tract was clearly distinguished by both CTACK and TSLP. [jacionline.org]
Acute gastritis is caused due to sudden and severe inflammation of the stomach lining. If gastritis continues for a prolonged period, it becomes chronic in nature. [nandadiagnosis.blogspot.com]
Gastroenteritis is an inflammation of the stomach and the small bowel, Gastroenteritis (also called intestinal flu, traveler's diarrhea, viral enteritis, and food poisoning) is an inflammation of the stomach and small intestine that is self-limiting. [nurse-thought.blogspot.com]
- Asymptomatic
Upon phylogenetic analysis, the nucleotide sequences showed high similarity to type 5 between the patients, asymptomatic controls, asymptomatic food handler and ground water ( Figure 2 ). [omicsonline.org]
Virus-like particles were present in 28 of 45 patients, and in 24 of 74 asymptomatic room contacts. [jpeds.com]
Infections have been reported to occur repeatedly in humans and most of cases in adults are asymptomatic. Infections in young children lead to acute diarrhea. [genome.jp]
Infection with EHEC can cause a wide range of manifestations, including asymptomatic infection, non-bloody diarrhoea, hemorrhagic colitis and hemolytic uremic syndrome (HUS). [atmph.org]
Smouldering (indolent) multiple myeloma Smouldering (indolent) multiple myeloma is also called asymptomatic myeloma because it does not cause any symptoms. [cancer.ca]
- Anorexia
Imbalanced Nutrition: Less Than Body Requirements related to inadequate intake, anorexia. 3. Acute Pain related to inflammation of gastric mucosa. 4. Activity intolerance related to physical weakness. 5. [nandadiagnosis.blogspot.com]
Salmonella typhi is the etiological agent of typhoid fever, a condition with diarrhea, vomiting, anorexia, fever, headaches and rose spots. Bloody stools may be present both in Salmonella and Shigella patients. [symptoma.com]
[…] of crucial electrolytes, which can lead to shock, vascular collapse, renal failure Assessment Nursing Care Plans for gastroenteritis acute onset of diarrhea accompanied by abdominal pain and discomfort cramping, nausea, and vomiting malaise, fatigue, anorexia [nurse-thought.blogspot.com]
Gastritis Nursing Diagnosis : Imbalanced Nutrition Less Than Body Requirements Imbalanced Nutrition Less Than Body Requirements related to anorexia, vomiting, and irregularities in body perception. [nanda-nursinginterventions.blogspot.com]
Symptoms of this disease include fever, anorexia, nausea, vomiting, diarrhea, and abdominal discomfort. The treatment is symptomatic, although in cases of bacterial and parasitic infections require antibiotic therapy. [nurseslabs.com]
- Chills
The symptoms, which may not appear for up to 2 days following infection, include: Abdominal pain Diarrhoea Nausea and vomiting Chills, clammy skin or sweating Fever Joint stiffness or muscular pain Poor feeding Weight loss We advise you to drink plenty [myhealthportal.co.uk]
Symptoms of gastroenteritis usually begin one or two days after infection and include: diarrhea nausea and vomiting headache, muscle aches, or joint aches fever or chills sweating or clammy skin abdominal cramps and pain loss of appetite These symptoms [healthline.com]
Determine the presence of fever, chills, myalgias, rash, rhinorrhea, sore throat, cough, known immunocompromised status. [nurseslabs.com]
Symptoms Frequency (%) Diarrhea 10 (100) Abdominal pain 10 (100) Headache 8 (80) Nausea 7 (70) Tenesmus 7 (70) Chill 5 (50) Fever 3 (30) Vomiting 1 (10) Table 1: Symptom–wise distribution of case (n=10). Figure 1: Epidemic curve of the outbreak. [omicsonline.org]
Respiratoric
- Sneezing
Adenovirus is contracted through the air via sneezing and coughing, by touching contaminated objects, or by touching the hands of someone with the virus. [healthline.com]
[…] in children, pustules in young children, and apparently diphtheria; Oribasius' 4th Century writings on infant rashes, cough, coryza, draining ears, and siriasis (inflammation of the brain); Aetius' 6th Century discussion of fevers, eye inflammation, sneezing [nature.com]
Gastrointestinal
- Diarrhea
