Clinical Assessment, Diagnosis, Etiology, Treatment, Bibliography, Valery…
Classifications of diarrhea
Acute watery diarrhea
Loose or watery stools, at least 3 times in a 24 hr pediod
Dehydration is the primary cause of death in patients with diarrhea
Evaluated with fontanel depth and by difference in the weights at entry and during their stay at the hospital
Fever is common.
May be indicative of the type of the causal pathogen
Hypothermia should be indicative of a comorbidity
Exaggerated pain may be indicative of a surgical emergencies such as apendicitis.
Intussusception is possible and may present in some cases
Central Nervous System
Dehydration causes irritability
Severe dehydrations may cause lethargy and coma
Pathogenic microorganism penetrates the epithelial cells. Accompanied with blood and mucus
Loose, watery or blood stools during at least 14 days.
Mechanism of action
Infects and replicates in mature non-dividing enterocytes in the middle and top of the villi, as well as enteroendocrine small intestines.
Attachment to cell is mediated by VP4 and binding partners such as GM1, GD1a and HBGAs
Rotavirus-HBGA interactions are dependent on the rotavirus genotype P
Following cellular uptake rotavirus replication and assembly occur in cytoplasmic viroplasms and newly produced rotavirus are released from the cell lysis or Golgi independent non-classical vesicular transport.
Incidence in infants peaks between 4-24 months of age
Severe watery diarrhea
Through stool samples
Abnormal enzyme levels
alanine aminotransferase (ALT)
aspartate aminotransferase (AST)
Mechanism of action
Bacteria colonizes mucosal surface of small intestine
ETEC adherence to enterocytes cells mediated by fimbrins
Allows transfer of enterotoxins produced by ETEC bacteria
Production of enterotoxins heat-stable (ST) and heat-labile (LT)
Stimulating the release of liquid from the cell lining in the small intestine walls
Leading cause of diarrhea in children < 5 years old
Mechanism of action
Bacteria survives through acid gastric barrier
Invades small and large intestine mucosa
Stimulates release of pro-inflammatory cytokines
May lead to ulceration and destruction of mucosa
Enters macrophages and disseminates through reticuloendothelial system
Through M cells
Culture at site of infection
Acute Gastroenteritis in children is associated with pathogenic infections, for which there are a series of diagnostic tests
Stool Sample + bacterial cultive
Gold standard, although time-consuming
It is a very precise diagnostic test, with which we can see the type of pathogen present in the stool and give the correct treatment accordingly
For certain kinds of pathogens specific types of light microscopy that can be used for their identification.
, using a dark field microscopy
Glucose and electrolyte assessment
For patients with seizures or states of altered consciousness
Severe dehydration can be prevented and corrected if it is already present
The most common causes for acute gastroenteritis in low-income countries are pathogenic agents. Of which, the most probable and common pathogens are
All of the pathogens mentioned above will have different pathogenic mechanisms by which the clinical presentation will vary.
Treatment for acute gastroenterits on children consists primarily on compensatory fluis and electrolyte administration. Thi due to the dehydration that comes with prominent diarrhea.
*An antibiotic pharmacological approach may also be viable in some cases
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Jason B Harris, MD, MPHMark Pietroni, MA, FRCP, FFPH, DTM&H (2021). Approach to the child with acute diarrhea in resource-limited countries.
Centers for Disease Control and Prevention. (2014, December 1). Enterotoxigenic E. coli (ETEC). CDC. Retrieved from
Duan, Q., Xia, P., Nandre, R., Zhang, W., & Zhu, G. (2019). Review of newly identified functions associated with the heat-labile toxin of enterotoxigenic Escherichia coli. Frontiers in cellular and infection microbiology, 292.
Emory university. (2022). What is Enterotoxigenic E. coli (ETEC)? Emory university. Retrieved from
Giannella RA. Salmonella. In: Baron S, editor. Medical Microbiology. 4th edition. Galveston (TX): University of Texas Medical Branch at Galveston; 1996. Chapter 21. Available from:
Ríos-Muñiz, D., Cerna-Cortés, J. F., Morán-García, N., Meza-Segura, M., & Estrada-García, T. (2019). Escherichia coli enterotoxigénica y enteroagregativa: prevalencia, patogénesis y modelos múridos. Gaceta médica de México, 155(4), 410-416.
Crawford, S. E., Ramani, S., Tate, J. E., Parashar, U. D., Svensson, L., Hagbom, M., Franco, M. A., Greenberg, H. B., O'Ryan, M., Kang, G., Desselberger, U., & Estes, M. K. (2017). Rotavirus infection. Nature reviews. Disease primers, 3, 17083.
Valery Maria Valverde | A00822550
César González Zermeño | A01283078