Introduction
Background
Rotavirus is one of several viruses known to cause gastroenteritis. The rotavirus genome consists of 11 segments of double-stranded RNA enclosed in a double-shelled capsid. It is classified in the Reoviridae family. Rotavirus is a self-limited infection. Fluid stool losses may be dramatic, and death from dehydration is not uncommon, particularly in developing countries.
Transmission electron micrograph of intact rotavirus particles, double-shelled. Image courtesy of Centers for Disease Control and Prevention and Dr. Erskine Palmer.
Rotavirus infection most commonly strikes during the winter months (December through May), but it occurs year round in developing countries. In the United States every year, rotavirus first appears in the Southwest and spreads to the Northeast.1 Almost every child 5 years and younger at some point will be infected with rotavirus in both developed countries and developing countries.
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. Because these particular cells have a role in the digestion of carbohydrates and in the intestinal absorption of fluid and electrolytes, rotavirus infections lead to malabsorption by impaired hydrolysis of carbohydrates and excessive fluid loss from the intestine. A secretory component of the diarrhea with increased motility can further exacerbate the illness. This increased motility appears to be secondary to virus-induced functional changes at the villus epithelium.
The pathologic changes to the intestinal lining may not correlate well with the clinical manifestations of the illness. In normal hosts, infections rarely occur in another organ system, although extraintestinal infections have been seen in immunocompromised hosts.2
The virus is shed in high titers in the stool starting before the onset of symptoms and persists for up to 10 days after symptom appearance.
Frequency
United States
Before the introduction of the rotavirus vaccines, this virus was estimated to cause 2.7 million diarrheal illnesses each year, with 55,000-70,000 of these requiring hospitalization annually.3,4 In the 1990s and early 2000s, 410,000 office visits and 205,000-272,000 emergency department annual visits were attributed to rotavirus, and this resulted in yearly direct and indirect costs of the illness to be approximately $1 billion.3
International
Worldwide incidence of rotavirus is estimated to cause more than 125 million cases of diarrhea annually. Rotavirus is the foremost cause of childhood dehydrating gastroenteritis worldwide.
Mortality/Morbidity
- Before the introduction of the newer rotavirus vaccines, rotavirus was estimated to cause 20-60 deaths annually in the United States in children younger than 5 years.3,5
- Approximately 527,000 deaths in children younger than 5 years are seen worldwide due to rotavirus.6 Virtually all these deaths occur as a result of hypovolemia.
- Significant morbidity is rare in the United States, but dehydration and shock can result in ischemic injury to the kidneys or the central nervous system.
- Children who become severely dehydrated may develop deep venous thromboses or cerebral venous thromboses.
Race
Race is not a factor in rotavirus infection, but one study did show that there was a reduced risk of hospitalization in infants born from Asian mothers in Washington State.7 Socioeconomic class also plays an important role as this disease is more prevalent among children with Medicaid insurance.7
Sex
Rotavirus affects males and females equally, although males with viral gastroenteritis have been associated with an increased risk of hospitalization compared with females.7
Age
Rotavirus can cause illness in adults and children. However, adults are often asymptomatic or less severely affected.
- Adults, if affected, usually have a few days of nausea, anorexia, and cramping pain.8 Diarrhea is a less significant symptom in adults than in children.
- Young children aged 4-24 months, particularly those in group daycare settings, are at increased risk for acquiring rotavirus.
- Low birth weight and prematurity as well as the paucity of breastfeeding have been associated with hospitalization from rotavirus.9
Clinical
History
- Often, a history of exposure to other children with diarrhea is reported.
- Symptoms usually begin within 2 days of exposure and include the following:
- Anorexia
- Low-grade fever
- Watery, bloodless diarrhea
- Vomiting
- Abdominal cramps
- Stool output can be copious during the diarrheal phase of the illness, and dehydration is a common presenting complaint.
Physical
The physical examination findings for rotavirus infection are often unremarkable except for signs of dehydration.
- The most common finding is hyperactive bowel sounds.
- Rectal examination may stimulate the production of watery, heme-negative stools.
- Tachycardia can be disproportionate to the temperature.
- Sunken eyes and/or anterior fontanelle may be present.
- Dry or sticky-appearing mucosa may be present.
- Rough skin or diarrhea-induced diaper dermatitis may occur.
- Depressed sensorium may be seen.
- Significantly decreased urine output is an important sign. However, it may be hard to identify this in diapered infants because the massive watery stool output makes it difficult to determine the amount of urine output.
- Weight loss can also occur.
Causes
The most significant risk factor for rotavirus infection appears to be participation in group daycare, presumably because the virus is spread through fecal-oral contact by the children themselves and by the daycare workers who are responsible for diapering. Also, fomites serve as important vectors for viral transmission.
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References
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Further Reading
Keywords
rotavirus, rotavirus infection, rotavirus symptoms, rotavirus treatment, rotavirus vaccine, gastroenteritis, contagious virus, infection in children, enteritis, viral infection, diarrheal illness, childhood dehydrating gastroenteritis, severe dehydration, dehydration, fluid loss, diarrhea, Reoviridae, hypovolemia, viral enteritis, rotavirus outbreak, rotavirus genome
