Abstract
Acute gastroenteritis is one of the most common illnesses seen in children in the USA. It is the most common infectious disease syndromes in humans rivaled only by respiratory tract infections. Five billion cases occur worldwide annually accounting for 15–30 % of all deaths in developing countries [1]. Close to five million cases of gastroenteritis occur annually in the USA alone, with four million cases seen by a healthcare provider [1, 2]. Gastroenteritis (GE) is the single most common disorder seen in the emergency department (ED). It can be the result of infectious agents such as viruses, bacteria, protozoa, or parasitic infections, or as a result of other non-gastrointestinal illness Table 10.1 [2–4]. The vast majority of the cases of GE (60 % of mild cases in children aged 2 months to 2 years, and 80 % of moderate to severe diarrhea) are viral in origin. Proven pathogens include rotavirus (the most common), caliciviruses, astroviruses, enteric adenovirus serotypes 40 and 41 (group F), and some picornaviruses (Aichi virus). A smaller percentage of these cases are bacterial in origin such as those caused by Escherichia coli, Salmonella, Shigella, Vibrio species and Clostridium difficile. Recent advances in public health infrastructure have dramatically reduced the incidence of bacterial and parasitic GE in developing countries with improvements in the treatment and delivery of water [1]. Tragically, viral GE has not demonstrated the same decline.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
World Health Organization. The world health report. Geneva: WHO; 1999.
King CK, Glass R, Bresee JS, Duggan C; Centers for Disease Control and Prevention. Managing acute gastroenteritis among children: oral rehydration, maintenance, and nutritional therapy. MMWR Recomm Rep. 2003;52(RR-16)1–16.
Cohen MB. Etiology and mechanisms of acute infectious diarrhea in infants in the United States. J Pediatr. 1991;118:S34.
Pang XL, Honma S, Nakata S, Vesikari T. Human caliciviruses in acute gastroenteritis of young children in the community. J Infect Dis. 2000;181 Suppl 2:S288.
Castro GA. Fluid and electrolyte absorption. In: Johnson LR, editor. Gastrointestinal physiology. St. Louis: Mosby; 2001. p. 131.
Field M. Intestinal ion transport and the pathophysiology of diarrhea. J Clin Invest. 2003;111:931.
Vanderhoof JA. Chronic diarrhea. Pediatr Rev. 1998;19:418.
Beers MH, Berkow R. The Merck manual of diagnosis and therapy. 18th ed. Whitehouse Station: Merck; 2006 [online] Dysentery http://www.merck.com/mmpe/sec14/ch185/ch185b.html?qt=dysentery&alt=sh.
Binder HJ. Causes of chronic diarrhea. N Engl J Med. 2006;355:236.
Bhutta ZA, Ghishan F, Lindley K, et al. Persistent and chronic diarrhea and malabsorption: Working Group report of the second World Congress of Pediatric Gastroenterology, Hepatology, and Nutrition. J Pediatr Gastroenterol Nutr. 2004;39 Suppl 2:S711.
Gibbons T, Fuchs GJ. Chronic enteropathy: clinical aspects. Nestle Nutr Workshop Ser Pediatr Program. 2007;59:89.
Ochoa TJ, Salazar-Lindo E, Cleary TG. Management of children with infection-associated persistent diarrhea. Semin Pediatr Infect Dis. 2004;15:229.
Finkelstein JA, Schwartz JS, Torrey S, Fleisher GR. Common clinical features as predictors of bacterial diarrhea in infants. Am J Emerg Med. 1989;7:469.
Bonadio WA, Hennes HH, Machi J, Madagame E. Efficacy of measuring BUN in assessing children with dehydration due to gastroenteritis. Ann Emerg Med. 1989;18:755–7.
Mackenzie A, Barnes G, Shann F. Clinical signs of dehydration in children. Lancet. 1989;2:605–7.
Yilmaz K, Karabocuoglu M, Citak A, Uzel N. Evaluation of laboratory tests in dehydrated children with acute gastroenteritis. J Paediatr Child Health. 2002;38:226–8.
Shaoul R, Okev N, Tamir A, Lanir A, Jaffe M. Value of laboratory studies in assessment of dehydration in children. Ann Clin Biochem. 2004;41:192–6.
