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].

• Diarrhea

  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. [symptoma.com]

  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]

  Hitherto, factors associated with rotavirus diarrhea have not been reported from Uganda. We found that rotavirus diarrhea accounted for almost half the acute diarrhea hospitalizations in children. [bmcpediatr.biomedcentral.com]

• 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]

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.

• Lymphopenia

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

There is no clear role for drug treatment of viral gastroenteritis. (Antibiotics are used to treat bacterial infections, not viral infections.) It is important that the child is seen by a physician for evaluation and treatment. [healthcentral.com]

Supportive treatment: Do’s and don’ts No specific antiviral treatment is available for rotavirus infection. That said, the do’s and don’ts that follow will help guide your care. [mdedge.com]

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]

Rotavirus diarrhea occurred mostly in winter months and was significantly more frequently associated with respiratory symptoms than were diarrheas with other etiologies. [academic.oup.com]

INTRODUCTION Diarrhea is a leading cause of deaths in children despite the decline in mortality observed over the past few years. 1,2 Rotavirus (RV) is the most important etiological agent of diarrhea in children under five years old, and accounts for [scielo.br]

Publication Expert opinion on rotavirus vaccination in infancy Peer-Reviewed Publication PRECEPT: An evidence assessment framework for infectious disease epidemiology, prevention and control Publication Expert opinion on rotavirus vaccination in infancy [ecdc.europa.eu]

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]

The pathophysiology of a HLH associated encephalopathy was considered to be a local immune response within the CNS, because interferon-gamma can induce the expression of major histocompatibility complex class I and II antigens on glial cells in the CNS [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]

Pathophysiology Rotavirus, like other viruses that cause enteritis, primarily infects the cells of the small intestinal villi, especially those cells near the tips of the villi. [emedicine.medscape.com]

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

Vaccination is the most effective preventive measure and is very effective in preventing severe rotavirus disease in young children and infants. [medicinenet.com]

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