What are the symptoms and treatment options for viral gastroenteritis?

Symptoms of Viral Gastroenteritis

Viral gastroenteritis typically presents with nausea (79%), abdominal cramps (71%), vomiting (69%), and diarrhea (66%) that is never bloody, with symptoms usually lasting 12-60 hours for Norwalk-like viruses and up to 7 days for other viral pathogens. 1

Common Symptoms by Frequency

• Nausea: 79% of cases
• Abdominal cramps: 71% of cases
• Vomiting: 69% of cases
• Diarrhea (non-bloody): 66% of cases
• Headache: 50% of cases
• Fever: 37% of cases
• Chills: 32% of cases
• Muscle aches (myalgias): 26% of cases
• Sore throat: 18% of cases 1

Symptom Patterns by Viral Agent

Norovirus

• Incubation period: 12-48 hours
• Symptoms: Vomiting, diarrhea, abdominal pain, myalgia, low fever
• Duration: 24-72 hours (typically self-limiting)
• Viral shedding: Up to 3 weeks 1, 2

Rotavirus

• Incubation period: 1-3 days
• Symptoms: Diarrhea, vomiting, fever
• Duration: 4-7 days
• Viral shedding: 8-14 days 1, 2

Astrovirus

• Incubation period: 24-36 hours
• Symptoms: Vomiting, diarrhea, fever, abdominal pain
• Duration: 1-4 days 1, 2

Adenovirus

• Incubation period: 3-10 days
• Symptoms: Diarrhea, vomiting
• Duration: ≥1 week 2

Calicivirus

• Incubation period: 1-3 days
• Symptoms: Vomiting, diarrhea
• Duration: Average of 4 days 1, 2

Age-Specific Presentation

• Children: Higher proportion experience vomiting
• Adults: Higher proportion experience diarrhea
• Elderly: May experience more severe symptoms and prolonged duration 1, 2

Warning Signs Requiring Medical Attention

• Symptoms persisting beyond 7 days
• Severe dehydration
• Bloody diarrhea (suggests bacterial rather than viral cause)
• Immunocompromised status
• Severe or worsening symptoms despite appropriate hydration 2

Treatment Approach

1. Oral rehydration therapy (ORT) is the first-line treatment

   • Use oral rehydration solution (ORS) to replace fluids and electrolytes 2

2. Dietary management

   • Continue normal feeding during illness
   • Resume age-appropriate usual diet during or immediately after rehydration
   • Easily digestible foods (bananas, rice, applesauce, toast) may be better tolerated 2

3. Symptomatic treatment

   • Bismuth subsalicylate may reduce duration of Norwalk infection 2
   • Antimotility drugs (e.g., loperamide) should NOT be given to children <18 years and are generally not recommended as they may prolong viral shedding 2
   • Ondansetron may be considered for severe vomiting preventing adequate oral rehydration, particularly in children >4 years 2

Prevention Measures

• Vigorous handwashing with soap and water for at least 20 seconds
• Alcohol-based hand sanitizers (≥70% ethanol) as an adjunct but not substitute for handwashing
• Exclusion of ill staff from food service, childcare, and healthcare settings until 48-72 hours after symptom resolution
• Cleaning and disinfection of contaminated surfaces with chlorine bleach solution or EPA-approved disinfectants 2

Special Considerations

Viral gastroenteritis in immunocompromised individuals may cause:

• Prolonged viral shedding
• More severe disease
• Longer symptom duration
• Higher risk of complications 1, 2

Viral gastroenteritis is generally self-limiting in immunocompetent hosts, with proper hydration being the cornerstone of management.