Reoviruses Workup

  • Author: Gholamreza Rasouli, MD; Chief Editor: Burke A Cunha, MD   more...
 
Updated: Dec 2, 2011
 

Laboratory Studies

Routine laboratory tests, such as CBC count, electrolytes, and liver profile, may be needed.

  • Reovirus
    • Reoviruses have been shown to replicate in various cell culture types used by laboratories for general viral culture, but these agents are only rarely isolated from clinical samples.
    • Paired acute- and convalescent-phase serum samples can be used to detect seroconversion via hemagglutination inhibition, complement fixation, or virus neutralization.
  • Colorado tick fever
    • Diagnosis of CTF in humans has been established most reliably by isolation of the virus from the erythrocyte fraction of whole blood or by demonstrating the presence of viral antigen in the erythrocytes via the direct fluorescent-antibody technique. The CTF virus has been shown to persist in erythrocytes of patients for as long as 120 days. The virus has been found in cerebrospinal fluid in people with no apparent encephalitis or meningitic involvement. Whole blood specimens shipped unrefrigerated to the laboratory by surface mail are satisfactory for virus isolation. However, virus isolation and identification takes 1-2 weeks from the time of receipt of the specimen. The fluorescent-antibody technique requires special equipment that some laboratories do not possess, and interpretation of the results is subjective.
    • Detection of antibody is also an adequate tool for diagnosing infection with this virus, but dependence on this method has several drawbacks. Various serologic procedures, such as neutralization tests in suckling and weanling mice, tissue culture neutralization, plaque-reduction methods, complement fixation, and direct immunofluorescence, have been used. Complement fixation antibody titers are low usually, and about 25% of infected individuals do not develop a complement fixation antibody response.
    • To demonstrate a diagnostically significant change in antibody titer, sera must be obtained at least 1 week after onset and again 3-4 weeks later. The specific neutralizing and complement fixing antibodies appear in the blood between the eighth and 14th days of the illness; neutralizing antibodies have been demonstrated to be present for many years. Blood from acute- or convalescent-phase samples can be inoculated into suckling mice or susceptible cell cultures (eg, baby hamster kidney [BHK] or Vero cells).
    • PCR techniques have been developed that allow the diagnosis to be established from the first day of symptoms.
  • Rotavirus
    • Rotaviruses are fastidious agents to culture and cannot be detected via routine viral isolation techniques. Most HRVs can be cultivated if pretreated with the proteolytic enzyme trypsin and if low levels of trypsin are included in the tissue culture medium. This cleaves an outer capsid protein and facilitates uncoating.
    • Direct electron microscopy, although the least sensitive technique, affords by far the most rapid method for detecting fecal viruses and has proven to be an especially useful diagnostic and teaching tool when used to test the first available stool sample from acutely ill patients with diarrhea during periods of rotavirus activity.
    • Direct EIA and on-grid immunoelectron microscopy (IEM) techniques are approximately equivalent in sensitivity and reliability. Compared with the conventional electron microscopy method, both techniques are about 9 times more sensitive in detecting purified SA-11 (simian rotavirus) and 3 times more sensitive in detecting HRV in crude stool samples. The IEM technique is presently the best method for detecting all of the known gastroenteritis viruses, especially in rectal swab specimens, but, with most stool specimens, IEM takes hours longer than direct electron microscopy to provide the same diagnostic result.
    • The Rotazyme test is a useful tool in the diagnosis of HRV gastroenteritis. Testing should be performed early in the course of the illness. The maximum number of viral particles is found in the stool of infants in the first few days of illness, especially between the second and fifth days. Excretion generally continues for as long as 8 days, with some reports of excretion as late as 23 days and even later in the immunosuppressed population.
      • Because of the decreasing concentrations of viral particles excreted as the patient improves, testing after 23 days may fail to detect viral antigen. Because rotavirus infects the epithelial cells of small intestinal villi, mucosal gut antibodies are the most reliable indicators of immune response following natural rotavirus infection or rotavirus vaccination.
      • In one study, saliva was used as a marker of intestinal immune response following natural rotavirus diarrhea in infants, the reasoning being that primed immunocompetent cells from the gut migrate to distant mucosal sites where they produce antibodies.[16]
    • Usually, no abnormalities of peripheral white blood cell count or significantly elevated numbers of polymorphonuclear leukocytes or immature forms are found. These cells may have higher alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels.
    • Hypophosphatemia may be present in as many as 50% of cases of rotavirus gastroenteritis. Uric acid levels above 10 mg/dL also can be present. Most patients have mild compensated metabolic acidosis with decreased plasma bicarbonate levels.
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Contributor Information and Disclosures
Author

