What is an Intestinal Infection and Diarrhea?
Acute gastroenteritis (AGE) is a common condition characterized by inflammation of the stomach and intestines, often leading to diarrhea, vomiting, and abdominal pain. Globally, AGE is a major public health concern, especially among children, where it ranks second among causes of hospitalizations and mortality [1]. Diarrhea, the main symptom of AGE, manifests as frequent loose or watery stools. It can be caused by various pathogens, including viruses, bacteria, and parasites.
Causes of Intestinal Infections in Children and Adults
Intestinal infections can affect people of all ages, but children and the elderly are particularly vulnerable.
- In children: Acute gastroenteritis is one of the leading causes of morbidity and mortality, especially in developing countries [1]. Children are frequently exposed to various pathogens due to the immaturity of their immune system and behavioral characteristics. In resource-limited settings and poor sanitation, such as displaced persons camps, multiple parasitic infections (such as ascariasis, trichuriasis, strongyloidiasis, hymenolepiasis, amebiasis) combined with bacterial infections, such as those caused by Helicobacter pylori, are common [8]. Pinworms (Enterobius vermicularis) are also a typical childhood condition [2]. These infections can lead to chronic abdominal pain, vomiting, diarrhea, weight loss, and anemia [8].
- In adults: Adults are also susceptible to intestinal infections, especially with poor hygiene, consumption of contaminated food or water. Elderly individuals, particularly those taking immunosuppressive drugs (e.g., long-term courses of corticosteroids), may experience rare or atypical infections, such as pinworm infestation (Enterobius vermicularis), which is usually associated with children [2]. Helicobacter pylori is widely known as the causative agent of chronic gastritis and peptic ulcer disease [2, 8].
Acute Conditions and Their Complications
Acute intestinal infections accompanied by diarrhea can have serious consequences, especially for children. The severity of acute gastroenteritis in children can be assessed using specialized scoring systems, such as the Vesikari clinical severity scale [1]. The primary acute complication of diarrhea is dehydration, which can lead to electrolyte imbalances and, in severe cases, life-threatening conditions. In children with acute kidney injury (AKI), gastrointestinal diseases are frequently concurrent conditions, which underscores the systemic impact of infections and the importance of a comprehensive approach to treatment [4].
The Link Between Intestinal Infections and Irritable Bowel Syndrome (IBS)
One of the significant long-term consequences of past intestinal infections is the development of post-infectious irritable bowel syndrome (PI-IBS).
- In children: Acute gastroenteritis is recognized as a risk factor for the development of PI-IBS in the pediatric population. Studies show that there is a correlation between the clinical severity of past AGE and the likelihood of PI-IBS in children and adolescents aged 4 to 15 years [1]. Rome IV criteria are used to diagnose IBS in children, and the Bristol Stool Scale is used to assess stool form [1]. Among children hospitalized with a diagnosis of IBS, the most common subtype is diarrhea-predominant IBS (IBS-D), accounting for about 61.9% of cases, and it is more common in boys [5]. Children with IBS may experience sleep disturbances, and their symptoms may worsen with the consumption of cold or irritating foods [5].
- In adults: Adults are also at risk of developing IBS after infectious enteritis. A large-scale cohort study involving over 200,000 patients showed that people who suffered from infectious enteritis have a significantly increased long-term risk of developing IBS (relative risk 2.35 at one year) and functional dyspepsia compared to the control group [7]. This highlights that even after the resolution of an acute intestinal infection, chronic impairments of intestinal function may persist, requiring attention and management.
Diagnosis and Treatment
Timely and accurate diagnosis of intestinal infections and related conditions is the key to effective treatment.
- Diagnostics:
- Stool analysis: Microbiological analysis of stool samples helps identify bacterial and parasitic pathogens [1, 2, 8].
- Specific tests: A rapid urease test, PCR, and histopathological examination are used to diagnose Helicobacter pylori [2].
- Clinical evaluation: The Vesikari scale is used to assess the severity of AGE in children [1]. IBS diagnosis is based on clinical criteria such as Rome IV [1].
- Treatment:
- Rehydration: The main principle of diarrhea treatment is the replenishment of lost fluids and electrolytes.
- Antimicrobial therapy: Appropriate medications are prescribed for confirmed bacterial or parasitic infections. For example, Albendazole is effective for enterobiasis (pinworms), and a standard treatment regimen is used to eradicate H. pylori [2].
- Symptomatic treatment: May include antiemetics and probiotics.
- IBS management: Treating IBS often requires a comprehensive approach, including dietary modifications, stress management, and sometimes pharmacotherapy for symptom relief.
Prevention
Prevention of intestinal infections plays a key role in reducing morbidity and preventing long-term complications. The main measures include:
- Observing personal hygiene rules, especially thorough hand washing.
- Consuming only safe, heat-treated food and clean drinking water.
- Avoiding unwashed fruits and vegetables.
- Complying with sanitary standards in public catering establishments.
Sources
- [1] Post-infectious irritable bowel syndrome in a paediatric population: first data in a Middle Eastern country. https://pubmed.ncbi.nlm.nih.gov/40616004/
- [2] Enterobius vermicularis and Helicobacter pylori coinfection in a geriatric patient on long-term steroids: A case report. https://pubmed.ncbi.nlm.nih.gov/41997297/
- [4] An epidemiological assessment of hemodialysis, continuous kidney replacement therapy, and peritoneal dialysis in pediatric acute kidney injury patients. https://pubmed.ncbi.nlm.nih.gov/42572520/
- [5] Clinical characteristics and nutritional profiles of children with different irritable bowel syndrome subtypes: a retrospective hospital-based study. https://pubmed.ncbi.nlm.nih.gov/42158707/
- [7] Cohort Study: Long-Term Risk and Healthcare Burden of Irritable Bowel Syndrome Following Infection Enteritis in 202,244 Patients. https://pubmed.ncbi.nlm.nih.gov/41826274/
- [8] A Case Report from Somalia: Multispecies Intestinal Parasitism and <i>Helicobacter pylori</i> Coinfection in a Child from a Displacement Camp. https://pubmed.ncbi.nlm.nih.gov/41439149/
Important: The information provided in this article is for reference purposes only and should not be used for self-diagnosis or self-treatment. Always consult a qualified physician for diagnosis and appropriate treatment.