Gastroenteritis in Infants: Is It a Viral Infection?

Gastroenteritis? Enterovirus? Adenovirus?

My daughter is currently 7 and a half months old and weighs 7.5 kg.
She started experiencing mild diarrhea last Thursday (June 26), having three bowel movements a day (some formed, some semi-formed).
The next day (June 27), she had two bowel movements (some formed, some semi-formed), but since this is a common occurrence for her and she seemed to be in good spirits, we did not seek medical attention.
On Saturday (June 28), she did not have any bowel movements, but her body felt a bit warm for a while before returning to normal.
Over the past few days, her milk intake has been normal.

On Sunday (June 29), she started crying at 5 AM, and her rectal temperature was 39 degrees Celsius.
We administered half a dose of antipyretic medication, and her fever reduced after about an hour.
At 8:30 AM, we visited the clinic, where her ear temperature was 38.6 degrees Celsius.
The initial diagnosis was a gastrointestinal viral infection, and she was prescribed antipyretics, anti-inflammatory medication, and anti-diarrheal medication.
After taking the medication on schedule, she did not have a fever again.

On Monday (June 30), at 4 AM, she had a fever again, with a rectal temperature of 38.5 degrees Celsius.
She refused to drink milk (having not eaten for over ten hours), but she managed to take 200 cc of medication via a dropper.
During the day, after taking her medication, she did not have a fever, but she continued to drink milk using a dropper.
In the evening, we returned for a follow-up, and the doctor suspected a possible enterovirus infection, prescribing the same medications and advising us to monitor her temperature closely.

Today (July 1), at 4 AM, she felt extremely hot, with a rectal temperature of 39.8 degrees Celsius (the last medication was given at 8:30 PM).
We administered antipyretics again, and her fever subsided after about an hour.
At this point, she was willing to drink milk, but preferred it at a cooler temperature.
After taking her medication during the day, her temperature was normal, but in the afternoon, her milk intake became irregular, and her appetite decreased.

I would like to ask if this could be an enterovirus infection or another type of adenovirus infection? Thank you!

Lan, 30~39 year old female. Ask Date: 2003/07/01

Dr. Liang Hongjian reply Pediatrics

Thank you, Miss Lan, for your letter.
In response to your question, the term "cold" generally refers specifically to an illness caused by the influenza virus, with clinical symptoms typically including fever, cough, runny nose, body aches, and fatigue.
On the other hand, the term "gastrointestinal flu" does not have a formal medical designation; it is widely used because it is easier to understand and does not require in-depth analysis like other medical terms.
Gastrointestinal flu broadly refers to symptoms resembling a cold, accompanied by gastrointestinal symptoms.
However, most cases are not caused by the cold virus but are primarily due to adenovirus infections.

As for enteroviruses, including Coxsackie, Echovirus, and poliovirus, the enteroviruses we commonly refer to are predominantly Coxsackie and Echovirus, particularly the EV71 type.
Clinical symptoms associated with these include herpangina and hand, foot, and mouth disease, with the most common being oral pharyngitis, often accompanied by high fever lasting three to five days.
The treatment for these various conditions is generally similar, focusing on supportive care and symptomatic treatment while preventing complications.
Regarding your daughter's recent infection, it is difficult to determine the specific type of virus based solely on the symptoms.
It is best for an experienced physician to conduct a general physical examination before making a diagnosis.
If your doctor suspects an enterovirus infection, it is likely that enterovirus is the predominant cause.
The treatment prescribed, which is likely aimed at symptom relief, should be appropriate.
I hope your daughter recovers soon.
If you have any further questions, please feel free to write again.

Reply Date: 2003/07/01

More Info

Gastroenteritis in infants, particularly in the context of your daughter's symptoms, is often caused by viral infections, with rotavirus and norovirus being the most common culprits. Given your daughter's age and the symptoms you've described, it is indeed possible that she is experiencing a viral gastroenteritis, which can manifest as diarrhea, vomiting, fever, and general malaise.

From the timeline you've provided, it appears that your daughter initially exhibited mild diarrhea, which is not uncommon in infants and can often be attributed to dietary changes or minor infections. However, the subsequent development of a high fever and more pronounced gastrointestinal symptoms raises the suspicion of a viral infection, particularly if her symptoms have persisted or worsened.

Viral gastroenteritis is typically characterized by the following symptoms:
1. Diarrhea: This can range from mild to severe and may be watery. In infants, it is crucial to monitor for signs of dehydration.

2. Vomiting: This can occur alongside diarrhea, leading to further fluid loss.

3. Fever: A mild to moderate fever is common, but high fevers can also occur, especially in response to the viral infection.

4. Irritability and lethargy: Infants may become more fussy and less active when unwell.

In your daughter's case, the presence of a high fever (39.8°C) and the fluctuation in her appetite are concerning signs that warrant close monitoring. The fact that she has had episodes of fever that respond to antipyretics (fever-reducing medications) is a positive sign, but persistent high fevers and changes in feeding patterns should be evaluated by a healthcare professional.

As for distinguishing between viral gastroenteritis and other infections, such as those caused by adenoviruses or enteroviruses, it can be challenging without specific laboratory tests. Adenoviruses can also cause gastroenteritis and respiratory symptoms, and they are known for their ability to cause outbreaks, particularly in settings like daycare centers. Enteroviruses, including the well-known coxsackievirus, can lead to similar gastrointestinal symptoms and are often associated with hand, foot, and mouth disease.

In terms of management, the primary focus should be on preventing dehydration, which is a significant risk in infants with gastroenteritis. Here are some recommendations:
- Hydration: Ensure your daughter is receiving adequate fluids. Oral rehydration solutions (ORS) can be beneficial in replacing lost fluids and electrolytes.

- Diet: If she is willing to eat, offer bland foods that are easy on the stomach. Avoid dairy products, as they can sometimes exacerbate diarrhea.

- Monitoring: Keep a close eye on her symptoms, especially her fever and hydration status. Look for signs of dehydration, such as decreased urine output, dry mouth, or lethargy.

- Follow-up: If her symptoms persist or worsen, or if she shows signs of dehydration, it is essential to seek medical attention promptly.

In conclusion, while your daughter's symptoms are consistent with viral gastroenteritis, the exact cause may require further evaluation by a healthcare provider. It is essential to monitor her closely and ensure she remains hydrated, as this is the most critical aspect of managing gastroenteritis in infants. If you have any concerns about her condition, do not hesitate to reach out to her pediatrician for further guidance.

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