Gupta DN, Sircar BK, Sengupta PG, et al. Epidemiological and clinical profiles of acute invasive diarrhoea with special reference to mucoid episodes: a rural community-based longitudinal study. Trans R Soc Trop Med Hyg. 1996;90:544.
Dutta P, Mitra U, Saha DR, et al. Mucoid presentation of acute enterocolitis in children: a hospital-based case–control study. Acta Paediatr. 1999;88:822.
Rothrock SG, Skeoch G, Rush JJ, Johnson NE. Clinical features of misdiagnosed appendicitis in children. Ann Emerg Med. 1991;20:45.
Boyce TG, Swerdlow DL, Griffin PM. Escherichia coli O157:H7 and the hemolytic-uremic syndrome. N Engl J Med. 1995;333:364.
Torrey S, Fleisher G, Jaffe D. Incidence of Salmonella bacteremia in infants with Salmonella gastroenteritis. J Pediatr. 1986;108:718.
Ashkenazi S. Shigella infections in children: new insights. Semin Pediatr Infect Dis. 2004;15:246.
Issenman RM, Hewson S, Pirhonen D, et al. Are chronic digestive complaints the result of abnormal dietary patterns? Diet and digestive complaints in children at 22 and 40 months of age. Am J Dis Child. 1987;141:679.
Talley NJ, Zinsmeister AR, Van Dyke C, Melton III LJ. Epidemiology of colonic symptoms and the irritable bowel syndrome. Gastroenterology. 1991;101:927.
Glass RI, Bresee J, Jiang B, et al. Gastroenteritis viruses: an overview. Novartis Found Symp. 2001;238:5.
Guarino A, Albano F, Ashkenazi S, et al. European Society for Paediatric Gastroenterology, Hepatology, and Nutrition/European Society for Paediatric Infectious Diseases evidence-based guidelines for the management of acute gastroenteritis in children in Europe. J Pediatr Gastroenterol Nutr. 2008;46 Suppl 2:S81.
Matson DO, Estes MK. Impact of rotavirus infection at a large pediatric hospital. J Infect Dis. 1990;162:598.
Velázquez FR, Matson DO, Calva JJ, et al. Rotavirus infections in infants as protection against subsequent infections. N Engl J Med. 1996;335:1022.
Doan LT, Okitsu S, Nishio O, et al. Epidemiological features of rotavirus infection among hospitalized children with gastroenteristis in Ho Chi Minh City, Vietnam. J Med Virol. 2003;69:588.
Subekti D, Lesmana M, Tjaniadi P, et al. Incidence of Norwalk-like viruses, rotavirus and adenovirus infection in patients with acute gastroenteritis in Jakarta, Indonesia. FEMS Immunol Med Microbiol. 2002;33:27.
Oh DY, Gaedicke G, Schreier E. Viral agents of acute gastroenteritis in German children: prevalence and molecular diversity. J Med Virol. 2003;71:82.
Jamieson FB, Wang EE, Bain C, et al. Human torovirus: a new nosocomial gastrointestinal pathogen. J Infect Dis. 1998;178:1263.
Yamashita T, Sakae K, Tsuzuki H, et al. Complete nucleotide sequence and genetic organization of Aichi virus, a distinct member of the Picornaviridae associated with acute gastroenteritis in humans. J Virol. 1998;72:8408.
Joki-Korpela P, Hyypiä T. Diagnosis and epidemiology of echovirus 22 infections. Clin Infect Dis. 1998;27:129.
Tucker AW, Haddix AC, Bresee JS, et al. Cost-effectiveness analysis of a rotavirus immunization program for the United States. JAMA. 1998;279:1371.
Ho MS, Glass RI, Pinsky PF, et al. Diarrheal deaths in American children. Are they preventable? JAMA. 1988;260:3281.
Rodriguez WJ, Kim HW, Arrobio JO, et al. Clinical features of acute gastroenteritis associated with human reovirus-like agent in infants and young children. J Pediatr. 1977;91:188.
Staat MA, Azimi PH, Berke T, et al. Clinical presentations of rotavirus infection among hospitalized children. Pediatr Infect Dis J. 2002;21:221.
Konno T, Suzuki H, Imai A, Ishida N. Reovirus-like agent in acute epidemic gastroenteritis in Japanese infants: fecal shedding and serologic response. J Infect Dis. 1977;135:259.
