General Characteristics and Epidemiology
Basic features of Rotavirus
- Family: Reoviridae
- Genus: Rotavirus
- RNA virus:
- Double stranded
- Positive- and negative-sense strands
- Segmented (11 segments)
- “Wheel like”
- Non-enveloped virus
- 3-layered icosahedral capsid
- Protein spikes
- Can remain viable for weeks to months in the environment
Rotaviruses causes gastroenteritis.
- Leading cause of acute gastroenteritis in children < 5 years old
- Worldwide distribution
- Children have a more clinically apparent disease than adults.
- More common during winter in temperate climates
Humans are the primary reservoir.
Transmission occurs through the fecal-oral route:
- Ingestion of contaminated food or water
- Contact with contaminated surfaces/fomites
Host risk factors
- Young children
- Individuals who have not been immunized
- Immunocompromised individuals
- Individuals living in long-term care facilities
- Virions penetrate the cells of the small intestinal villi.
- Cholera toxin-like protein production → destruction and blunting of the microvilli → disruption in electrolyte and water absorption
- ↓ Disaccharidase activity → malabsorption of lactose and D-xylose → osmotic influx into the intestine
- Active water secretion and impaired absorption → watery diarrhea
- Virions are shed in feces → allows transmission
- Incubation period < 48 hours
- Duration: 4–5 days
- Abdominal pain
- Can be severe and lead to serious dehydration
Signs of dehydration:
- Dry mucous membranes
- ↓ Urine output
- ↓ Skin turgor
- Sunken eyes
Diagnosis and Management
Rotavirus infections are difficult to distinguish from other diarrheal diseases on the basis of clinical exam alone.
- Lab testing is generally not needed.
- Detection of rotavirus in the stool can be performed (if necessary):
- The disease is self-limiting.
- Symptomatic therapy
- Oral rehydration
- IV fluids in patients with severe dehydration
Live attenuated vaccines have been developed to prevent rotavirus infections:
- Given to all children before 8 months of age
- History of intussusception
- Allergy to vaccine components
- Norovirus: a non-enveloped, positive-sense, ssRNA virus belonging to the Caliciviridae family. Norovirus is a common cause of acute diarrhea worldwide. Transmission is via the fecal-oral route. Patients with norovirus infections present with nausea, vomiting, and diarrhea. The diagnosis is usually based on clinical suspicion. Treatment is symptomatic.
- Campylobacter jejuni: curved, gram-negative bacilli. Common symptoms of infection are fever, headache, severe abdominal pain, myalgias, and diarrhea, which is sometimes bloody. Rarely, patients may exhibit arthritis, endocarditis, or meningitis. The diagnosis can be made with a stool culture. Treatment includes rehydration therapy and antibiotics (e.g., macrolides or fluoroquinolones).
- Shigellosis: an acute bacterial infection of the GI tract caused by the gram-negative Shigella species. Patients develop symptoms of fever, tenesmus, and bloody diarrhea. Shigellosis is diagnosed clinically and confirmed by stool culture. Management can include rehydration therapy and antibiotics (in severe cases or in high-risk patients).
- Non-typhoidal Salmonella: an infection caused by the gram-negative bacilli, S. enteritidis or S. typhimurium. Vomiting, abdominal cramping, fever, and inflammatory diarrhea may be present. Stool cultures can provide the diagnosis. Management is supportive, and antibiotics are only used for systemic manifestations or severe diarrhea.
- Giardiasis: an infection of the intestinal tract caused by Giardia lamblia, a flagellated protozoan. The hallmark symptom of giardiasis is foul-smelling steatorrhea. Patients who develop chronic infections may experience weight loss, failure to thrive, and vitamin deficiencies resulting from malabsorption. The diagnosis is made through the detection of Giardia organisms, antigens, or DNA in the stool. Management includes supportive treatment and antimicrobial therapy with metronidazole, tinidazole, or nitazoxanide.
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