Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.
The continued reports on outbreaks of norovirus infection on cruise ships has left many
would-be cruisers worried about contracting the illness and wondering if they
can prevent it. Many people may not be familiar with the term norovirus, but
it's actually a relatively new term for an old disease. The many strains of
noroviruses cause a self-limited gastrointestinal illness that many refer to as
the "stomach flu." Outbreaks of norovirus infection have also been documented as
coming from restaurants, schools, and nursing homes.
Norovirus is now the official name for the group of viruses that, for a time,
were referred to as "Norwalk-like" viruses, after the original strain "Norwalk
virus," which caused an outbreak of gastroenteritis in a school in Norwalk,
Ohio, in 1968. Other names for this group of viruses have included caliciviruses
(the virus family name) and small round structured viruses (SRSVs).
Gastroenteritis is inflammation of the gastrointestinal tract, involving the
stomach, intestines, or both; usually resulting in diarrhea, abdominal cramps,
nausea and possibly vomiting. Gastroenteritis is frequently termed
"stomach flu"
or "gastric flu" because the most frequent cause of gastroenteritis is viral.
However, this loose terminology confuses some people because
influenza viruses
(flu viruses) do not cause gastroenteritis.
Gastroenteritis also can be confusing to people because gastroenteritis
itself is considered a disease, but gastroenteritis can also be considered a
symptom of other diseases. For example, a person who has the symptoms of
gastroenteritis and eventually develops bloody diarrhea is usually not diagnosed
with gastroenteritis, but with a specific disease such
as shigellosis. Unfortunately, there are many specific diseases that manifest
with symptoms of gastroenteritis, usually early in the disease process.
To complicate things even more, often confusion is generated when the term gastroenteritis is modified by
words like "mild" or "severe." "Severe gastroenteritis" is a non-specific term
that usually means different things to different investigators. The meaning is
usually implied by the disease process that is being discussed. For example, if
the context of an article about a viral cause of gastroenteritis, it often means
diarrhea that causes dehydration; while another article about a bacterial cause
of gastroenteritis it may mean bloody diarrhea with fever.
The best way to sort out this non-specific terminology associated with
gastroenteritis is for authors and health care practitioners to define what they mean by
gastroenteritis and its modifying terms. While there may be disagreement about
the terms, at least their meaning will be clear to the readers of individual
articles. Consequently, for this article, gastroenteritis will mean the
short-term (lasting about 2 to 5 days and resolution, sometime over an additional
few days) occurrence of symptoms that may include some or all of the following:
Abdominal cramping (intermittent, usually relieved by a bowel movement)
Other symptoms may develop such as a mild fever (about 100 F, 37.7 C),
mild chills,
occasionally a headache, and/or muscle aches, and a feeling of being tired. All of
the above symptoms may develop into severe gastroenteritis which means for this
article, dehydration, which may be life-threatening, especially in children.
People with symptoms of diarrhea, bloody diarrhea, nausea, or vomiting that
lasts more than five days, and often may have additional symptoms of fever
(greater than 101 F, 38.3 C), malaise, dehydration, and sepsis, for this article,
will
not be considered to have gastroenteritis. However, people with such problems
will be considered to have symptoms of gastroenteritis that are related to a
specific disease, for example, shigellosis.
Not all investigators will agree with this
designation and consider bloody diarrhea, vomiting more than 48 hours, fever
higher than 101 F (38.3 C), dehydration, and relatively constant abdominal pain as severe
gastroenteritis. However, these symptoms are not frequently associated with gastroenteritis or stomach flu
that does not run a limited course, and does not resolve without professional or
medical treatment, and are more often associated with
other specific diseases, most of which require medical care.
Most children and
adults diagnosed with shigellosis,
E. coli 0157:H7 infections, salmonellosis, and
other diseases are usually not diagnosed as having severe gastroenteritis or
severe stomach flu. Readers may wonder why then, should such pathogens be listed
as causes of gastroenteritis. The answer is simple. The pathogens are listed
because in many people, the pathogens produce only symptoms of gastroenteritis
and do not go on to develop worse symptoms, often because an otherwise healthy
person self-limits the infection. Not to list them would not give an accurate
summation of the causes of gastroenteritis.
Gastroenteritis (Stomach Flu) - Effective TreatmentsQuestion: How long did the symptoms of your gastroenteritis (stomach flu) last? Was there anything in particular that helped with pain/symptom relief?
Rectal bleeding (hematochezia) refers to the passage of bright red blood from the anus. Rectal bleeding may be moderate to severe and most bleeding comes from the colon, rectum, or anus. Common causes include anal fissures, hemorrhoids, diverticulitis, and more.
Diarrhea is a change is the frequency and looseness of bowel movements. Cramping, abdominal pain, and the sensation of rectal urgency are all symptoms of diarrhea. Absorbents and anti-motility medications are used to treat diarrhea.
Dehydration is the excessive loss of body water. There are a number of causes of dehydration including heat exposure, prolonged vigorous exercise, and some diseases of the gastrointestinal tract. The best way to treat dehydration is to prevent it from occurring.
Dizziness is a symptom that is often applies to a variety of sensations including lightheadedness and vertigo. Causes of dizziness include low blood pressure, heart problems, anemia, dehydration, and more. Treatment of dizziness depends on the cause.
Nausea is an uneasiness of the stomach that often precedes vomiting. Nausea and vomiting are not diseases, but they are symptoms of many conditions. The causes of vomiting differ according to age, and treatment depends upon the cause of nausea and vomiting.