Arias CF, Isa P, Guererro CA, Mendez E, Zárate S, López T, Espinosa R, Romero P, López S. Molecular biology of rotavirus cell entry. Arch Med Res. 2002;33(4):356–61.
Chin J, editor. Control of communicable diseases manual. 17th ed. Washington: American Public Health Association; 2000.
Centers for Disease Control and Prevention (CDC). Preliminary food net data on the incidence of infection with pathogens transmitted commonly through food—10 states, 2009. MMWR Morb Mortal Wkly Rep. 2010;59:418.
American Medical Association, Centers for Disease Control and Prevention, Center for Food Safety and Applied Nutrition, Food and Drug Administration, Food Safety and Inspection Service, US Department of Agriculture. Diagnosis and management of foodborne illnesses: a primer for physicians. MMWR Recomm Rep. 2001;50:1.
Glass RI, Noel J, Ando T, et al. The epidemiology of enteric caliciviruses from humans: a reassessment using new diagnostics. J Infect Dis. 2000;181 Suppl 2:S254.
Acheson D. Campylobacter jejuni infections: update on emerging issues and trends. Clin Infect Dis. 2001;32(8):1201–6.
Nachamkin I, Mishu-Allos B, Ho TW. Campylobacter jejuni infection and the association with Guillain–Barré syndrome. In: NachamkinI BMJ, editor. Campylobacter. 2nd ed. Washington DC: American Society for Microbiology; 2000. p. 155–78.
Zilbauer M, Dorrell N, Wren BW, Bajaj-Elliott M. Campylobacter jejuni-mediated disease pathogenesis: an update. Trans R Soc Trop Med Hyg. 2008;102(2):123–9.
Coburn B, Grassl GA, Finlay BB. Salmonella, the host and disease: a brief review. Immunol Cell Biol. 2007;85(2):112–8.
Grassl GA, Finlay BB. Pathogenesis of enteric Salmonella infections. Curr Opin Gastroenterol. 2008;24(1):22–6.
Chambers HF, McPhee SJ, Papadakis MA, Tierney LM, editors. Current medical diagnosis and treatment. 47th ed. New York: McGraw-Hill; 2008. p. 1250–2.
Weinberger M, Keller N. Recent trends in the epidemiology of non-typhoid Salmonella and antimicrobial resistance: the Israeli experience and worldwide review. Curr Opin Infect Dis. 2005;18(6):513–21.
Boyle EC, Bishop JL, Grassl GA, Finlay BB. Salmonella: from pathogenesis to therapeutics. J Bacteriol. 2007;189(5):1489–95.
Linam WM, Gerber MA. Changing epidemiology and prevention of Salmonella infections. Pediatr Infect Dis J. 2007;26(8):747–8.
Peques DA, Miller SI. Salmonella species, including Salmonella typhi (Chap. 23). In: Mandell GL, Bennett JE, Dolan R, editors. Mandell, Douglas, and Bennett’s principles and practice of infectious disease. 7th ed. Orlando: Elsevier; 2009.
Abubakar I, Irvine L, Aldus CF, et al. A systematic review of the clinical, public health and cost-effectiveness of rapid diagnostic tests for the detection and identification of bacterial intestinal pathogens in faeces and food. Health Technol Assess. 2007;11(36):1–216.
Kappeli U, Hachler H, Giezendanner N, Beutin L, Stephan R. Human infections with Non-O157 Shiga toxin-producing Escherichia coli, Switzerland, 2000–2009. Emerg Infect Dis. 2011;17(2):180–5.
Donnenberg MS, Kaper JB. Enteropathogenic Escherichia coli. Infect Immun. 1992;60(10):3953–61.
DuPont HL. Travellers’ diarrhoea: contemporary approaches to therapy and prevention. Drugs. 2006;66(3):303–14.
Eisenstein BI, Jones GW. The spectrum of infections and pathogenic mechanisms of Escherichia coli. Adv Intern Med. 1988;33:231–52.
Khan WA, Dhar U, Salam MA, et al. Central nervous system manifestations of childhood shigellosis: prevalence, risk factors, and outcome. Pediatrics. 1999;103(2):E18.
Disease Control and Prevention, US Department of Health and Human Services; Nov 2008.