Bacillus cereus causes precocious emetic syndrome that usually resolves within 24 hours and watery diarrhea accompanied by severe cramps. Campylobacter infection is characterized by a pre-diarrhea period, with fever, myalgia and abdominal pain. [symptoma.com]
Diarrhea occurred in 41 of 165 infants (25%), with probable nosocomial acquisition in 26 patients. Two infants each had two episodes of diarrhea, and one had three. A putative pathogen was found in 31 of 45 case episodes (69%). [jpeds.com]
Blood samples were extracted from each child with diarrhea, in the acute and convalescence period, complement fixing antibodies being measured with antigen of Nebraska Calf Diarrhea Virus (NCDV). [nature.com]
Part III examines the epidemiological relationship between malnutrition and chronic diarrhea in infants and children. Part IV focuses on the diagnosis and dietary and pharmacological management of chronic diarrhea. [books.google.de]
- Vomiting
[…] by the picture of vomiting and diarrhea, in addition to the appearance of the fever produced by the viral character of the infantile gastroenteritis. [parenthotline.net]
The occurrence of vomiting is controlled by the vomiting center in the central nervous system (brain) us. Vomiting occurs when there are certain conditions that stimulate the vomiting center. [nanda-health.blogspot.com]
[…] of young children (6 months-12 years) that is especially widespread during winter, caused by strains of rotavirus (family Reoviridae); the incubation period is 2-4 days, with symptoms lasting 3-5 days, including abdominal pain, diarrhea, fever, and vomiting [medical-dictionary.thefreedictionary.com]
She has been vomiting and having severe diarrhea for 2... 36-year-old client was admitted with gastroenteritis. She has been vomiting and having severe diarrhea for 2 days. She is very weak. [homeworklib.com]
- Nausea
Imbalanced Nutrition, Less Than Body Requirements related to nausea and vomiting. Intervention Diagnosis 1 Imbalanced Nutrition, Less Than Body Requirements related to nausea and vomiting. [free-nursingcareplan.blogspot.com]
Other symptoms of gastroenteritis include: vomiting nausea stomach cramps headaches a high temperature (fever) of 38–39C (100.4–102.2F) Symptoms of dehydration include: tiredness apathy (a lack of emotion or enthusiasm) dizziness nausea headaches muscle [care-plan.blogspot.com]
The feeling that one is about to vomit is called nausea; it often precedes, but does not always lead to vomiting. Antiemetics are sometimes necessary to suppress nausea and vomiting. [en.wikipedia.org]
[…] symptoms were there, but you were ignoring them. you have to deal in facts. because you assumed "taking medications with empty stomach causes irritation in her gastric lining that make her feel nauseated and was like to vomit" you missed a valuable clue--nausea [allnurses.com]
The symptoms that usually appear with the infantile gastroenteritis are similar to which occurs in adults with the same virus, that is, that our son can suffer nausea, vomiting, fever, dizziness, abdominal pain and episodes of diarrhea. [parenthotline.net]
- Food Poisoning
The major risk factor for gastroenteritis that is caused by food poisoning is improper handling and storage of food. [nurse-thought.blogspot.com]
Food poisoning (from eating food infected with microbes) causes some cases of gastroenteritis. Food poisoning is usually caused by a bacterial infection. [patient.info]
Food-borne gastroenteritis or food poisoning is associated with bacteria strains such as Escherichia coli, Clostridium, Campylobacter, and salmonella. [nurseslabs.com]
Ordinarily, food poisoning results in a much quicker onset of symptoms, which can strike the sufferer within the hour of eating infected foods. [nanda-nursing-diagnosis.blogspot.com]
- Abdominal Cramps
Assess for abdominal pain, abdominal cramping, hyperactive bowel sounds, frequency, urgency, and loose stools. These assessment findings are commonly connected with diarrhea. [nurseslabs.com]
[…] pain and cramping. [nanda-list.blogspot.com]