Gholamreza Rasouli, MD  Fellow, Department of Medicine, Division of Infectious Diseases, Louisiana State University Medical Center at Shreveport

Gholamreza Rasouli, MD is a member of the following medical societies: American College of Physicians-American Society of Internal Medicine and American Medical Association

Disclosure: Nothing to disclose.

Coauthor(s)

John W King, MD  Professor of Medicine, Chief, Section of Infectious Diseases, Director, Viral Therapeutics Clinics for Hepatitis, Louisiana State University Health Sciences Center; Consultant in Infectious Diseases, Overton Brooks Veterans Affairs Medical Center

John W King, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Federation for Medical Research, American Society for Microbiology, Association of Subspecialty Professors, Infectious Diseases Society of America, and Sigma Xi

Disclosure: emedicine $50.00 Author of chapter; MERCK None Other

Specialty Editor Board

Wesley W Emmons, MD, FACP  Assistant Professor, Department of Medicine, Thomas Jefferson University; Consulting Staff, Infectious Diseases Section, Department of Internal Medicine, Christiana Care, Newark, DE

Wesley W Emmons, MD, FACP is a member of the following medical societies: American College of Physicians, American Medical Association, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, and International AIDS Society

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Aaron Glatt, MD  Professor of Clinical Medicine, New York Medical College; President and CEO, Former Chief Medical Officer, Departments of Medicine and Infectious Diseases, St Joseph Hospital (formerly New Island Hospital)

Aaron Glatt, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physician Executives, American College of Physicians, American College of Physicians-American Society of Internal Medicine, American Medical Association, American Society for Microbiology, American Thoracic Society, American Venereal Disease Association, Infectious Diseases Society of America, International AIDS Society, and Society for Healthcare Epidemiology of America

Disclosure: Nothing to disclose.

Eleftherios Mylonakis, MD  Clinical and Research Fellow, Department of Internal Medicine, Division of Infectious Diseases, Massachusetts General Hospital

Eleftherios Mylonakis, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Society for Microbiology, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Chief Editor

Burke A Cunha, MD  Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital

Burke A Cunha, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

References

  1. Hjelt K, Grauballe PC, Henriksen L, Krasilnikoff PA. Rotavirus infections among the staff of a general paediatric department. Acta Paediatr Scand. Jul 1985;74(4):617-8. [Medline].

  2. Philipp CS, Callaway C, Chu MC, Huang GH, Monath TP, Trent D, et al. Replication of Colorado tick fever virus within human hematopoietic progenitor cells. J Virol. Apr 1993;67(4):2389-95. [Medline].

  3. Rosen L, Hovis JF, Mastrota FM. An outbreak of infection with type 1 reovirus among children in an institution. Am J Hyg. 1960;71:266-74.

  4. Tillotson JR, Lerner AM. Reovirus type 3 associated with fatal pneumonia. N Engl J Med. May 11 1967;276(19):1060-3. [Medline].

  5. Joske RA, Keall DD, Leak PJ, Stanley NF, Walters MN. Hepatitis-encephalitis in humans with reovirus infection. Arch Intern Med. Jun 1964;113:811-6. [Medline].

