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Rotavirus

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Topic updated on 11/04/17 10:42am

Snapshot
  • A 2-year old boy in daycare presents to the pediatrician with two-day history of severe watery diarrhea, vomiting, and fevers. While previously healthy, his parents have opted to place him on a delayed vaccination schedule. Per mom, multiple other kids at daycare have had similar symptoms. On exam he is febrile to 39.5 degrees Celsius, listless, pale, and has dry mucous membranes.
Introduction
  • Classification
    • virus
      • RNA
        • double-stranded
          • reovirus
  • Pathogenesis
    • transmission
      • fecal-oral
    • molecular biology
      • replication in epithelium of small intestine
      • destruction and atrophy of intestinal villi
      • leads to ↓ absorption of Na+ and water (isotonic diarrhea)
Diseases
  • Gastroenteritis
    • the most important cause of severe gastroenteritis in infants worldwide
      • leading cause of infant mortality (500,000 diarrheal deaths/year)
      • near universal infection by age 5 
    • acute diarrhea in U.S. during winter months
      • epidemics in daycares, kindergartens
    • symptoms include
      • fever
      • severe dehydrating diarrhea
      • vomiting
    • GI symptoms typically resolve in 3-7 days
    • first infection is typically most severe
    • complications may include
      • dehydration
      • metabolic acidosis
      • persistent disease in immunodeficient children
Laboratory
  • Characteristics
    • RNA
      • double-stranded
      • linear
      • 10-11 segments
    • naked capsid
    • icosahedral
      • double shelled
    • contains polymerase
  • Diagnose with ELISA (stool sample)
Treatment
  • Self-limiting illness
    • IV fluids and electrolytes may be required, depending on the severity of dehydration
  • Vaccine
    • given routinely (oral administration)
      • first dose given at 2 months of age
      • minimum interval between doses is 4 weeks
      • maximum age for any dose is 8 months of age
    • past versions of vaccine associated with intussusception
      • condition where the intestine collapses on itself


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