Symptoms may include abdominal cramps or pain, bloody stools, loss of appetite and nausea and vomiting. Most forms of bacterial gastroenteritis should only last a couple of days and we advise you to avoid dehydration by drinking plenty of fluids. [myhealthportal.co.uk]
The major clinical manifestations are diarrhea of varying degrees and abdominal pain and cramping. [rnpedia.com]
Symptoms of gastroenteritis usually begin one or two days after infection and include: diarrhea nausea and vomiting headache, muscle aches, or joint aches fever or chills sweating or clammy skin abdominal cramps and pain loss of appetite These symptoms [healthline.com]
Musculoskeletal
- Myalgia
Diarrhea usually lasts for 1 to 3 days and is accompanied by headache, dizziness, lymphadenopathy, rash and myalgia. [symptoma.com]
Determine the presence of fever, chills, myalgias, rash, rhinorrhea, sore throat, cough, known immunocompromised status. [nurseslabs.com]
Skin
- Sweating
Excessive sweating; typically sweating is more likely to cause dehydration than fluid volume deficit because the body generally expels far more water than electrolytes, but sweating can also cause deficient fluid volume in some cases. [blog.prepscholar.com]
[…] abdominal bloating More serious symptoms Blood in vomit or stool Vomiting more than 48 hours Fever higher than 101°F (40°C) Swollen abdomen or abdominal pain Dehydration - weakness, lightheadedness, decreased urination, dry skin, dry mouth and lack of sweat [free-nursingcareplan.blogspot.com]
The symptoms, which may not appear for up to 2 days following infection, include: Abdominal pain Diarrhoea Nausea and vomiting Chills, clammy skin or sweating Fever Joint stiffness or muscular pain Poor feeding Weight loss We advise you to drink plenty [myhealthportal.co.uk]
Symptoms of gastroenteritis usually begin one or two days after infection and include: diarrhea nausea and vomiting headache, muscle aches, or joint aches fever or chills sweating or clammy skin abdominal cramps and pain loss of appetite These symptoms [healthline.com]
Vomiting also initiates an SNS response causing both sweating and increased heart rate. [en.wikipedia.org]
Neurologic
- Headache
Diarrhea usually lasts for 1 to 3 days and is accompanied by headache, dizziness, lymphadenopathy, rash and myalgia. [symptoma.com]
Other symptoms of gastroenteritis include: vomiting nausea stomach cramps headaches a high temperature (fever) of 38–39C (100.4–102.2F) Symptoms of dehydration include: tiredness apathy (a lack of emotion or enthusiasm) dizziness nausea headaches muscle [care-plan.blogspot.com]
Some viral causes may also be associated with fever, fatigue, headache, and muscle pain. If the stool is bloody, the cause is less likely to be viral and more likely to be bacterial. [nanda-list.blogspot.com]
You might also have stomach pain, cramping, fever, nausea, and a headache. Because of diarrhea and vomiting, you also can become dehydrated. [webmd.com]
Symptoms associated with astrovirus include: diarrhea headache mild dehydration stomach pain The virus usually affects people in late winter and early spring. [healthline.com]
- Hyperactivity
Attention-deficit hyperactivity disorder (ADHD) is a brain disorder comprising of inattention and/or hyperactivity-impulsivity that interferes with normal functioning of the child. ADHD is... [chaitanyahospital.org]
Hyperactive bowel sounds. Loose stools. Urgency. Desired Outcomes Client will have a negative stool culture. Client will pass soft, formed stool no more than 3 x a day. [nurseslabs.com]
Associated clinical manifestations are nausea, vomiting, fever anorexia, distention, tenesmus (straining on defecation), and borborygmi (hyperactive bowel sounds). [rnpedia.com]
[…] expresses feelings with response to the situation Makes eye contact with examiner, hyperactive expresses feelings with response to the situation Normal XIX. [slideshare.net]
Workup
In cases where physical examination suggests a bacterial, protozoal or parasitic infection, laboratory tests are required in order to elucidate the etiology. In all situations where dehydration signs are observed, the physician should evaluate the gravity of the condition by ordering complete blood cell count, serum electrolytes, urea, and creatinine.
