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Thomas G. Boyce

, MD, MPH, University of North Carolina School of Medicine

Last full review/revision Jun 2019| Content last modified Jun 2019
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Gastroenteritis is inflammation of the lining of the stomach and small and large intestines. Most cases are infectious, although gastroenteritis may occur after ingestion of drugs and chemical toxins (eg, metals, plant substances). Acquisition may be foodborne, waterborne, or via person-to-person spread. In the US, an estimated 1 in 6 people contracts foodborne illness each year. Symptoms include anorexia, nausea, vomiting, diarrhea, and abdominal discomfort. Diagnosis is clinical or by stool culture, although polymerase chain reaction testing and immunoassays are increasingly used. Treatment is symptomatic, although some parasitic and some bacterial infections require specific anti-infective therapy.

Gastroenteritis is usually uncomfortable but self-limited. Electrolyte and fluid loss is usually little more than an inconvenience to an otherwise healthy adult but can be grave for people who are very young (see Dehydration in Children Dehydration in Children Dehydration is significant depletion of body water and, to varying degrees, electrolytes. Symptoms and signs include thirst, lethargy, dry mucosa, decreased urine output, and, as the degree... read more ), elderly, or immunocompromised or who have serious concomitant illnesses. Worldwide, an estimated 1.5 to 2.5 million children die each year from infectious gastroenteritis (1 General reference Gastroenteritis is inflammation of the lining of the stomach and small and large intestines. Most cases are infectious, although gastroenteritis may occur after ingestion of drugs and chemical... read more ); although high, this number represents one half to one quarter of previous mortality. Improvements in water sanitation in many parts of the world and the appropriate use of oral rehydration therapy for infants with diarrhea are likely responsible for this decrease.

General reference

  • 1. Sattar SBA, Singh S: Bacterial gastroenteritis [Updated 2019 Mar 8]. In StatPearls (Internet). Treasure Island, StatPearls Publishing, 2020.

Etiology of Gastroenteritis

Infectious gastroenteritis may be caused by viruses, bacteria, or parasites. Many specific organisms are discussed further in the Infectious Diseases section.

Viral gastroenteritis

The viruses most commonly implicated are

  • Norovirus

  • Rotavirus

Viruses are the most common cause of gastroenteritis in the US. They infect enterocytes in the villous epithelium of the small bowel. The result is transudation of fluid and electrolytes into the intestinal lumen; sometimes, malabsorption of carbohydrates worsens symptoms by causing osmotic diarrhea. Diarrhea is watery. Inflammatory diarrhea (dysentery), with fecal white blood cells (WBCs) and red blood cells (RBCs) or gross blood, is uncommon. Four categories of viruses cause most gastroenteritis: norovirus and rotavirus cause the majority of viral gastroenteritis, followed by astrovirus and enteric adenovirus.

Norovirus infects people of all ages. Since the introduction of rotavirus vaccines, norovirus has become the most common cause of acute gastroenteritis in the US, including in children. Infections occur year-round, but 80% occur from November to April. Norovirus is now the principal cause of sporadic and epidemic viral gastroenteritis in all age groups; however, the peak age is between 6 months and 18 months. Large waterborne and foodborne outbreaks occur. Person-to-person transmission also occurs because the virus is highly contagious. This virus causes most cases of gastroenteritis epidemics on cruise ships and in nursing homes. Incubation is 24 to 48 hours.

Rotavirus is the most common cause of sporadic, severe, dehydrating diarrhea in young children worldwide (peak incidence, 3 to 15 months). Its incidence has decreased by about 80% in the US since the introduction of routine rotavirus immunization Rotavirus Vaccine The rotavirus vaccine is recommended for infants to protect against gastroenteritis caused by rotavirus disease. For more information, see Rotavirus Advisory Committee on Immunization Practices... read more . Rotavirus is highly contagious; most infections occur by the fecal-oral route. Adults may be infected after close contact with an infected infant. The illness in adults is generally mild. Incubation is 1 to 3 days. In temperate climates, most infections occur in the winter. Each year in the US, a wave of rotavirus illness begins in the Southwest in November and ends in the Northeast in March.

Astrovirus can infect people of all ages but usually infects infants and young children. Infection is most common in winter. Transmission is by the fecal-oral route. Incubation is 3 to 4 days.

