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Rotavirus Infection

A rotavirus infection is a viral infection by a rotavirus, an RNA virus which belongs to the Reoviridae family. This disease mainly affects children, resulting in gastroenteritis that may be accompanied by systemic manifestations.


Presentation

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
  • 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]
  • 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]
  • KEYWORDS: Antibody; Diarrhea; Immunity; Protection; Rotavirus[ncbi.nlm.nih.gov]
  • CONCLUSIONS: In Democratic Republic of the Congo, 61% of the diarrhea in children in[ncbi.nlm.nih.gov]
  • Abstract Documentation of rotavirus diarrhea in a rural, resource-poor setting is a difficult task.[ncbi.nlm.nih.gov]
Purpura
  • Infantile acute hemorrhagic edema (AHE) is a benign condition characterized by a dramatic onset of inflammatory edema and ecchymotic purpura in a target or cockade pattern.[ncbi.nlm.nih.gov]
  • BACKGROUND Henoch-Schönlein purpura (HSP), a small vessel vasculitis mediated by deposition of immune-complexes containing IgA in the skin, gut, and glomeruli, often presents with abdominal pain, purpuric rash in the lower extremities and buttocks, joint[ncbi.nlm.nih.gov]
Decreased Skin Turgor
  • Dehydrated patients exhibit diminished urine output, decreased skin turgor, and hypotension.[symptoma.com]
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]
Neurologic Manifestation
  • It is known that rotavirus gastroenteritis may be accompanied by neurological manifestations, including encephalitis/encephalopathy and seizures.[ncbi.nlm.nih.gov]

Workup

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]
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]
  • Rotavirus replicates in the cytoplasm of infected cells in unique virus-induced cytoplasmic inclusion bodies called viroplasms (VMs), which are nucleated by two essential viral nonstructural proteins, NSP2 and NSP5.[ncbi.nlm.nih.gov]

Treatment

  • 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]
  • Symptoms such as duration of fever ( p 0.119), frequency of diarrhea ( p 0.119), and frequency of vomiting ( p 0.331) tended to be ameliorated by the probiotic treatment; however, differences were not statistically significant between the two groups.[ncbi.nlm.nih.gov]
  • The developments of specific, potent and accessible antiviral treatments that restrain rotavirus infection remain important to control rotavirus disease.[ncbi.nlm.nih.gov]
  • Treatment of interferon-alpha or ribavirin inhibited viral replication in organoids of both species.[ncbi.nlm.nih.gov]
  • Here, we found sialidase treatment increased cellular GM1 availability and the infectivity of several other human (including RV-3) and animal rotaviruses, typically rendering them susceptible to methyl α-d-N-acetylneuraminide treatment, but did not alter[ncbi.nlm.nih.gov]

Prognosis

  • The disease most commonly targets children but can affect adults who tend to have a worse prognosis.[ncbi.nlm.nih.gov]
  • Both myocardial and hepatic damages presented a temporary feature in the infants and had no significant influence on prognosis. Age, feeding pattern, and central nervous system damage are significant independent prognostic factors for RV infection.[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]

Etiology

  • Appropriate microbiologic investigations are advisable to confirm the possible etiologic role of rotavirus.[ncbi.nlm.nih.gov]
  • According to the data provided by WHO, 180 million diarrheal diseases with rotavirus etiology are registered every year. The aim of this article is to examine of current views on diagnosis and management of rotavirus infection in children.[ncbi.nlm.nih.gov]
  • The murine model of BA supports a viral etiology, because infection of neonatal mice with rhesus rotavirus (RRV) results in biliary obstruction. Viral infection targets the biliary epithelium and development of the model is viral strain dependent.[ncbi.nlm.nih.gov]
  • Etiology Clinical features Diagnostics Differential diagnoses The differential diagnoses listed here are not exhaustive. Treatment Prevention[amboss.com]
  • S 9 , Yori PP 10, 11 , Lima AAM 12 , Bodhidatta L 4, 5 , Svensen E 6 , Bessong P 7 , Ahmed T 8 , Seidman JC 3 , Zaidi AKM 9 , Kosek MN 10, 11 , Guerrant RL 13 , Gratz J 13 , Platts-Mills JA 13 , Lang DR 14 , Gottlieb M 14 , Houpt ER 13 , Kang G 2 ; Etiology[ncbi.nlm.nih.gov]

