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Detailed information of ROTAVIRUS ENTERITIS
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ROTAVIRUS ENTERITIS
DEFINITION:
A viral infectious disease of the small bowel caused by a dsDNA
reovirus resulting in a cytotoxic diarrhea.
EPIDEMIOLOGY:
- incidence: 15-35% (most common viral cause of enteritis)
- risk factors:
- age: most < 2 years and uncommon > 4 years
- season: winter (80%) and summer (20%)
- route: direct: fecal-oral
- indirect: respiratory droplets
- environ: endemic - usually diarrhea in household Bone marrow
recipients represent a high risk group
- incubation period: 3 days
PATHOGENESIS:
- Rotaviruses are usually transmitted by a fecal-oral route
and symptoms usually appear within 3 days. The rotaviruses
invade the mucosa of the small intestine. These viruses have a
predilection for mature villous cells which are injured and
replaced by immature enterocytes from the crypts. The
replacement of mature villous cells by immature enterocytes
results in the following changes:
- Diarrhea probably results from a combination of factors:
- Rotavirus is subsequently shed during the diarrhea and for
up to 8 days afterwards.
- Rotavirus antibody is found in 70% of 3 year olds.
- Invasion of the jejunum is usual but the infection may
affect the whole small bowel. Gastric and colonic mucosa do not
appear to be affected.
CLINICAL FEATURES:
- two thirds of patients have a history of preceding or
concurrent respiratory illness with rhinorrhea, cough, red
throat, otitis media, and fever
2. Diarrhea
- large and watery
- sudden onset of diarrhea and vomiting usually associated
with fever
- usually lasts for 4-5 days but mild diarrhea may persist up
to 10 days
3. Complications
- chronic diarrhea secondary to disaccharidase deficiency
- dehydration
- encephalitis
- intestinal hemorrhage
- intussusception
- Reyes syndrome
INVESTIGATIONS:
- rotavirus is detected by ELISA, immune electron microscopy (EM)
- content of Na: 30-35 mmol/L
2. Biopsy
- Invasion by rotavirus and loss of villous cells leads to the
typical appearance on biopsy: the mucosa show patchy changes
with shortened villi with viral particles seen on EM in the
endoplasmic reticulum of the enterocytes. The mucosa usually
returns to normal by 4 weeks after infection.
3. Serum
MANAGEMENT:
- oral rehydration fluid (ORF) or intravenous rehydration
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