  6. El-Rai FM, Evans AS. Reovirus infections in children and young adults. Arch Environ Health. Dec 1963;7:700-4. [Medline].

  7. Bellum SC, Dove D, Harley RA, Greene WB, Judson MA, London L, et al. Respiratory reovirus 1/L induction of intraluminal fibrosis. A model for the study of bronchiolitis obliterans organizing pneumonia. Am J Pathol. Jun 1997;150(6):2243-54. [Medline].

  8. Joensuu J, Koskenniemi E, Pang XL, Vesikari T. Randomised placebo-controlled trial of rhesus-human reassortant rotavirus vaccine for prevention of severe rotavirus gastroenteritis. Lancet. Oct 25 1997;350(9086):1205-9. [Medline].

  9. Jun HS, Yoon JW. A new look at viruses in type 1 diabetes [reprint]. ILAR J. 2004;45(3):349-74.

  10. Santosham M, Yolken RH, Quiroz E, Dillman L, Oro G, Reeves WC, et al. Detection of rotavirus in respiratory secretions of children with pneumonia. J Pediatr. Oct 1983;103(4):583-5. [Medline].

  11. Yolken R, Murphy M. Sudden infant death syndrome associated with rotavirus infection. J Med Virol. 1982;10(4):291-6. [Medline].

  12. Matsuno S, Utagawa E, Sugiura A. Association of rotavirus infection with Kawasaki syndrome. J Infect Dis. Jul 1983;148(1):177. [Medline].

  13. Vollet JJ, Ericsson CD, Gibson G, Pickering LK, DuPont HL, Kohl S, et al. Human rotavirus in an adult population with travelers' diarrhea and its relationship to the location of food consumption. J Med Virol. 1979;4(2):81-7. [Medline].

  14. Chiappini E, Azzari C, Moriondo M, Galli L, de Martino M. Viraemia is a common finding in immunocompetent children with rotavirus infection. J Med Virol. Jun 2005;76(2):265-7. [Medline].

  15. Wong CJ, Price Z, Bruckner DA. Aseptic meningitis in an infant with rotavirus gastroenteritis. Pediatr Infect Dis. May-Jun 1984;3(3):244-6. [Medline].

  16. Aiyar J, Bhan MK, Bhandari N, Kumar R, Raj P, Sazawal S. Rotavirus-specific antibody response in saliva of infants with rotavirus diarrhea. J Infect Dis. Dec 1990;162(6):1383-4. [Medline].

  17. Centers for Disease Control and Prevention (CDC. Suspension of rotavirus vaccine after reports of intussusception--United States, 1999. MMWR Morb Mortal Wkly Rep. Sep 3 2004;53(34):786-9. [Medline].

  18. Bines JE. Rotavirus vaccines and intussusception risk. Curr Opin Gastroenterol. Jan 2005;21(1):20-5. [Medline].

  19. Yang WQ, Senger DL, Lun XQ, Muzik H, Shi ZQ, Dyck RH, et al. Reovirus as an experimental therapeutic for brain and leptomeningeal metastases from breast cancer. Gene Ther. Nov 2004;11(21):1579-89. [Medline].

  20. Norman KL, Lee PW. Reovirus as a novel oncolytic agent. J Clin Invest. Apr 2000;105(8):1035-8. [Medline].

  21. Clarke P, Debiasi RL, Goody R, Hoyt CC, Richardson-Burns S, Tyler KL. Mechanisms of reovirus-induced cell death and tissue injury: role of apoptosis and virus-induced perturbation of host-cell signaling and transcription factor activation. Viral Immunol. 2005;18(1):89-115. [Medline].

  22. Kim M, Chung YH, Johnson RN. Reovirus and tumor oncolysis. J Microbiol. 06/2007;45(3):187-92. [Medline].

  23. Coulson BS, Grimwood K, Hudson IL, Barnes GL, Bishop RF. Role of coproantibody in clinical protection of children during reinfection with rotavirus. J Clin Microbiol. Jul 1992;30(7):1678-84. [Medline].

