Rotavirus is a double-stranded RNA virus, that is categorized under the family of Reoviridae. It is responsible for the onset of severe gastroenteritis, being the primary culprit behind exhausting diarrhea amongst pediatric patients [1] [2].

Typical symptoms associated with a rotavirus infection encompass all the manifestations of acute gastroenteritis, that persists for 3 to 8 days on average. Multiple episodes of diarrhea are accompanied by vomiting, nausea, widespread abdominal pain, and cramping. Bloody diarrhea is not reported as a rotavirus infection-related manifestation. Patients are most commonly children, who may often be febrile and report a decreased appetite and fatigue.

Gastroenteritis that is caused by a rotavirus is usually attributed to the serogroup A rotavirus pathogen [3]. Symptomatology is profound and children run the risk of developing dehydration as a result of massive diarrhea. Dehydrated patients exhibit diminished urine output, decreased skin turgor, and hypotension. Rotavirus infection in infants leads to the same symptoms, including severe diarrhea, vomiting, and fever; dehydration also leads to sunken fontanelles, a decreased production of tears, lethargy, and irritability.

Adults are not frequently infected by rotavirus. When the infection does occur, manifestations vary between a complete absence of complaints and nausea, vomiting, diarrhea, fever, and fatigue [4]. An equally variable is the clinical presentation in immunodeficient adults [4].

Although gastroenteritis is the predominant manifestation of a rotavirus infection, isolated studies have proposed a potential causal association between rotavirus infection and manifestations encompassing epileptic seizures, inflammation of the cerebellum, pneumonia, and rash [5] [6] [7] [8] [9].

• Increased Susceptibility to Infections

  Neonates have an increased susceptibility to infections, particularly those caused by intracellular pathogens, leading to high morbidity and mortality rates. [ncbi.nlm.nih.gov]

• Diarrhea

  Both loperamide and atropine decreased intestinal motility and attenuated diarrhea. Analysis of passage of fluorescent dextran from the intestine into serum indicated unaffected intestinal permeability at the onset of diarrhea (24 to 48 h p.i.). [ncbi.nlm.nih.gov]

• Agalactia

  The bacterial infections included three cases of urinary tract infection (Escherichia coli, n 2; Klebsiella pneumoniae, n 1), and two cases of sepsis complicated with meningitis (all Streptococcus agalactiae). [ncbi.nlm.nih.gov]

• Spastic Quadriplegia

  The neurological symptoms consisted of coma, seizures and spastic quadriplegia. On therapy with steroids, etoposide and cyclosporin A, the patient recovered without any neurological deficits. [ncbi.nlm.nih.gov]

• Neurologic Manifestation

  It is known that rotavirus gastroenteritis may be accompanied by neurological manifestations, including encephalitis/encephalopathy and seizures. [ncbi.nlm.nih.gov]

• Quadriplegia

  The neurological symptoms consisted of coma, seizures and spastic quadriplegia. On therapy with steroids, etoposide and cyclosporin A, the patient recovered without any neurological deficits. [ncbi.nlm.nih.gov]

In order to accurately diagnose a rotavirus infection, a complete medical history is required. Patients are typically in their childhood and present with signs and symptoms consistent with profound gastroenteritis, such as many reported episodes of diarrhea, vomiting, fatigue, and nausea; they may also be dehydrated to a severe extent.

A complete blood count (CBC) and a thorough biochemical profile is the first step towards a successful diagnosis. Leucocytosis and leukocyte type, inflammation markers, and electrolytes levels can help to confirm inflammation and its general origin. The detection of rotavirus is rendered possible through the analysis of a stool sample. Various techniques can be employed towards this aim, including a culture, electron microscopy, latex agglutination, reverse transcriptase polymerase chain reaction (RT-PCR), and an enzyme immunoassay; the latter is the most common method used [10]. Studies have revealed high levels of sensitivity and specificity (over 91%) for an enzyme immunoassay and latex agglutination, although a considerable variability in the results has been reported [11].

In general, despite the fact that a rotavirus infection can be identified by laboratory tests, those tend to be time-consuming and do not contribute to the acute therapeutic plan in an emergency department. Viral detection is carried out for public health or research purposes.

• Pericardial Effusion

  Echocardiography excluded pericardial effusion. Two albumin infusions (1 g/kg) were required to sustain normal serum albumin levels. Over the next 2 weeks, there was gradual normalisation of stools and progressive reduction of oedema. [ncbi.nlm.nih.gov]

• Lymphopenia

  Laboratory examinations showed lymphopenia, hypoproteinemia, hypoalbuminemia, hypogammaglobulinemia, and elevation of alpha-1-antitrypsin (alpha1-AT) clearance. [ncbi.nlm.nih.gov]

• Complement Fixing Antibody

  Thirteen of 15 symptomatic patients who had serum samples, collected during the acute and convalescent phases, tested manifested high titers (greater than or equal to 1:32) of complement-fixing antibody to rotavirus antigen. [ncbi.nlm.nih.gov]

• Colitis

  Forum Medycyny Rodzinnej, 6, 491-498. [ 7 ] De Villiers, F.P. and Driessen, M. (2012) Clinical Neonatal Rotavirus Infection: Association with Necrotizing Entero-colitis. [dx.doi.org]

• Cytoplasmic Inclusion Bodies

  Abstract Rotaviruses, nonenveloped viruses presenting a distinctive triple-layered particle architecture enclosing a segmented double-stranded RNA genome, exhibit a unique morphogenetic pathway requiring the formation of cytoplasmic inclusion bodies called [ncbi.nlm.nih.gov]

Importantly, continuous treatment with MPA for 30 passages did not attenuate its antiviral potency, indicating a high barrier to drug resistance development. [ncbi.nlm.nih.gov]

The disease most commonly targets children but can affect adults who tend to have a worse prognosis. [ncbi.nlm.nih.gov]

Prognosis Most of the infections resolve spontaneously. Dehydration due to severe diarrhea is one of the major complications. [medical-dictionary.thefreedictionary.com]

Appropriate microbiologic investigations are advisable to confirm the possible etiologic role of rotavirus. [ncbi.nlm.nih.gov]

Etiology Clinical features Diagnostics Differential diagnoses The differential diagnoses listed here are not exhaustive. Treatment Prevention [amboss.com]

Our study supported the association between rotavirus infection and the host HBGA phenotypes, which would help further understanding of rotavirus host range and epidemiology. [ncbi.nlm.nih.gov]

Epidemiology References: [1] [2] Epidemiological data refers to the US, unless otherwise specified. Etiology Clinical features Diagnostics Differential diagnoses The differential diagnoses listed here are not exhaustive. Treatment Prevention [amboss.com]

These results demonstrate that HIEs are a novel pathophysiological model that will allow the study of HRV biology, including host restriction, cell type restriction, and virus-induced fluid secretion. [ncbi.nlm.nih.gov]

Despite its significant clinical importance, the pathophysiological mechanisms by which rotavirus induces fluid and electrolyte secretion are still not fully understood. [news-medical.net]

However, much remains to be learned about the epidemiology, transmission and pathophysiology of the virus. [samj.org.za]

Viral Disease Control and Prevention, China CDC, Beijing, China. [ncbi.nlm.nih.gov]

[…] research team that described the method as a novel means to prevent and treat viral infection. [medicalxpress.com]

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11. Ruggeri FM, Marziano ML, Salvatori E, et al. Laboratory diagnosis of rotavirus infection in diarrhoeal patients by immunoenzymatic and latex-agglutination assays. Microbiologica. 1992;15(3):249-257.