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Detailed information of NORWALK ENTERITIS
NORWALK ENTERITIS
DEFINITION:
A viral infectious disease of the small bowel caused by an RNA
virus resulting in a cytotoxic diarrhea.
EPIDEMIOLOGY:
- incidence: 5-15%
- risk factors:
- age: all ages except young infants, most > 5 years
- season: all year, cold season peak
- route: direct: fecal-oral
- indirect: food, water, oysters, clams; airbourne
- environ: epidemics - schools, camps, cruises, nursing homes
- intubation period: 1-2 days
PATHOGENESIS:
- first identified in 1972 in Norwalk, Ohio
- Norwalk virus is transmitted by a fecal-oral route and
symptoms usually appear within 2 days of exposure. The viruses
invade the mucosa of the proximal small bowel. No gastric or
colonic involvement has been demonstrated. There is no change in
cAMP levels (i.e., no increase in adenylate cyclase levels).
CLINICAL FEATURES:
- mild fever, headache, abdominal pain and myalgias may be
present and last for 12-24 hours
2. Diarrhea
- large watery stools with no cells
- diarrhea lasting only 1-2 days (not prolonged)
- associated with nausea, vomiting, and abdominal cramps
3. Complications
- chronic diarrhea (secondary to disaccharidase deficiency)
- dehydration - severe dehydration is unusual
- malabsorption - fat and D-xylose
INVESTIGATIONS:
- Norwalk viruses detected with immune EM, RIA, and ELISA
2. Biopsy
- Histologically there are patches of broad, blunt villi and
some infiltration with mononuclear cells. EM shows shortening of
the microvilli. These mucosal changes disappear within 2 weeks.
3. Serum
MANAGEMENT:
- oral rehydration fluid (ORF) or intravenous rehydration
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Pediatric Database - NORWALK ENTERITIS
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