Clinical judgment indicates what tests may be necessary for a specific patient. Giardia lamblia is identified by enzyme immunoassay. Rapid antigen stool testing may highlight the presence of rotavirus, while polymerase chain reaction is used in calicivirus infection. Human astrovirus genotyping is possible in selected cases [15]. The stool should be examined for parasite ova and larvae [16], as well as leukocytes, that signify enteroinvasive infection. Bacterial cultures are extremely valuable [17] and should always be performed if the patient is febrile. Cultures for Campylobacter, Salmonella, and Shigella should be obtained if white or red blood cells are identified in the stool. Escherichia coli is identified if the stool is cultured on a specific environment such as a chromogenic media [18]. This is method valuable in Yersinia [19], Salmonella [20] and Vibrio [21] species, as well. A blood agar plate is useful for the detection of Aeromonas spp., Vibrio spp. and Plesiomonas spp. Campylobacter should be cultured on blood-free charcoal-cefoperazone-deoxycholate agar or Skirrow medium [22] or it can be identified using its characteristic Gram stain morphology. Antibiotic susceptibility testing is indicated in infants younger than 6 months or immunocompromised children, as well as those with prolonged evolution.
If the diarrhea is considered to be part of an ulcerative colitis or Crohn's disease, a colonoscopy may be indicated. This procedure sometimes visualizes pseudomembranes in Clostridium difficile infection. If this microorganism is identified, the physician should keep in mind and monitor the risk of developing toxic megacolon [23], intestinal perforation [24], renal failure or septic shock.
Treatment
After 8 hours on parenteral treatment, the child was given oral solution, either glucose-electrolyte solution or milk formula in ¼ dilution. [paediatricaindonesiana.org]
We recommend 1 day of treatment with low-dose carbamazepine as the first-line treatment for BISMG. The unnecessary use of AEDs for BISMG should be avoided after the acute phase because seizures in BISMG rarely recur. [jstage.jst.go.jp]
Abstract BACKGROUND: Standard treatment of infants who are dehydrated as a result of acute gastroenteritis is to administer oral rehydration therapy (ORT). [bjgp.org]
In 8 patients with CwG due to norovirus, treatment with the anticonvulsant carbamazepine (serum level 5.4 +/- 1.1 mg/dl) significantly shortened duration of seizures as compared to treatment with phenobarbital. [pediatricneurologybriefs.com]
Prognosis
The prognosis is good. doi: 10.3969/j.issn.1672-6731.2014.03.019 Keywords Gastroenteritis; Seizures, febrile; Encephalitis, viral; Child [cjcnn.org]
The interictal EEG is normal, response to anticonvulsants is variable, often poor, but the prognosis is favorable. The entity is reported mainly in Asia, and outbreaks are rare in the US and Europe. [pediatricneurologybriefs.com]
They are characterized by brief generalized seizure or seizures in cluster, normal laboratory findings and good prognosis. We believe that individualized approach is needed in the management of rotavirus gastroenteritis with afebrile convulsion. [kjp.or.kr]
Prognosis of the neurological complications of acute hypernatraemia. Lancet. 1967 Dec 30;2(7531):1385–1389. [PubMed] [Google Scholar] Ramsay AM. Acute infective diarrhoea. Br Med J. 1968 May 11;2(5601):347–350. [ncbi.nlm.nih.gov]
Prognosis is very poor in secondary PCL. [cancernetwork.com]
Etiology
Severe abdominal pain and bloody diarrhea point to a bacterial etiology. The existence of dehydration should be thoroughly assessed. [symptoma.com]
No wardwide etiologic pattern was evident, but minirotavirus or calicivirus or both were associated with diarrhea in 20 patients, accompanied by vomiting in 15 of these infants. [jpeds.com]