Epidemiology

  • 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]
  • […] and Intervention Research Unit/London School of Hygiene & Tropical Medicine, Chilumba, Malawi. 5 Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, United States of America. 6 NIHR Health Protection Research Unit[ncbi.nlm.nih.gov]
  • Long-term monitoring will need to continue to assess the effects of rotavirus immunization programs and epidemiologic strain surveillance is necessary to determine whether changes in strain ecology will affect the rotavirus vaccine effectiveness and whether[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]
  • Common epidemiological settings for rotavirus infection among adults include endemic disease, epidemic outbreak, travel-related infection, and disease resulting from child-to-adult transmission.[ncbi.nlm.nih.gov]
Sex distribution
Age distribution

Pathophysiology

  • 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]
  • 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]
  • In this review we intend to familiarise clinicians who primarily provide care for adult patients with the salient features of rotavirus pathophysiology, clinical presentation, epidemiology, treatment, and prevention.[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]

Prevention

  • Viral Disease Control and Prevention, China CDC, Beijing, China.[ncbi.nlm.nih.gov]
  • , Christian Medical College, Vellore, Tamil Nadu 632004, India. 2 National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road, MS-G04, Atlanta, GA 30333, USA.[ncbi.nlm.nih.gov]
  • Exclusive breastfeeding was found to be effective in prevention of Rotavirus infection and in reducing the risk of Rotavirus infection among children (OR   0.62, 95 % CI   0.48-0.81).[ncbi.nlm.nih.gov]
  • CONCLUSIONS: Rotavirus vaccines are effective in preventing rotavirus-diarrhoea in children in Latin America. The vaccines were associated with changes in genotype distribution.[ncbi.nlm.nih.gov]
  • […] research team that described the method as a novel means to prevent and treat viral infection.[medicalxpress.com]

References

Article

  1. Lanata CF, Fischer-Walker CL, Olascoaga AC, Torres CX, Aryee MJ, Black RE. Global causes of diarrheal disease mortality in children <5 years of age: a systematic review. PLoS One. 2013;8:e72788.
  2. Santos VS, Marques DP, Martins-Filho PRS, Cuevas LE, Gurgel RQ. Effectiveness of rotavirus vaccines against rotavirus infection and hospitalization in Latin America: systematic review and meta-analysis. Infect Dis Poverty. 2016; 5: 83.
  3. Diggle L. Rotavirus diarrhoea and future prospects for prevention. Br J Nurs. 2007;16:970–974.
  4. Anderson EJ, Weber SG. Rotavirus infection in adults. Lancet Infect Dis. 2004 Feb;4(2):91-99.
  5. Nishimura S, Ushijima H, Nishimura S, et al. Detection of rotavirus in cerebrospinal fluid and blood of patients with convulsions and gastroenteritis by means of the reverse transcription polymerase chain reaction. Brain Dev. 1993;15:457–459.
  6. Pang XL, Joensuu J, Vesikari T. Detection of rotavirus RNA in cerebrospinal fluid in a case of rotavirus gastroenteritis with febrile seizures. Pediatr Infect Dis J. 1996;15:543–545.
  7. Nigrovic LE, Lumeng C, Landrigan C, Chiang VW. Rotavirus cerebellitis? Clin Infect Dis. 2002;34:130.
  8. Santosham M, Yolken RH, Quiroz E, et al. Detection of rotavirus in respiratory secretions of children with pneumonia. J Pediatr. 1983;103:583–585.
  9. Ruzicka T, Rosendahl C, Braun-Falco O. A probable case of rotavirus exanthem. Arch Dermatol. 1985;121:253–254.
  10. Cortese MM, Parashar UD. Prevention of rotavirus gastroenteritis among infants and children: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 2009;58:1-25.
  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.

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Last updated: 2019-07-11 21:15