Adenoviruses Adenovirus Infections Infection with one of the many adenoviruses may be asymptomatic or result in specific syndromes, including mild respiratory infections, keratoconjunctivitis, gastroenteritis, cystitis, and primary... read more are the 4th most common cause of childhood viral gastroenteritis. Infections occur year-round, with a slight increase in summer. Children < 2 years are primarily affected. Transmission is by the fecal-oral route. Incubation is 3 to 10 days.

Bacterial gastroenteritis

The bacteria most commonly implicated are

Bacterial gastroenteritis is less common than viral. Bacteria cause gastroenteritis by several mechanisms.

Enterotoxins are produced by certain species (eg, Vibrio cholerae, enterotoxigenic strains of E. coli) that adhere to intestinal mucosa without invading. These toxins impair intestinal absorption and cause secretion of electrolytes and water by stimulating adenylate cyclase, resulting in watery diarrhea. C. difficile Overview of Clostridial Infections Clostridia are spore-forming, gram-positive, anaerobic bacilli present widely in dust, soil, and vegetation and as normal flora in mammalian gastrointestinal tracts. Pathogenic species produce... read more produces a similar toxin.

Mucosal invasion occurs with other bacteria (eg, Shigella Shigellosis Shigellosis is an acute infection of the intestine caused by the gram-negative Shigella species. Symptoms include fever, nausea, vomiting, tenesmus, and diarrhea that is usually bloody. Diagnosis... read more , Salmonella Overview of Salmonella Infections The genus Salmonella is divided into 2 species, S. enterica and S. bongori, which include > 2400 known serotypes. Some of these serotypes are named. In such cases, common usage sometimes shortens... read more , Campylobacter Campylobacter and Related Infections Campylobacter infections typically cause self-limited diarrhea but occasionally cause bacteremia, with consequent endocarditis, osteomyelitis, or septic arthritis. Diagnosis is by culture, usually... read more , C. difficile Overview of Clostridial Infections Clostridia are spore-forming, gram-positive, anaerobic bacilli present widely in dust, soil, and vegetation and as normal flora in mammalian gastrointestinal tracts. Pathogenic species produce... read more , some Escherichia coli Escherichia coli Infections The gram-negative bacterium Escherichia coli is the most numerous aerobic commensal inhabitant of the large intestine. Certain strains cause diarrhea, and all can cause infection when they invade... read more subtypes) that invade the mucosa of the small bowel or colon and cause microscopic ulceration, bleeding, exudation of protein-rich fluid, and secretion of electrolytes and water. The invasive process and its results can occur whether or not the organism produces an enterotoxin. The resulting diarrhea contains WBCs and RBCs and sometimes gross blood.

Salmonella and Campylobacter are common bacterial causes of diarrheal illness in the US. Both infections are most frequently acquired through undercooked poultry; unpasteurized milk is also a possible source. Campylobacter is occasionally transmitted from dogs or cats with diarrhea. Salmonella can be transmitted by consuming undercooked eggs and by contact with reptiles, birds, or amphibians. Species of Shigella are also common bacterial causes of diarrhea in the US and are usually transmitted person to person, although foodborne epidemics occur. Shigella dysenteriae type 1 (not present in the US) produces Shiga toxin, which can cause hemolytic-uremic syndrome Hemolytic-Uremic Syndrome (HUS) Hemolytic-uremic syndrome (HUS) is an acute, fulminant disorder characterized by thrombocytopenia, microangiopathic hemolytic anemia, and acute kidney injury. HUS usually occurs in children... read more Hemolytic-Uremic Syndrome (HUS) .

Several different subtypes of E. coli cause diarrhea. The epidemiology and clinical manifestations vary greatly depending on the subtype:

Each of these E. coli subtypes can be detected in stool by polymerase chain reaction testing, typically using a multiplex panel. Sometimes more than one organism is detected simultaneously, the clinical significance of which is unclear.

In the past, Clostridium difficile Overview of Clostridial Infections Clostridia are spore-forming, gram-positive, anaerobic bacilli present widely in dust, soil, and vegetation and as normal flora in mammalian gastrointestinal tracts. Pathogenic species produce... read more infection occurred almost exclusively in hospitalized patients receiving antibiotics. With the emergence of the hypervirulent NAP1 strain in the US in the late 2000s, many community-associated cases are now occurring. C. difficile is now probably the most common bacterial cause of diarrhea in the US.

Pearls & Pitfalls

  • C. difficile is now probably the most common bacterial cause of diarrhea in the US.

