key: cord-0009543-u9etvfnl authors: Friedman, Allan D. title: Acute infectious nonbacterial gastroenteritis (AING) date: 2007-01-19 journal: Infect Dis Newsl (N Y) DOI: 10.1016/s0278-2316(83)80058-9 sha: a0d82fc39467f64b0f2050b98e6d5e7383c68942 doc_id: 9543 cord_uid: u9etvfnl nan Acute infectious nonbacterial gastroenteritis (AING) in children is a common cause of hospitalization. First described by Zahorsky as "winter vomiting disease," it has long been assumed to be due to viral etiologies. 1 Only recent-01y with the advent of newer technologies have we been able to identify specific v~ruses in infected patients. Most AING has been attributed to rotavirus and Norwalk-like viruses. Other viruses, including corona virus~like particles, adenoviruses, astroviruses and caliciviruses may also cause AING. 2, 3 Diagnoses are made with the aid of electron microscopy (EM), immunoelectronmicroscopy, tissue culture, and a variety of serologic techniques including enzymelinked immunosorbent assay (ELISA) and radioimmunoassay (RIA). 4 Demonstration of the virus in stool along with serologic evidence of antibody in patients with gastroenteritis is strong evidence for a causative role of the virus. We know most about Norwalk-like viruses and rotaviruses. Norwalk virus and Norwalk-like viruses ire associated with gastroenteritis, usually outside the infant age group. 5 This disease has an explosive onset, short duration (24 to 48 hours), is usually self-limited and characteristically occurs in epidemics. Symptoms include yomiting, diarrhea, nausea, abdominal cramps, low-grade fever, anorexia, headache, malaise and myalgias. Mucosal lesions of the proximal small bowel are produced by the virus. Antibody is present in most adults, usually first appearing during late adolescence and early adult life. The role of antibody in immunity to reinfection is not clear. Diagnosis is made by immunoelectronmicroscopy. Radioimmunoassay can also be used. Neither of these techniques is available on a routine basis in most clinical settings which makes diagnosis difficult. Rotavirus AING is a disease of infants and young children. It usually occurs during cooler months in temperate climates. The illness is more prolonged than Norwalk-like virus AING (usually about one week) and is potentially more serious. Rotavirus AING results in significant morbidity and mortality in third world nations and accounts for a significant number of infant hospitalizations in the United States. 6 Most children over 2 years of age have antibody. Antibody appears to be serotype specific. There are at least two serotypes of rotavirus that afflict humans. 3 Symptoms include diarrhea which is usually severeand watery; vomiting and fever may accompany the diarrhea. Severe dehydration may ensue resulting in hospitalization. The diagnosis of rotavirus AING is by EM of stool specimens. This method is not readily available in most settings. Alternatives include ELISA and RIA. Therapy for AING, regardless of viral etiology, is fluid and electrolyte replacement. There is not any available antiviral therapy for these infections. Prevention depends on interrupting the fecal-oral route cycle. Immunization against rotavirus is still in the experimental state but may be available in a few years. There is not yet a candidate Norwalk-virus vaccine developed. Acute infectious nonbacterial gastroenteritis results in high morbidity and mortality in developing nations. In the United States, it accounts for a significant number of infant hospitalizations as well as days lost from school or work. Hyperemesis hiemis or the winter vomiting disease New' pediatric infectious diseases Viral gastroenteritis Viral gastrointestinal infections Philadelphia: W. B. Saunders Company A prospective study of rotavirus infections in infants and young adults