Intestinal disease throughout the country: hundreds of cases due to viral or salmonella bacteria

A wave of intestinal illness throughout the country: hundreds of children have been referred to emergency rooms in recent weeks due to dehydration resulting from "gastroenteritis", an infectious inflammation of the intestines following infection with viruses and bacteria that cause nausea, vomiting, diarrhea and loss of fluids. Some of the children were hospitalized for intravenous infusions.

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"Acute gastroenteritis" is one of the most common diseases in children and affects tens of thousands of children in Israel every year. It is an infection of the digestive tract, usually by the rotavirus (more typical of the winter season), norovirus and calcivirus. Other viruses that cause the disease are adenovirus, astrovirus, coronavirus, pestivirus and torovirus. In the minority of cases it is dysentery, a disease caused by infection with Shigella, Salmonella, E. coli or Campylobacter bacteria.

The main danger, especially in risk populations including babies, children and the elderly, is dehydration which causes a disturbance in the balance of salts and sugars in the body. The result is dehydration, loss of consciousness, damage to the heart, up to convulsions and in extreme cases even death.

The infection is "paco-oral", that is, by the passage of viruses and bacteria into the mouth, usually after improper hand washing at the end of a visit to the bathroom, contact of contaminated hands with food or changing diapers followed by contact with food. The infection is also common among children who bite their nails. The disease usually lasts for several days, between three and seven on average, but may also "stretch" for a month or even more. The duration of the disease depends on the level of hygiene maintained, the strain of the virus, the immune capacity and the age of the patient.

As mentioned in the last few weeks, hundreds of parents went to the HMO clinics due to complaints about the symptoms of gastroenteritis, in some cases the multiple vomiting and prolonged diarrhea raised the suspicion of dehydration and the children were taken to the emergency rooms for examination and hospitalization. The data of the Ministry of Health indicate in recent weeks an increase in the incidence of infection with the Salmonella bacterium, of which approximately 250 cases of infection were reported, compared to 180 cases of infection in the same period last year. It should be noted that only some of the cases are reported to the Ministry of Health, so the real infection rate is much higher. Infections have also been reported with Campylobacter bacteria, rotavirus and adenovirus. Surprisingly, the more dangerous bacteria called Shigella caused fewer infections this year, possibly due to a change in the dominance of the bacterial populations.

The signs of the disease include vomiting or nausea, the child's reluctance to drink and eat (mainly due to the fear of the feelings of nausea and vomiting), excessive sleepiness, and a lack of urination. In babies, it is possible to notice the subsidence of the cranium – that frontal area of the skull that has not yet closed and under which the brain is located.

What can you do to prevent the deterioration?

1. Mineral solution
A mineral solution must be given (such as "Mineral" or "Electrorice"). Prefer to give water mixed with a solution of electrolytes, which improve the absorption of fluids in the body and balance it in terms of the level of salts and minerals. The sooner you drink the solution, the less serious the disease will be. We note that it has not been proven in the medical literature that adding other ingredients to this solution, such as zinc or honey, results in a significant improvement.

2. Dry and salty food
If the patient is able to swallow, give him dry and salty food. Such food will make him feel dry in his mouth which will encourage drinking and also the salts in the product will help restore the sodium deficiency. You can add to the economy one or two bananas per day, which are rich in sugar and potassium.

3. Strict hygiene
To prevent infection of other family members and to shorten the duration of the disease, observe maximum hygiene: a separate towel must be assigned to the patient and be sure to wash hands thoroughly with soap and water after changing a diaper, staying in the bathroom, and before any contact with food. Throw the diaper into a bag and seal it well before throwing it in the trash, disinfect your hands with alcohol, disinfect strategic surfaces (signs, handles) with alcohol and change towels frequently. Maximum hygiene is the key to shortening the duration of the disease and preventing infection.

4. Do not give medicine to stop diarrhea
There is no place to treat with medicines to stop diarrhea (such as loperamide), which may worsen the disease and cause the period of diarrhea to be prolonged.

5. Probiotics
There is some evidence in the medical literature that probiotics may in some cases reduce the duration and intensity of diarrhea, in addition to administering a mineral solution. Therefore, the latest recommendations state that it is possible to try adding probiotics to the treatment, in strains that have been proven to be effective, including the Lactobacillus and Saccharomyces species. However, the efficacy of prebiotics (Prebiotis) has not been proven.

6. Antibiotics
Most of the cases of infectious disease in the digestive system are caused by viruses, antibiotics should not be treated, unless growth of the bacterium Shigella was found in the stool culture. The recommended treatment in such a case is the antibiotic zenil for five days or an injection of ceftriaxone (rocepin) if the child suffers from vomiting and is unable to swallow medicine orally. In the case of an infection caused by salmonella, antibiotic treatment should not be given, except when there is a fear of infection in children suffering from immune deficiency or in children under three months of age. In such a case, the treatment is ceftriaxone injection, zenil or cipro antibiotics or respers given in syrup.

7. The cases that require medical treatment:
If the patient refuses to drink or shows signs of dehydration, he must be brought to a clinic or a medical center, where he will receive an infusion of fluids into the vein. As mentioned, there are no antibiotics for a viral infection, so the only treatment is to return the fluids to the body and rest.

If signs of severe dehydration appear (failure to urinate for ten hours or more, noticeable dryness in the oral cavity, crying without tears, vomiting or multiple diarrheas) – go to the emergency room.

According to the latest guidelines, in case of vomiting, the medicine "Zopran" can be given in the emergency room. This is a very effective drug that until recently was only used to prevent vomiting and nausea in cancer patients, but in recent years it has been given orally or intravenously to children suffering from vomiting due to a viral infection.