  24. Adelberg EA, Brooks GF, Jawetz E, et al. Medical Microbiology. 19th ed. Norwalk, Conn: Appleton & Lange; 1991:460-468.

  25. Andersen RD, Entringer MA, Robinson WA. Virus-induced leukopenia: Colorado tick fever as a human model. J Infect Dis. Mar 1985;151(3):449-53. [Medline].

  26. Anderson EJ, Weber SG. Rotavirus infection in adults. Lancet Infect Dis. Feb 2004;4(2):91-9. [Medline].

  27. Armstrong D, Cohen J. Infectious Diseases. Vol 2. St. Louis, Mo: Mosby Inc; 1999.

  28. Bishop RF, Barnes GL, Cipriani E, Lund JS. Clinical immunity after neonatal rotavirus infection. A prospective longitudinal study in young children. N Engl J Med. Jul 14 1983;309(2):72-6. [Medline].

  29. Brandt CD, Kim HW, Rodriguez WJ, Thomas L, Yolken RH, Arrobio JO, et al. Comparison of direct electron microscopy, immune electron microscopy, and rotavirus enzyme-linked immunosorbent assay for detection of gastroenteritis viruses in children. J Clin Microbiol. May 1981;13(5):976-81. [Medline].

  30. Burgdorfer W. Tick-borne diseases in the United States: Rocky Mountain spotted fever and Colorado tick fever. A review. Acta Trop. Jun 1977;34(2):103-26. [Medline].

  31. Carr ME, McKendrick GD, Spyridakis T. The clinical features of infantile gastroenteritis due to rotavirus. Scand J Infect Dis. 1976;8(4):241-3. [Medline].

  32. Champsaur H, Questiaux E, Prevot J, Henry-Amar M, Goldszmidt D, Bourjouane M, et al. Rotavirus carriage, asymptomatic infection, and disease in the first two years of life. I. Virus shedding. J Infect Dis. May 1984;149(5):667-74. [Medline].

  33. Christy C, Madore HP, Pichichero ME, Gala C, Pincus P, Vosefski D, et al. Field trial of rhesus rotavirus vaccine in infants. Pediatr Infect Dis J. Sep 1988;7(9):645-50. [Medline].

  34. Chua KB, Voon K, Yu M, Keniscope C, Abdul Rasid K, Wang LF. Investigation of a potential zoonotic transmission of orthoreovirus associated with acute influenza-like illness in an adult patient. PLoS One. 2011;6(10):e25434. [Medline]. [Full Text].

  35. Clark HF, Offit PA. Vaccines for rotavirus gastroenteritis universally needed for infants. Pediatr Ann. Aug 2004;33(8):536-43. [Medline].

  36. Davidson GP, Hogg RJ, Kirubakaran CP. Serum and intestinal immune response to rotavirus enteritis in children. Infect Immun. May 1983;40(2):447-52. [Medline].

  37. Elliott EJ, Dalby-Payne JR. 2. Acute infectious diarrhoea and dehydration in children. Med J Aust. Nov 15 2004;181(10):565-70. [Medline].

  38. Emmons RW, Lennette EH. Immunofluorescent staining in the laboratory diagnosis of Colorado tick fever. J Lab Clin Med. Dec 1966;68(6):923-9. [Medline].

  39. Feigin RD, Cherry JD. In: Textbook of Pediatric Infectious Diseases. Vol 2. Philadelphia, Pa: WB Saunders Co; 1998:1897-1922.