This finding should provide additional evidence for the etiologic role of calicivirus in acute infantile gastroenteritis. [ncbi.nlm.nih.gov]
The difficulties in assessing the value of chemotherapeutic agents in such a disease as infantile gastroenteritis, of varied and as yet not thoroughly understood etiology, are not unexpected. [jamanetwork.com]
The concussed data on various etiological agents of gastroenteritis was limited in the journals. This article is an attempt to put forth the varied etiology of gastroenteritis as a disease. [atmph.org]
Epidemiology
Serological studies of a diagnostic but not epidemiological nature may also be performed with equal facility by this same test scheme using highly purified IGV antigen derived from stool. [ncbi.nlm.nih.gov]
European Journal of Epidemiology, Vol. 21, Issue. 2, p. 161. CrossRef Google Scholar Desselberger, Ulrich Wolleswinkel-van den Bosch, Judith Mrukowicz, Jacek Rodrigo, Carlos Giaquinto, Carlo and Vesikari, Timo 2006. [cambridge.org]
Epidemiology and clinical features of rotavirus and norovirus infection among children in Ji'nan, China. Virol J, 2013; 10(1): 302. Chen CJ, Lartey B,A gbemabiese C, Armah G et al. The Epidemiology of Noroviruses in Ghana. [ejmm.edu.eg]
Pathophysiology
Lesson Print Pathophysiology Abdominal pain can be a very minor issue that is easily resolved, or a medical emergency. There are many different things that can cause abdominal pain, whose pathophysiology can differ widely. [nursing.com]
[…] nursing process when care planning. step 1 assessment - collect data from medical record, do a physical assessment of the patient, assess adl's, look up information about your patient's medical diseases/conditions to learn about the signs and symptoms and pathophysiology [allnurses.com]
Sleisenger and Fordtran's Gastrointestinal and Liver Disease: Pathophysiology/Diagnosis/Management. 10th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 16. Updated by: Michael M. [medlineplus.gov]
[citation needed] Pathophysiology Receptors on the floor of the fourth ventricle of the brain represent a chemoreceptor trigger zone, known as the area postrema, stimulation of which can lead to vomiting. [en.wikipedia.org]
Pathophysiology The 2 primary mechanisms responsible for acute gastroenteritis are: There is damage to the villous brush border of the intestine, causing malabsorption of intestinal contents and leading to an osmotic diarrhea. [nurseslabs.com]
Prevention
Centers for Disease Control and Prevention. Advisory Committee Recommends New Vaccine to Prevent Rotavirus. [Full Text]. Centers for Disease Control and Prevention. [medscape.com]
Special attention is given to the prevention and treatment of these diseases found in developing countries as well as the latest findings about new antimicrobial agents, gram-negative infections and their management, and recommendations for immunization [books.google.de]
To prevent dehydration & maintain hydration status. Provide frequent oral care To prevent from dryness Administer Intravenous fluids as prescribed To deliver fluids accurately and at desired rates. Determine effects of age. [rnpedia.com]
Prevent infection Abdominal pain may have been caused by a pathogen (gastroenteritis, for example). It is essential to promote adequate hand hygiene and infection prevention to prevent the spread to others or preventing the issue from resolving. [nursing.com]
References
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- Calbo E, Freixas N, Xercavins M, et al. Foodborne nosocomial outbreak of SHV1 and CTX-M-15-producing Klebsiella pneumoniae: epidemiology and control. Clin Infect Dis. 2011;52(6):743-9.
- Janda J, Abbott L. The genus Aeromonas: taxonomy, pathogenicity, and infection. Clin Microbiol Rev. 2010;23:35–73.