Edwards BH. Salmonella and Shigella species. Clin Lab Med. 1999;19(3):469–87.
Gomez HF, Cleary TG. Shigella species. In: Long SS, Pickering LK, Prober CG, editors. Principles and practice of pediatric infectious diseases. New York: Churchill Livingstone; 1997. p. 429–34.
Niyogi SK. Shigellosis. J Microbiol. 2005;43(2):133–43.
Ochoa TJ, Cleary TG. Shigella. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, editors. Nelson textbook of paediatrics. 18th ed. Philadelphia, PA: Saunders Elsevier; 2007. p. 1191–3.
Sonjai K, Soisangwan R, Sakolvaree Y, Kurazono H, Chongsa-nguan M, Tapchaisri P, Mahakunkijcharoen Y, Nair GB, Hayashi H, Chaicumpa W. Validation of salmonellosis and shigellosis diagnostic test kits at a provincial hospital in Thailand. Asian Pac J Allergy Immunol. 2001;19(2):115–27.
American Academy of Pediatrics. Cholera (Vibrio cholerae). In: Pickering LK, editor. Red Book: 2009 Report of the committee on infectious diseases. 28th ed. American Academy of Pediatrics: Elk Grove Village, IL; 2009. p. 727–9.
Centers for Disease Control and Prevention (CDC). Vibrio illnesses after Hurricane Katrina–multiple states. MMWR Morb Mortal Wkly Rep. 2005;54(37):928–31.
Olsen SJ, MacKinnon LC, Goulding JS, Bean NH, Slutsker L. Surveillance for foodborne-disease outbreaks–United States, 1993–1997. MMWR CDC Surveill Summ. 2000;49(1):1–62.
Brennt CE, Wright AC, Dutta SK. Growth of Vibrio vulnificus in serum from alcoholics: association with high transferrin iron saturation. J Infect Dis. 1991;164(5):1030–2.
Hor LI, Chang TT, Wang ST. Survival of Vibrio vulnificus in whole blood from patients with chronic liver diseases: association with phagocytosis by neutrophils and serum ferritin levels. J Infect Dis. 1999;179(1):275–8.
Miyoshi S, Nakazawa H, Kawata K, Tomochika K, Tobe K, Shinoda S. Characterization of the hemorrhagic reaction caused by Vibrio vulnificus metalloprotease, a member of the thermolysin family. Infect Immun. 1998;66(10):4851–5.
Mead PS, Slutsker L, Dietz V, McCaig LF, Bresee JS, Shapiro C, et al. Food-related illness and death in the United States. Emerg Infect Dis. 1999;5(5):607–25.
Morris JG, Black RE. Cholera and other vibrioses in the United States. N Engl J Med. 1985;312(6):343–50.
Daniels NA, MacKinnon L, Bishop R. Vibrio parahaemolyticus infections in the United States, 1973–1998. J Infect Dis. 2000;181(5):1661–6.
Shapiro RL, Altekruse S, Hutwagner L. The role of Gulf Coast oysters harvested in warmer months in Vibrio vulnificus infections in the United States, 1988–1996. Vibrio Working Group. J Infect Dis Sep. 1998;178(3):752–9.
Anand RG, Lopez FA, deBoisblanc B. Vibrio vulnificus sepsis successfully treated with antibiotics, surgical debridement, and recombinant human activated protein C. J La State Med Soc. 2004;156(3):130–3; quiz 133.
Helms M, Simonsen J, Mølbak K. Foodborne bacterial infection and hospitalization: a registry-based study. Clin Infect Dis. 2006;42(4):498–506.
Zheng H, Sun Y, Lin S, Mao Z, Jiang B. Yersinia enterocolitica infection in diarrheal patients. Eur J Clin Microbiol Infect Dis. 2008;27(8):741–52.
Young VB, Falkow S, Schoolnik GK. The invasin protein of Yersinia enterocolitica: internalization of invasin-bearing bacteria by eukaryotic cells is associated with reorganization of the cytoskeleton. J Cell Biol. 1992;116(1):197–207.
Handley SA, Newberry RD, Miller VL. Yersinia enterocolitica invasin-dependent and invasin-independent mechanisms of systemic dissemination. Infect Immun. 2005;73(12):8453–5.