  40. Fraser CH, Schiff DW. Colorado Tick Fever Encephalitis. Pediatrics. 1962;29:187-190.

  41. Gorbach SL, Bartlett JG, Neil RB. Infectious Diseases. 2nd ed. Philadelphia, Pa: WB Saunders Co; 1998:2193-9.

  42. Gothefors L, Wadell G, Juto P, Taniguchi K, Kapikian AZ, Glass RI. Prolonged efficacy of rhesus rotavirus vaccine in Swedish children. J Infect Dis. Apr 1989;159(4):753-7. [Medline].

  43. Gouvea V, Glass RI, Woods P, Taniguchi K, Clark HF, Forrester B, et al. Polymerase chain reaction amplification and typing of rotavirus nucleic acid from stool specimens. J Clin Microbiol. Feb 1990;28(2):276-82. [Medline].

  44. Grimwood K, Lund JC, Coulson BS, Hudson IL, Bishop RF, Barnes GL. Comparison of serum and mucosal antibody responses following severe acute rotavirus gastroenteritis in young children. J Clin Microbiol. Apr 1988;26(4):732-8. [Medline].

  45. Johnson AJ, Karabatsos N, Lanciotti RS. Detection of Colorado tick fever virus by using reverse transcriptase PCR and application of the technique in laboratory diagnosis. J Clin Microbiol. May 1997;35(5):1203-8. [Medline].

  46. Kapikian AZ, Kim HW, Wyatt RG, Cline WL, Arrobio JO, Brandt CD, et al. Human reovirus-like agent as the major pathogen associated with "winter" gastroenteritis in hospitalized infants and young children. N Engl J Med. Apr 29 1976;294(18):965-72. [Medline].

  47. Klasco R. Colorado tick fever. Med Clin North Am. Mar 2002;86(2):435-40, ix. [Medline].

  48. Kovacs A, Chan L, Hotrakitya C, Overturf G, Portnoy B. Rotavirus gastroenteritis. Clinical and laboratory features and use of the Rotazyme test. Am J Dis Child. Feb 1987;141(2):161-6. [Medline].

  49. Lane RS, Emmons RW, Devlin V, Dondero DV, Nelson BC. Survey for evidence of Colorado tick fever virus outside of the known endemic area in California. Am J Trop Med Hyg. Jul 1982;31(4):837-43. [Medline].

  50. Lerner AM, Cherry JD, Klein JO, Finland M. Infections with reoviruses. N Engl J Med. Nov 8 1962;267:947-52. [Medline].

  51. Madore HP, Christy C, Pichichero M, Long C, Pincus P, Vosefsky D, et al. Field trial of rhesus rotavirus or human-rhesus rotavirus reassortant vaccine of VP7 serotype 3 or 1 specificity in infants. The Elmwood, Panorama, and Westfall Pediatric Groups. J Infect Dis. Aug 1992;166(2):235-43. [Medline].

  52. Major AS, Rubin DH, Cuff CF. Mucosal immunity to reovirus infection. Curr Top Microbiol Immunol. 1998;233 Reovir.ii:163-77. [Medline].

  53. Mandell GL, Bennett JE, Dolin R. Principles and Practice of Infectious Diseases. Vol 2. St. Louis, Mo:. Mosby;2000:1693-1703.

  54. Matson DO, O'Ryan ML, Herrera I, Pickering LK, Estes MK. Fecal antibody responses to symptomatic and asymptomatic rotavirus infections. J Infect Dis. Mar 1993;167(3):577-83. [Medline].

  55. McLean RG, Shriner RB, Pokorny KS, Bowen GS. The ecology of Colorado tick fever in Rocky Mountain National Park in 1974. III. Habitats supporting the virus. Am J Trop Med Hyg. Jan 1989;40(1):86-93. [Medline].

  56. Meurman OH, Laine MJ. Rotavirus epidemic in adults. N Engl J Med. Jun 2 1977;296(22):1298-9. [Medline].

  57. Perez-Schael I, Garcia D, Gonzalez M, Gonzalez R, Daoud N, Perez M, et al. Prospective study of diarrheal diseases in Venezuelan children to evaluate the efficacy of rhesus rotavirus vaccine. J Med Virol. Mar 1990;30(3):219-29. [Medline].

