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Viral diarrhea still represents a major threat to childhood health, worldwide. It has an immense, but distinct, impact in poor and rich countries, being responsible for a substantial number of deaths in the former and of heavy money loss in the latter. Rotavirus is the leading agent and its pathophysiology involves multiple mechanisms, several of which are triggered by NSP4 entero-toxin. Diarrhea is the hallmark of viral diarrhea and is usually self-limiting. However, it may run a severe course and have a fatal outcome in children with malnutrition or immune impairment and in those who have no access to rehydration. Diagnosis is usually based on clinical grounds, and investigations are not necessary. Treatment is based on carbohydrate and electrolyte solution administered through the oral or parenteral route. Selected probiotics may be effective in reducing the duration of symptoms, whereas, in severe cases in which rotavirus is involved, oral administration of human serum immunoglobulin may be effective. Efforts towards vaccine development have been hampered by withdrawal of anti-rotavirus vaccine, because of its association with intussusception, but novel vaccines are currently under investigation.


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