Bradford WD, Noce PS, Gutman LT. Pathologic features of enteric infection with Yersinia enterocolitica. Arch Pathol. 1974;98(1):17–22.
Cover TL, Aber RC. Yersinia enterocolitica. N Engl J Med. 1989;321(1):16–24.
Guerrant RL, Van Gilder T, Steiner TS, et al. Practice guidelines for the management of infectious diarrhea. Clin Infect Dis. 2001;32(3):331–51.
Nylund CM, Goudie A, Garza JM, Fairbrother G, Cohen MB. Clostridium difficile infection in hospitalized children in the United States. Arch Pediatr Adolesc Med. 2011;165(5):451–7.
Cleary RK. Clostridium difficile-associated diarrhea and colitis: clinical manifestations, diagnosis, and treatment. Dis Colon Rectum. 1998;41(11):1435–49.
Starr J. Clostridium difficile associated diarrhoea: diagnosis and treatment. BMJ. 2005;331(7515):498–501.
Poxton IR, McCoubrey J, Blair G. The pathogenicity of Clostridium difficile. Clin Microbiol Infect. 2001;7:421–7. doi:10.1046/j.1198-743x.2001.00287.x.
Yoder JS, Harral C, Beach MJ. Giardiasis surveillance-United States, 2006–2008. MMWR Surveill Summ. 2010;59(6):15–25.
Thompson RC. Giardiasis as a re-emerging infectious disease and its zoonotic potential. Int J Parasitol. 2000;30(12–13):1259–67.
Welch TP. Risk of giardiasis from consumption of wilderness water in North America: a systematic review of epidemiologic data. Int J Infect Dis. 2000;4(2):100–3.
Scallan E, Hoekstra RM, Angulo FJ, Tauxe RV, Widdowson MA, Roy SL, Jones JL, Griffin PM. Foodborne illness acquired in the United States–major pathogens. Emerg Infect Dis. 2011;17(1):7–15.
Ravdin JI. Amebiasis. Clin Infect Dis. 1995;20:1453–66.
Sturchler D. Parasitic diseases of the small intestinal tract. Baillieres Clin Gastroenterol. 1987;1:397–424.
Stauffer W, Ravdin JI. Entamoeba histolytica: an update. Curr Opin Infect Dis. 2003;16:479–85.
Segarra-Newnham M. Manifestations, diagnosis, and treatment of Strongyloides stercoralis infection. Ann Pharmacother. 2007;41(12):1992–2001.
Ardiç N. An overview of Strongyloides stercoralis and its infections. Mikrobiyol Bul. 2009;43(1):169–77 (Review. Turkish).
Siddiqui AA, Berk SL. Diagnosis of Strongyloides stercoralis infection. Clin Infect Dis. 2001;33(7):1040–7.
Tanowitz HB, Weiss LM, Wittner M. Diagnosis and treatment of common intestinal helminths. II: Common intestinal nematodes. Gastroenterologist. 1994;2(1):39–49.
Albano F, Lo Vecchio A, Guarino A. The applicability and efficacy of guidelines for the management of acute gastroenteritis in outpatient children: a field-reandomized trial on primary care pediatricians. J Pediatr. 2010;156(2):226–30.
Duggan C, Refat M, Hashem M, Wolff M, Fayad I, Santosham M. How valid are clinical signs of dehydration in infants? J Pediatr Gastroenterol Nutr. 1996;22:56–61.
Duggan C, Nurko S. Feeding the gut: the scientific basis for continued enteral nutrition during acute diarrhea. J Pediatr. 1997;131:801–8.
Sandhu BK, European Society of Paediatric Gastroenterology, Hepatology and Nutrition Working Group on Acute Diarrhoea. Rationale for early feeding in childhood gastroenteritis. J Pediatr Gastroenterol Nutr. 2001;33(Suppl2):S13–6.
Nager AL, Wang VJ. Comparison of nasogastric and intravenous methods of rehydration in pediatric patients with acute dehydration. Pediatrics. 2002;109:566–72.
Ho MS, Glass RI, Pinsky PF. Diarrheal deaths in American children. Are they preventable? JAMA. 1988;260:3281–5.
Adrogue HJ, Madias NE. Hypernatremia. N Engl J Med. 2000;342(20):1493–9.
