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Diarrheoa occurring in infant (up to 1 year of age) is known as infantile diarrheoa. It is

one of the most common diseases in infants and toddlers. It is not a definitely disease
but a syndrome caused by infectious and non infectious factors. Clinical manifestations
are mainly diarrhea and vomiting, in severe cases it usually associated with dehydration
and electrolyte and acid base disturbances.


 

Classification by the course of diarrhea

î Acute diarrhea: continuous course < two weeks

î Prolonged diarrhea: continuous course varies

between 2 weeks ~ 2 months

î Chronic diarrhea: > 2 months.

According to severity of diarrhea it may be

divided into 2 types:

  
 

Predisposing age

Incidence is high among children under two to three years of age. But peak in infant
less than one year, which account for about half of the patients.

Predisposing factors
1. Immature digestive function

½  Normally in adults and adolescents the majority of ingested
bacterial pathogens will be killed at the acid environment of stomach (pH 1.5 1.5-2.0,
<4) and can not get into the intestine  
 
  


 
  

½
  Enzymes such as amylase can not suit the
changes of food in quantity and quality.

2. The rapid growth.

The body weight of one year old children is 3 times of birth weight. The nutrient
requirements are relatively great. 
         
      

3. Poor immune function (host defenses)

Immunoglobulins especially the level of IgM and secretory IgA from gastrointestinal
mucosa are very low
   

 
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4. Disturbed enteric bacterial flora:

Normal bacterial flora is highly effective in resisting colonization by potentially

pathogenic invaders. 
  
 
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5. Formula feeding:

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   ; Breast milk
contains many factors such as SIgA SIgA, complement C3, C4, , lysozyme lysozyme,
lysosome lysosome, lectoferrin and some cells, these
    
 
  
  

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Infectious factors

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± Rotavirus is the most common cause of infantile diarrhea especially in cold seasons.

± Norwalk virus is more responsible for diarrhea among older children and adults.

± Others such as calicivirusåenteric adenovirus, astrovirus astrovirus, corona , corona-

like viruses, small round viruses, ECHO, Coxsackie, CMV.

 

Escherichia coli (E. coli)

Enteropathogenic E. coli EPEC

Enterotoxigenic E. coli ETEC

Enteroinvasive E. coli EIEC

Enterohemorrhagic E. coli EHEC

Enteroadherent-aggregative E. coli EAEC

Campylobacter jejuni ,

Yersinia enterocolitica .

Other bacteria: staphylococcus aureus, pseudomonas aeruginosa, proteus , Klebsiella,

Salmonella,

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especially Candida albicans Protracted use of broad broad-spectrum antibiotics may
alter the normal enteric flora, that may allow the emergence of resistant organisms such
as staphylococcus aureus     $$ 

   

 
 

 

Entamoeba histolytic, Giardia Lamblia, Balantidium coli. A. duodenae, T. triturae

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 (toxin, fever).Pathogens infect intestine directly. Local
irritation of the rectum (bladder infection).

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Some antibiotics decrease carbohydrate transport and intestinal lactase levels.

Protracted use of broad broad-spectrum antibiotics may alter the normal enteric flora,
that may allow the emergence of resistant organisms such as staphylococcus aureus or
Candida albicans albicans

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Dietary factor :

Excess or irregular feeding Sudden alteration of diet. Feeding starch or fat too early,
changing food or weaning suddenly.

Allergy to cow's milk or disaccharidase deficiency.