- Ehling-Schulz M, Fricker M, Scherer S. Bacillus cereus, the causative agent of an emetic type of food-borne illness. Mol Nutr Food Res. 2004;48:479–487.
- Stenfors Arnesen L, Fagerlund A, Granum P. From soil to gut: Bacillus cereus and its food poisoning toxins. FEMS Microbiol Rev. 2008;32:579–606.
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- Dallal R, Harbrecht B, Boujoukas A, et al. Fulminant Clostridium difficile: an underappreciated and increasing cause of death and complications. Ann Surg. 2002;235:363–372.
- Rohde H, Qin J, Cui Y, et al. Open-source genomic analysis of Shiga-toxin-producing E. coli O104:H4. N Engl J Med. 2011;365:718–724.
- Tarr P, Gordon C, Chandler W. Shiga-toxin-producing Escherichia coli and haemolytic uraemic syndrome. Lancet. 2005;365:1073–1086.
- Parry C, Hien T, Dougan G, et al. Typhoid fever. N Engl J Med. 2002;347:1770–1782.
- von Seidlein L, Kim D, Ali M, et al. A multicentre study of Shigella diarrhoea in six Asian countries: disease burden, clinical manifestations, and microbiology. PLoS Med. 2006;3(9):e353.
- Harris J, LaRocque R, Qadri F, et al. Cholera. Lancet. 2012;379:2466–2476.
- Ong K, Gould L, Chen D, et al. Changing epidemiology of Yersinia enterocolitica infections: markedly decreased rates in young black children, Foodborne Diseases Active Surveillance Network (FoodNet), 1996-2009. Clin Infect Dis. 2012;54(5):S385–S390
- Rosner B, Werber D, Hohle M, et al. Clinical aspects and self-reported symptoms of sequelae of Yersinia enterocolitica infections in a population-based study, Germany 2009-2010. BMC Infect Dis. 2013;13:236.
- Cardoso D, Fiaccadori F, Souza M, et al. Detection and genotyping of astroviruses from children with acute gastroenteritis from Goiânia, Goiás, Brazil. Med Sci Monit. 2002;8: 624-628.
- La Via W. Parasitic gastroenteritis.Pediatr Ann. 1994;23(10):556-60.
- Humphries R, Linscott A. Laboratory diagnosis of bacterial gastroenteritis. Clin Microbiol Rev. 2015;28(1):3-31.
- Church D, Emshey D, Semeniuk H, et al. Evaluation of BBL CHROMagar O157 versus sorbitol-MacConkey medium for routine detection of Escherichia coli O157 in a centralized regional clinical microbiology laboratory. J Clin Microbiol. 2007;45:3098–3100.
- Renaud N, Lecci L, Courcol R, et al. CHRO Magar Yersinia, a new chromogenic agar for screening of potentially pathogenic Yersinia enterocolitica isolates in stools. J Clin Microbiol. 2013;51:1184–1187.
- Maddocks S, Olma T, , Chen S. Comparison of CHROMagar Salmonella medium and xylose-lysine-desoxycholate and Salmonella-Shigella agars for isolation of Salmonella strains from stool samples. J Clin Microbiol. 2002;40:2999–3003.
- Eddabra R, Piemont Y, Scheftel J. Evaluation of a new chromogenic medium, chromID Vibrio, for the isolation and presumptive identification of Vibrio cholerae and Vibrio parahaemolyticus from human clinical specimens. Eur J Clin Microbiol Infect Dis. 2011;30:733–737.
- Endtz H, Ruijs G, Zwinderman A, et al. Comparison of six media, including a semisolid agar, for the isolation of various Campylobacter species from stool specimens. J Clin Microbiol. 1991;29:1007–1010.
- Earhart M. The identification and treatment of toxic megacolon secondary to pseudomembranous colitis. Dimens Crit Care Nurs. 2008;27:249–254.
- Hall J, Berger D. Outcome of colectomy for Clostridium difficile colitis: a plea for early surgical management. Am J Surg. 2008;196:384–388.