Several other bacteria cause gastroenteritis, but most are uncommon in the US. Yersinia enterocolitica Plague and Other Yersinia Infections Plague is caused by the gram-negative bacterium Yersinia pestis. Symptoms are either severe pneumonia or massive lymphadenopathy with high fever, often progressing to septicemia. Diagnosis is... read more Plague and Other <i>Yersinia</i> Infections can cause gastroenteritis or a syndrome that mimics appendicitis. It is transmitted by undercooked pork, unpasteurized milk, or contaminated water. Several Vibrio Noncholera Vibrio Infections Noncholera vibrios include the gram-negative bacteria Vibrio parahaemolyticus, V. mimicus, V. alginolyticus, V. hollisae, and V. vulnificus; they may cause diarrhea, wound infection, or septicemia... read more species (eg, V. parahaemolyticus) cause diarrhea after ingestion of undercooked seafood. V. cholerae Cholera Cholera is an acute infection of the small bowel by the gram-negative bacterium Vibrio cholerae, which secretes a toxin that causes copious watery diarrhea, leading to dehydration, oliguria... read more sometimes causes severe dehydrating diarrhea in the developing world and is a particular concern after natural disasters or in refugee camps. Listeria Listeriosis Listeriosis is bacteremia, meningitis, cerebritis, dermatitis, an oculoglandular syndrome, intrauterine and neonatal infections, or rarely endocarditis caused by Listeria species. Symptoms vary... read more can rarely cause food-borne gastroenteritis but more often causes bloodstream infection or meningitis in pregnant women, neonates (see Neonatal Listeriosis Neonatal Listeriosis Neonatal listeriosis is acquired transplacentally or during or after delivery. Symptoms are those of sepsis. Diagnosis is by culture or polymerase chain reaction testing of mother and infant... read more ), or the elderly. Aeromonas is acquired from swimming in or drinking contaminated fresh or brackish water. Plesiomonas shigelloides can cause diarrhea in patients who have eaten raw shellfish or traveled to tropical regions of the developing world.

Parasitic gastroenteritis

The parasites most commonly implicated are

Certain intestinal parasites, notably Giardia intestinalis (G. lamblia), adhere to or invade the intestinal mucosa, causing nausea, vomiting, diarrhea, and general malaise. Giardiasis occurs in every region of the US and throughout the world. The infection can become chronic and cause a malabsorption syndrome. It is usually acquired via person-to-person transmission (often in day care centers) or from contaminated water.

Cryptosporidium parvum causes watery diarrhea sometimes accompanied by abdominal cramps, nausea, and vomiting. In healthy people, the illness is self-limited, lasting about 2 weeks. In immunocompromised patients, illness may be severe and prolonged, causing substantial electrolyte and fluid loss. Cryptosporidium is usually acquired through contaminated water. It is not easily killed by chlorine and is the most common cause of recreational waterborne illness in the US, accounting for about three fourths of outbreaks.

Symptoms and Signs of Gastroenteritis

The character and severity of symptoms of gastroenteritis vary. Generally, onset is sudden, with anorexia, nausea, vomiting, abdominal cramps, and diarrhea (with or without blood and mucus). Malaise, myalgias, and prostration may occur. The abdomen may be distended and mildly tender; in severe cases, muscle guarding may be present. Gas-distended intestinal loops may be palpable. Hyperactive bowel sounds are present on auscultation even without diarrhea (an important differential feature from paralytic ileus, in which bowel sounds are absent or decreased). Persistent vomiting and diarrhea can result in intravascular fluid depletion with hypotension and tachycardia. In severe cases, shock, with vascular collapse and oliguric renal failure, occurs.

Viral gastroenteritis

In viral infections, watery diarrhea is the most common symptom; stools rarely contain mucus or blood.

Rotavirus gastroenteritis in infants and young children may last 5 to 7 days. Vomiting occurs in 90% of patients, and fever > 39° C (>102.2° F) occurs in about 30%.

Norovirus typically causes acute onset of vomiting, abdominal cramps, and diarrhea, with symptoms lasting only 1 to 2 days. In children, vomiting is more prominent than diarrhea, whereas in adults, diarrhea usually predominates. Patients may also have fever, headache, and myalgias.

The hallmark of adenovirus gastroenteritis is diarrhea lasting 1 to 2 weeks. Affected infants and children may have mild vomiting that typically starts 1 to 2 days after the onset of diarrhea. Low-grade fever occurs in about 50% of patients. Respiratory symptoms may be present. Symptoms are generally mild but can last longer than with other viral causes of gastroenteritis.