Weather factors

Cool enterokinesia

Hot secretion of digestive juice

Take excessive milk because of thirsty


 

Each kind of diarrhea has different pathogenesis,

such as:

Osmotic diarrhea : much poorly absorbed and hyperosmotic solute

Secretory diarrhea : electrolytes hypersecretion

Exudative diarrhea : inflammatory states causing liquor exudation

Motility disturbance : dynamic abnormality of intestine

Noninfectious diarrhea : feeding factors

Pathogenesis Usually combination of several mechanisms

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i) Diarrhea :

ii) Vomiting may be absent initially

iii) Excessive thirst

iv) Fever may be present depending on the etiology

v) Signs of dehydration:

Depressed anterior fontanelle, Sunken eyes, Prominent zygoma, Dry harsh tongue,
Loss of skin elasticity

vi Signs of electrolyte imbalance due to ²

a) Hyponatremia b) Hypokalaemia

vii) Signs of vitamin and minerals deficiency (if the diarrhea is prolong):
Vit. A : Xerosis, Xerophthalmia, Keratomalasia

Vit. B. Complex : Beriberi, Aribollavinosis, Pelagra, Megaloblastic anaemia

Vit. C. : Scurvy

Vit. D. and Calcium. : Rickets

Iron : Iron deficiency anemia

viii) The child may come with shock in acute diarrhea if he/she is severely dehydrated

 

i) Dehydration and electrolyte imbalance.

ii) Abdominal distension

iii) Convulsion

iv) Paralytic ileus

v) Infections

vi) Anemia

vii) Intolerance of disaccharides

viii) Kwashiorkor and marasmas

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 . Finding ways to make breastfeeding safer for
infants of HIV-infected mothers has been an urgent research priority. A study
suggested.

Study over ORT shown that after three years of intervention, the infant mortality rate
was reduced 4.2 times from 65 in 1,000 to 15 in 1,000. The annual hospitalization rate
decreased nearly six times, from 13 percent to 2 percent. The prevalence of the height-
for-age deficit was diminished 22 percent, from 28 to 23 percent, and the 
 

  
 +-0) during diarrhea episodes increased 2.4 times to 91 percent
from 38 percent. Finally$  
 
  increased 31.5 percent
during the three years, a change to 96 percent from 73 percent .

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a) Correction of already existing deficit (Rehydration therapy)

b)Replacement of continuing loss (Maintenance therapy

c) Normal requirement of fluid.Rehydration fluids

2. Maintenance of Nutrition

3. Correction of elctrolyte inbalance

i) Sodium & Chloride helps in absorption and retaining water, thus corrects dehydration
ii) Bicarbonate corrects acidosis

iii) Potassium corrects K+ toss.

4.Control of infection

      

Correction of deficiency by multivitamin suppliments, Correction of anaemia, and

Gradual rehabilitation to solid food .

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    )-- reduced severe diarrheal illness by 88 percent in a
study of more than 2,000 infants in Venezuela. This is the largest and most successful
trial to date of arotavirus vaccine among children in a developing country."This is the
first study designed to determine if the vaccine prevents severe illness in a developing
country where rotavirus circulates year-round rather than seasonally," explains Anthony
S. Fauci, M.D., NIAID director. "In this setting, the vaccine proved to be very
efficacious."

1. Physiologic diarrhea

It occurs in infants apparently fatty, younger than six months, usually breast

feeding. Accompanied by eczema.

Beside diarrhea the infants have no other symptom and have good appetite and

normal weight gain. After solid foods (supplemental food ) are added the stools turn to
normal.

Differential diagnosis

1. Physiologic diarrhea

It occurs in infants apparently fatty, younger than six months, usually breast

feeding. Accompanied by eczema.

Beside diarrhea the infants have no other symptom and have good appetite and

normal weight gain. After solid foods (supplemental food ) are added the stools turn to
normal.

2. Bacillary dysentery

Epidemic data (contact history).

Stool bacteria culture.

3. Acute necrotizing enterocolitis enterocolitis: which must be treated with surgical

therapy in time.
Antibiotics: is not effective for viral and non non-invasive bacterial enteritis. But in cases
with severe systemic symptoms such as high fever, antibiotics should be given early,
specifically and in full dose.

Antidiarrheal medicines are ineffective or even dangerous. Such as loperamide

loperamide, tincture of opium, which may inhibit GI motility, increase the multiplication of
bacteria and absorption of toxin.