Brown KH, Peerson J, Fontaine O. Use of nonhuman milks in the dietary management of young children with acute diarrhea: a meta-analysis of clinical trials. Pediatrics. 1994;93:17–27.
Burks AW, Vanderhoof JA, Mehra S, Ostrom KM, Baggs G. Randomized clinical trial of soy formula with and without added fiber in antibiotic-induced diarrhea. J Pediatr. 2001;139:578–82.
Isolauri E, Juntunen M, Wiren S, Vuorined P, Koivula T. Intestinal permeability changes in acute gastroenteritis: effects of clinical factors and nutritional management. J Pediatr Gastroenterol Nutr. 1989;8:466–73.
Sachdev HP, Mittal NK, Mittal SK, Yadav H. A controlled trial on utility of oral zinc supplementation in acute dehydrating diarrhea in infants. J Pediatr Gastroenterol Nutr. 1988;7:877–81.
Strand TA, Chandyo RK, Bahl R, et al. Effectiveness and efficacy of zinc for the treatment of acute diarrhea in young children. Pediatrics. 2002;109:898–9003.
Penny ME, Peerson JM, Marin RM, et al. Randomized, community-based trial of the effect of zinc supplementation, with and without other micronutrients, on the duration of persistent childhood diarrhea in Lima, Peru. J Pediatr. 1999;135(2 Pt 1):208–17.
Bahl R, Bhandari N, Saksena M, et al. Efficacy of zinc-fortified oral rehydration solution in 6- to- 35month-old children with acute diarrhea. J Pediatr. 2002;141:677–82.
Gibson GR, Roberfroid MB. Dietary modulation of the human colonic microbiota: introducing the concept of prebiotics. J Nutr. 1995;125:1401–12.
Vanderhoof JA, Young RJ. Use of probiotics in childhood gastrointestinal disorders. J Pediatr Gastroenterol Nutr. 1998;27:323–32.
Guandalini S, Pensabene L, Zikri MA, et al. Lactobacillus GG administered in oral rehydration solution to children with acute diarrhea: a multicenter European trial. J Pediatr Gastroenterol Nutr. 2000;30:54–60.
D’Souza AL, Rajkumar C, Cooke J, Bupitt CJ. Probiotics in prevention of antibiotic associated diarrhea: meta-analysis. BMJ. 2002;324:1361–6.
Duggan C, Penny ME, Hibberd P, et al. Oligofructose-supplemented infant cereal: 2 randomized, blinded, community-based trials in Peruvian infants. Am J Clin Nutr. 2003;77:937–42.
Gilger MA. Pathogenesis of acute diarrhea in children. In: Basow DS, editor. UpToDate. UpToDate: Waltham; 2011.
Fleisher GR. Evaluation of diarrhea in children. In: Basow DS, editor. UpToDate. Waltham: UpToDate; 2011.
Matson DO. Epidemiology, pathogenesis, clinical presentation and diagnosis of viral gastroenteritis in children. In: Basow DS, editor. UpToDate. Waltham: UpToDate; 2011.
Duggan C, Santosham M, Glass RI. The management of acute diarrhea in children: oral rehydration, maintenance, and nutritional therapy. MMWR Recomm Rep. 1992;41(No. RR-16):1–20.
World Health Organization. The treatment of diarrhoea; a manual for physicians and other senior health workers. Geneva: World Health Organization; 1995. Available at http://www.who.int/child-adolescent-health/New_Publications/CHILD_HEALTH/WHO.CDR.95.3.htm
Tarr PI, Gordon CA, Chandler WL. Shiga-toxin-producing Escherichia coli and haemolytic uraemic syndrome. Lancet. 2005;365(9464):1073–86.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2013 Springer Science+Business Media New York
About this chapter
Cite this chapter
del Castillo, S., Catton, K. (2013). Dietary Methods to Treat Acute Gastroenteritis. In: Watson, R., Grimble, G., Preedy, V., Zibadi, S. (eds) Nutrition in Infancy. Nutrition and Health. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-62703-254-4_10
Download citation
DOI: https://doi.org/10.1007/978-1-62703-254-4_10
Published:
Publisher Name: Humana Press, Totowa, NJ
Print ISBN: 978-1-62703-253-7
Online ISBN: 978-1-62703-254-4
eBook Packages: MedicineMedicine (R0)