Astrovirus causes a syndrome similar to mild rotavirus infection.

Bacterial gastroenteritis

Parasitic gastroenteritis

Parasitic infections typically cause subacute or chronic diarrhea. Most cause nonbloody diarrhea; an exception is E. histolytica, which causes amebic dysentery (see Amebiasis Amebiasis Amebiasis is infection with Entamoeba histolytica. It is acquired by fecal-oral transmission. Infection is commonly asymptomatic, but symptoms ranging from mild diarrhea to severe dysentery... read more ). Fatigue and weight loss are common when diarrhea is persistent.

Diagnosis of Gastroenteritis

  • Clinical evaluation

  • Stool testing in select cases

Findings suggestive of gastroenteritis include copious, watery diarrhea; ingestion of potentially contaminated food (particularly during a known outbreak), untreated surface water, or a known gastrointestinal irritant; recent travel; or contact with certain animals or similarly ill people.

Recent oral antibiotic use (within 3 months) must raise suspicion for C. difficile infection Clostridioides (formerly Clostridium) difficile–Induced Diarrhea Toxins produced by Clostridioides difficile strains in the gastrointestinal tract cause pseudomembranous colitis, typically after antibiotic use. Symptoms are diarrhea, sometimes bloody, rarely... read more . However, about one fourth of patients with community-associated C. difficile infection do not have a history of recent antibiotic use.

Stool testing

Stool testing is guided by clinical findings and the organisms that are suspected based on patient history and epidemiologic factors (eg, immunosuppression, exposure to a known outbreak, recent travel, recent antibiotic use). Cases are typically stratified into

  • Acute watery diarrhea

  • Subacute or chronic watery diarrhea

  • Acute inflammatory diarrhea

Multiplex polymerase chain reaction platforms that can identify causative organisms in each of these categories are being used more often. However, this testing is expensive, and because the categories are distinguishable clinically, it is usually more cost-effective to test for specific microorganisms depending on the type and duration of diarrhea. In addition, polymerase chain reaction testing does not allow for antibiotic susceptibility testing.

Acute watery diarrhea is probably viral and testing is not indicated unless the diarrhea persists. Although rotavirus and enteric adenovirus infections can be diagnosed using commercially available rapid assays that detect viral antigen in the stool, these assays are rarely indicated.

Acute inflammatory diarrhea with gross blood should also prompt testing specifically for E. coli O157:H7, as should nonbloody diarrhea during a known outbreak. Specific cultures must be requested because this organism is not detected on standard stool culture media. Alternatively, a rapid enzyme assay for the detection of Shiga toxin in stool can be done; a positive test indicates infection with E. coli O157:H7 or one of the other serotypes of enterohemorrhagic E. coli. (NOTE: Shigella species in the US do not produce Shiga toxin.) However, a rapid enzyme assay is not as sensitive as culture. Polymerase chain reaction testing is used to detect Shiga toxin in some centers.

Adults with grossly bloody diarrhea should usually have sigmoidoscopy with cultures and biopsy. Appearance of the colonic mucosa may help diagnose amebic dysentery, shigellosis, and E. coli O157:H7 infection, although ulcerative colitis Diagnosis Ulcerative colitis is a chronic inflammatory and ulcerative disease arising in the colonic mucosa, characterized most often by bloody diarrhea. Extraintestinal symptoms, particularly arthritis... read more Diagnosis may cause similar lesions.

Patients with a history of recent antibiotic use or other risk factors for C. difficile infection (eg, inflammatory bowel disease Overview of Inflammatory Bowel Disease Inflammatory bowel disease (IBD), which includes Crohn disease and ulcerative colitis, is a relapsing and remitting condition characterized by chronic inflammation at various sites in the gastrointestinal... read more , use of proton pump inhibitors) should have a stool assay for C. difficile toxin, but testing should also be done in patients with significant illness even when these risk factors are not present because about 25% of cases of C. difficile infection currently occur in people without identified risk factors. Historically, enzyme immunoassays for toxins A and B were used to diagnose C. difficile infection. However, nucleic acid amplification tests targeting one of the C. difficile toxin genes or their regulator have been shown to have higher sensitivity and are now the diagnostic tests of choice.

