Optimal Therapy for Viral Gastroenteritis?

December 31, 2006

I have been caring for a child, now 18 months old, duringa series of visits over 71⁄2 weeks. The child was originallybrought to our community health clinic by her mother, whoreported that the toddler had diarrhea.

I have been caring for a child, now 18 months old, duringa series of visits over 71/2 weeks. The child was originallybrought to our community health clinic by her mother, whoreported that the toddler had diarrhea. Stool cultureshowed that Blastocystis hominis was responsible. Thechild was well-hydrated and active; however, she periodicallyspiked a fever, which was managed with acetaminophen.At one point during the 71/2 weeks, the diarrhea becamemore severe. A second culture was negative for parasites,with a few white blood cells. No treatment (other than theacetaminophen) was initiated.The child attends a day-care center, where 8 otherchildren are currently affected with the same symptoms. Sheis not allowed to attend day care while she is symptomatic.Can you offer any management suggestions?
---- MD
According to the Red Book published by theAmerican Academy of Pediatrics,1 B hominismay be associated with GI symptoms but alsomay be present in healthy persons. Many expertsbelieve that treatment should be reservedfor patients who have persistent symptoms and inwhom no other pathogen or process is found to explainthe GI symptoms.I suspect that this child and the others in day carewho were affected had gastroenteritis caused by a viralagent, such as rotavirus. Symptomatic treatment--whichinvolves ensuring adequate hydration, advising the parents,and close follow-up--is usually appropriate for thisself-limited disease.
-- Richard H. Rapkin, MD
    Professor and Vice Chairman of Pediatrics
    University of Medicine and Dentistry of New Jersey-
    New Jersey Medical School
    Newark

References:

REFERENCE:1. Blastocystis hominis infections. In: Pickering LK, ed. 2000 Red Book: Report ofthe Committee on Infectious Diseases. 25th ed. Elk Grove Village, Ill: AmericanAcademy of Pediatrics; 2000:188.