Norovirus infection causes stomach flu, or gastroenteritis. It's a very contagious illness with symptoms that include nausea and vomiting, diarrhea, stomach cramps, fever, headache, chills, and muscle aches. Norovirus infection cannot be treated with antibiotics, so treatment focuses on maintaining proper hydration.
Potassium is an essential electrolyte necessary for cell function. Low potassium (hypokalemia) may be caused by diarrhea, vomiting, ileostomy, colon polyps, laxative use, diuretics, elevated corticosteroid levels, renal artery stenosis, and renal tubular acidosis, or other medications. Symptoms of low potassium include weakness, aches, and cramps of the muscles. Treatment is dependant upon the cause of the low potassium (hypokalemia).
Food poisoning is common, but can also be life threatening. The most common form of food poisoning is caused by bacteria and include symptoms such as fever, abdominal pain, diarrhea, nausea and vomiting.
Salmonella bacteria are known to cause salmonellosis, typhoid fever, and paratyphoid fever in humans. Salmonella infection is usually caused by ingesting large amounts of the bacteria in contaminated food or water.
There are many types of E. Coli (Escherichia coli ). Pathogenic E. coli can cause urinary tract and bladder infections, or lead to sepsis. E coli O157:H7 (EHEC) causes bloody diarrhea and colitis. Complications of E. coli infection include hemorrhagic diarrhea, hemolytic-uremic syndrome, and thrombotic thrombocytopenic purpura. Symptoms include severe abdominal pain and bloody diarrhea. E coli O157:H7 commonly is due to eating raw or undercooked hamburger or raw milk or dairy products.
Rotavirus is the most common cause of severe diarrhea among infants and children throughout the world. Almost all children have become infected with rotavirus by their third birthday. Repeat infections with different viral strains are possible, and most children have several episodes of rotavirus infection in the first years of life. Children between the ages of six and 24 months are at greatest risk for developing severe disease from rotavirus infection. Rotavirus symptoms include: fever, vomiting, watery diarrhea, and abdominal pain. Rotavirus infection can be associated with severe dehydration in infants and children.
Travelers' diarrhea is generally contracted by eating contaminated food or drinking contaminated water. Food is the primary source of travelers' diarrhea. Enterotoxigenic E. coli is the cause of up to 70% of all cases of travelers' diarrhea. There are five unique classes of E. coli that causes gastroenteritis. Other bacteria responsible for travelers' diarrhea include
Campylobacter, jejuni, shigella, and salmonella. Viruses such as rotavirus and Norwalk virus (norovirus) and giardia lamblia a parasite may cause travelers' diarrhea. Prevention is careful eating and drinking of water.
Travelers should prepare for their trip by visiting their physician to get the proper vaccinations and obtain the necessary medication if they have a medical condition or chronic disease. Diseases that travelers may pick up from contaminated water or food, insect or animal bites, or from other people include malaria, meningococcal meningitis, yellow fever, hepatitis A, typhoid fever, polio, and cholera.
Drug resistance (antimicrobial resistance) is the ability of bacteria, fungi, parasites, and viruses to grow, even in the presence of a drug that would normally kill it (or limit it's growth). Drug resistance is a growing problem, particularly for infections such as MRSA, VRE (vancomycin-resistant enterococci), tuberculosis, HIV, STDs, gonorrhea, flu, pneumonia, malaria, E. coli, salmonella, Campylobacter, which causes diarrhea and gastroenteritis. Learn how to protect yourself from resistance to drugs.
Reye's syndrome (RS, or Reye syndrome) is a sudden, sometimes fatal, disease of the brain with degeneration of the liver. Reye syndrome occurs in children and comes after the chickenpox or an influenza-type illness, is also associated with taking medications containing aspirin. Symptoms include vomiting, listlessness, irritability or combativeness, confusion, delirium, delusions, convulsions, and loss of consciousness. Treatment depends on early diagnosis and focuses on protecting the brain against irreversible damage by reducing brain swelling, reversing the metabolic injury, preventing complications in the lungs, and anticipating cardiac arrest.
Hemolytic uremic syndrome (HUS) is a diseases in which blood clots within the capillaries. Causes associated with HUS include E. Coli, birth control pills, pneumonia, medications such as chemotherapy, Ticlid, and quinine. Symptoms of HUS include gastroenteritis, abdominal cramping, vomiting, and bloody diarrhea. Diagnosis of HUS includes medical history, physical examination, and medical tests. Treatment includes rest, fluids, possible hospitalization for blood transfusion or complications due to kidney failure.
Hemolytic uremic syndrome (HUS) is a condition characterized by destruction
of red blood cells and kidney failure.
HUS often follows a digestive infection caused by
E. coli OH157:H7, although
there are other causes.
Symptoms of HUS include vomiting and diarrhea (often bloody), weakness, lethargy,
and bruising (purpura). These symptoms are due to a combination of dehydration,
anemia and uremia (the inability of the kidneys to clear waste products from the
body).
Diagnosis of HUS is made by a combination of history, physical exam, and abnormal
blood tests. There is no one test that makes the diagnosis of hemolytic uremic
syndrome.
Treatment of HUS is supportive with intravenous fluids. Anemia may require blood
transfusion and temporary dialysis may be necessary.
Children tend to recover from HUS, while adults with HUS may fare less well./l...
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