General tests

Serum electrolytes, blood urea nitrogen (BUN), and creatinine should be obtained to evaluate hydration and acid-base status in patients who appear seriously ill. Complete blood count (CBC) is nonspecific, although eosinophilia Eosinophilia Eosinophilia is defined as a peripheral blood eosinophil count > 500/mcL (> 0.5 × 109/L). Causes and associated disorders are myriad but often represent an allergic reaction or a parasitic infection... read more Eosinophilia may indicate parasitic infection. Renal function tests and CBC should be done about a week after the start of symptoms in patients with E. coli O157:H7 to detect early-onset hemolytic-uremic syndrome. It is unclear whether this testing is necessary in patients with non–E. coli O157:H7 Shiga toxin infection.

Treatment of Gastroenteritis

  • Oral or IV rehydration

  • Consideration of antidiarrheal agents if C. difficile or E. coli O157:H7 infection is not suspected

  • Antibiotics only in select cases

Supportive treatment is all that is needed for most patients. Bed rest with convenient access to a toilet or bedpan is desirable. Oral glucose-electrolyte solutions, broth, or bouillon may prevent dehydration or treat mild dehydration. Even if vomiting, the patient should take frequent small sips of such fluids; vomiting may abate with volume replacement. For patients with E. coli O157:H7 infection, rehydration with isotonic IV fluids may attenuate the severity of any renal injury should hemolytic-uremic syndrome develop. Children may become dehydrated more quickly and should be given an appropriate rehydration solution (several are available commercially—see Oral Rehydration Oral Rehydration Oral fluid therapy is effective, safe, convenient, and inexpensive compared with IV therapy. Oral fluid therapy is recommended by the American Academy of Pediatrics and the WHO and should be... read more ). Carbonated beverages and sports drinks lack the correct ratio of glucose to sodium and thus are not appropriate, particularly for children < 5 years. If the child is breastfed, breastfeeding should continue. If vomiting is protracted or if severe dehydration is prominent, IV replacement of volume and electrolytes is necessary (see Intravenous Fluid Resuscitation Intravenous Fluid Resuscitation Almost all circulatory shock states require large-volume IV fluid replacement, as does severe intravascular volume depletion (eg, due to diarrhea or heatstroke). Intravascular volume deficiency... read more ).

When the patient can tolerate fluids without vomiting and the appetite has begun to return, food may be gradually restarted. There is no demonstrated benefit from restriction to bland food (eg, cereal, gelatin, bananas, toast). Some patients have temporary lactose intolerance.

Antidiarrheal agents are safe for patients > 2 years with watery diarrhea (as shown by heme-negative stool). However, antidiarrheals may cause deterioration of patients with C. difficile or E. coli O157:H7 infection and thus should not be given to any patient with recent antibiotic use or heme-positive stool, pending specific diagnosis. Effective antidiarrheals include loperamide 4 mg orally initially, followed by 2 mg orally for each subsequent episode of diarrhea (maximum of 6 doses/day or 16 mg/day), or diphenoxylate 2.5 to 5 mg 3 times a day or 4 times a day in tablet or liquid form. For children, loperamide is used. The dose for children 13 to 21 kg is 1 mg after the first loose stool then 1 mg after each subsequent loose stool (maximum dose is 3 mg/day); for children 21 to 28 kg, 2 mg after the first loose stool then 1 mg after each subsequent loose stool (maximum dose is 4 mg/day); and for children 27 to 43 kg, up to age 12, 2 mg after the first loose stool followed by 1 mg after each subsequent loose stool (maximum dose is 6 mg/day).

If vomiting is severe and a surgical condition has been excluded, an antiemetic may be beneficial. Drugs useful in adults include prochlorperazine 5 to 10 mg IV 3 times a day or 4 times a day, or 25 mg rectally 2 times a day and promethazine 12.5 to 25 mg IM 3 times a day or 4 times a day, or 25 to 50 mg rectally 4 times a day. These drugs are usually avoided in children because of lack of demonstrated efficacy and the high incidence of dystonic reactions. Ondansetron is safe and effective in decreasing nausea and vomiting in children and in adults, including those with gastroenteritis, and is available as a standard tablet, oral disintegrating pill, or IV formulation. The dose for adults is 4 or 8 mg orally or IV 3 times a day. For children, the IV dose is 0.15 or 0.3 mg/kg (maximum 16 mg) and the oral dose for children 8 to 15 kg is 2 mg, for children > 15 to 30 kg, 4 mg, and for children > 30 kg, 8 mg. A single dose of ondansetron is usually adequate for children, but if needed the dose may be repeated every 8 hours for 2 more doses; children still vomiting after 24 hours require reevaluation.