  58. Perez-Schael I, Guntinas MJ, Perez M, Pagone V, Rojas AM, Gonzalez R, et al. Efficacy of the rhesus rotavirus-based quadrivalent vaccine in infants and young children in Venezuela. N Engl J Med. Oct 23 1997;337(17):1181-7. [Medline].

  59. Riepenhoff-Talty M, Bogger-Goren S, Li P, Carmody PJ, Barrett HJ, Ogra PL. Development of serum and intestinal antibody response to rotavirus after naturally acquired rotavirus infection in man. J Med Virol. 1981;8(3):215-22. [Medline].

  60. Rubenstein AS, Miller MF. Comparison of an enzyme immunoassay with electron microscopic procedures for detecting rotavirus. J Clin Microbiol. May 1982;15(5):938-44. [Medline].

  61. [Best Evidence] Ruiz-Palacios GM, Pérez-Schael I, Velázquez FR, Abate H, Breuer T, Clemens SC, et al. Safety and efficacy of an attenuated vaccine against severe rotavirus gastroenteritis. N Engl J Med. Jan 5 2006;354(1):11-22. [Medline].

  62. Salmi TT, Arstila P, Koivikko A. Central nervous system involvement in patients with rotavirus gastroenteritis. Scand J Infect Dis. 1978;10(1):29-31. [Medline].

  63. Silver HK, Meiklejohn G, Kempe CH. Colorado Tick Fever. Am J Dis Child. 1961;101:56-62.

  64. Snyder JD, Merson MH. The magnitude of the global problem of acute diarrhoeal disease: a review of active surveillance data. Bull World Health Organ. 1982;60(4):605-13. [Medline].

  65. Spruance SL, Bailey A. Colorado Tick Fever. A review of 115 laboratory confirmed cases. Arch Intern Med. Feb 1973;131(2):288-93. [Medline].

  66. Tallett S, MacKenzie C, Middleton P, Kerzner B, Hamilton R. Clinical, laboratory, and epidemiologic features of a viral gastroenteritis in infants and children. Pediatrics. Aug 1977;60(2):217-22. [Medline].

  67. Tyler KL. Pathogenesis of reovirus infections of the central nervous system. Curr Top Microbiol Immunol. 1998;233 Reovir.ii:93-124. [Medline].

  68. Tyler KL, Sokol RJ, Oberhaus SM, Le M, Karrer FM, Narkewicz MR, et al. Detection of reovirus RNA in hepatobiliary tissues from patients with extrahepatic biliary atresia and choledochal cysts. Hepatology. Jun 1998;27(6):1475-82. [Medline].

  69. Virgin HW, Dermody TS, Tyler KL. Cellular and humoral immunity to reovirus infection. Curr Top Microbiol Immunol. 1998;233(Pt 2):147-61. [Medline].

  70. Walsh JA, Warren KS. Selective primary health care: an interim strategy for disease control in developing countries. N Engl J Med. Nov 1 1979;301(18):967-74. [Medline].

  71. Walther FJ, Bruggeman C, Daniels-Bosman MS, Pourier S, Grauls G, Stals F, et al. Symptomatic and asymptomatic rotavirus infections in hospitalized children. Acta Paediatr Scand. Sep 1983;72(5):659-63. [Medline].

  72. Widdowson MA, Bresee JS, Gentsch JR, Glass RI. Rotavirus disease and its prevention. Curr Opin Gastroenterol. Jan 2005;21(1):26-31. [Medline].

  73. Wright PF, Tajima T, Thompson J, Kokubun K, Kapikian A, Karzon DT. Candidate rotavirus vaccine (rhesus rotavirus strain) in children: an evaluation. Pediatrics. Oct 1987;80(4):473-80. [Medline].

 
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