Although probiotics appear to briefly shorten the duration of diarrhea, there is insufficient evidence that they affect major clinical outcomes (eg, decrease the need for IV hydration and/or hospitalization) to support their routine use in the treatment or prevention of infectious diarrhea.


Empiric antibiotics are generally not recommended except for certain cases of traveler’s diarrhea Treatment Traveler’s diarrhea is gastroenteritis that is usually caused by bacteria endemic to local water. Symptoms include vomiting and diarrhea. Diagnosis is mainly clinical. Treatment is with ciprofloxacin... read more or when suspicion of Shigella or Campylobacter infection is high (eg, contact with a known case). Otherwise, antibiotics should not be given until stool culture results are known, particularly in children, who have a higher rate of infection with E. coli O157:H7 (antibiotics increase the risk of Hemolytic-uremic syndrome Thrombotic Thrombocytopenic Purpura (TTP) Thrombotic thrombocytopenic purpura (TTP) is an acute, fulminant disorder characterized by thrombocytopenia and microangiopathic hemolytic anemia. Other manifestations may include alterations... read more Thrombotic Thrombocytopenic Purpura (TTP) in patients infected with E. coli O157:H7).

In proven bacterial gastroenteritis, antibiotics are not always required. They do not help with Salmonella and prolong the duration of shedding in the stool. Exceptions include immunocompromised patients, neonates, and patients with Salmonella bacteremia. Antibiotics are also ineffective against toxic gastroenteritis (eg, S. aureus, B. cereus, C. perfringens). Indiscriminate use of antibiotics fosters the emergence of drug-resistant organisms. However, certain infections do require antibiotics (see Table: Selected Oral Antibiotics for Infectious Gastroenteritis* Selected Oral Antibiotics for Infectious Gastroenteritis* Gastroenteritis is inflammation of the lining of the stomach and small and large intestines. Most cases are infectious, although gastroenteritis may occur after ingestion of drugs and chemical... read more ).

Initial management of C. difficile colitis involves stopping the causative antibiotic if possible. The drug of choice to treat C. difficile colitis is oral vancomycin, which is superior to metronidazole. Unfortunately, recurrences occur in about 20% of patients receiving vancomycin. A newer drug, fidaxomicin, may have a slightly lower relapse rate but is expensive and is not approved for use in children. Many centers are using fecal microbial transplantation for patients with multiple recurrences of C. difficile colitis. This treatment has been shown to be safe and effective in adults and children (see Treatment Treatment Toxins produced by Clostridioides difficile strains in the gastrointestinal tract cause pseudomembranous colitis, typically after antibiotic use. Symptoms are diarrhea, sometimes bloody, rarely... read more ).

For cryptosporidiosis, a 3-day course of nitazoxanide may be helpful in immunocompetent patients. The dose is 100 mg orally 2 times a day for children 1 to 3 years, 200 mg orally 2 times a day for children 4 to 11 years, and 500 mg orally 2 times a day for children 12 years and adults. Giardiasis is treated with metronidazole or nitazoxanide.


Prevention of Gastroenteritis

Prevention of infection is complicated by the frequency of asymptomatic infection and the ease with which many agents, particularly viruses, are transmitted from person to person. In general, proper procedures for handling and preparing food must be followed. Travelers Traveler’s Diarrhea Traveler’s diarrhea is gastroenteritis that is usually caused by bacteria endemic to local water. Symptoms include vomiting and diarrhea. Diagnosis is mainly clinical. Treatment is with ciprofloxacin... read more should avoid potentially contaminated food and drink.

To prevent recreational waterborne infections, people should not swim if they have diarrhea. Infants and toddlers should have frequent diaper checks and should be changed in a bathroom and not near the water. Swimmers should avoid swallowing water when they swim.

Infants and other immunocompromised people are particularly predisposed to developing severe cases of salmonellosis and should not be exposed to reptiles, birds, or amphibians, which commonly carry Salmonella.

Breastfeeding affords some protection to neonates and infants. Caregivers should wash their hands thoroughly with soap and water after changing diapers, and diaper-changing areas should be disinfected with a freshly prepared solution of 1:64 household bleach (¼ cup diluted in 1 gallon of water). Children with diarrhea should be excluded from child care facilities for the duration of symptoms. Children infected with enterohemorrhagic E. coli or Shigella should also have two negative stool tests before readmission to the facility.

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