Rotavirus gastroenteritis is a disease from the group of acute viral diarrhea, occurring with signs of damage to the gastrointestinal and respiratory tract. The course of rotavirus gastroenteritis is characterized by subfebrile or febrile temperature, moderate pharyngeal hyperemia, vomiting, abdominal pain, frequent watery stools up to 5-15 times a day. The diagnosis of rotavirus gastroenteritis is confirmed by PCR analysis of bowel movements and serological examination of blood by ELISA, RSC, RTGA methods. Therapeutic measures for rotavirus gastroenteritis include diet, rehydration, taking enzyme preparations, enterosorbents, antiviral drugs.
Rotavirus gastroenteritis (rotavirus infection) is an acute intestinal infection characterized by diarrheal syndrome, short-term fever and catarrhal phenomena. For its specific symptoms, rotavirus gastroenteritis is often called “small cholera” or “intestinal influenza“. Rotavirus infection is the most common cause of diarrhea in newborns and young children (40%). About 111 million cases of the disease and over 600 thousand deaths from rotavirus gastroenteritis are registered annually in the world. Rotavirus gastroenteritis is second only to ARI in the structure of infectious morbidity. The disease often occurs in the form of family and group outbreaks. These circumstances determine the relevance of rotavirus infection for pediatrics, gastroenterology and infectious diseases.
The infectious pathogen belongs to the genus Rotavirus, the family Reoviridae. The virion has a spherical shape, a two-layer capsid shell, a diameter of 70-75 nm, contains ribonucleic acid. There are 9 serotypes of rotavirus, of which serotypes 1-4, 8 and 9 are pathogenic for humans; the rest cause diarrheal diseases in animals. Rotaviruses remain viable in the external environment for a long time, from 1 to several months (in feces, tap water, vegetables, etc.), relatively resistant to disinfectants.
Virus carriers and patients with rotavirus gastroenteritis pose an epidemic danger to others: the former can secrete the virus for up to several months, the latter are most contagious in the first week of the disease (sometimes up to 20-30 days). Transmission of infection occurs by the fecal-oral mechanism; by food, water, airborne droplets or household. The infecting factors in most cases are tap water, milk and dairy products, vegetables and fruits, toys and household items.
The greatest susceptibility to rotavirus is observed among newborns with an unfavorable premorbid background and those on artificial feeding, as well as children under 3 years of age. It is believed that by the age of 5, 95% of children have had rotavirus gastroenteritis at least once. After a rotavirus infection, a short-term type-specific immunity remains. Rotavirus gastroenteritis often occurs in the form of nosocomial outbreaks in maternity hospitals and children’s hospitals of various profiles, as well as group outbreaks in organized preschool groups. The disease is characterized by spring-winter seasonality.
When they enter the digestive tract, rotaviruses begin to multiply in the enterocytes of the small intestine, causing dystrophy and destruction of the epithelium of the villi. This leads to a violation of the synthesis of disaccharidases and the accumulation of non-cleaved disaccharides in the intestine. Enzyme deficiency is accompanied by a violation of food digestion and water absorption in the large intestine, intestinal hypermotor activity, which ultimately causes the development of osmotic diarrheal syndrome.
Symptoms of rotavirus gastroenteritis unfold after a short incubation period lasting from 15 hours to 3-5 days (on average 1-2 days). Clinical manifestations manifest acutely and reach maximum severity within 12-24 hours. The most characteristic syndrome of rotavirus gastroenteritis is a digestive disorder: acute diarrhea, nausea, vomiting, abdominal pain. Usually vomiting is repeated no more than 3-4 times and only during the first day. The stool becomes more frequent up to 5-15 times a day; with a mild course of rotavirus gastroenteritis, it has a mushy consistency; in severe form, it acquires a watery, foamy character, yellow or yellow-green color, has a sharp sour smell, does not contain pathological impurities (mucus, blood). In some cases, the bowel movements become cloudy, whitish in color and resemble stool in cholera. Diarrhea is accompanied by constant or cramping pains in the epigastric region and in the navel area, rumbling in the abdomen. Manifestations of dehydration in infants are a decrease in body weight and tissue turgor; severe weakness, dizziness, convulsions are possible.
Body temperature in rotavirus gastroenteritis rises to subfebrile or febrile values and is usually maintained for 3-4 days. In 60-70% of patients, respiratory syndrome develops simultaneously with the defeat of the gastrointestinal tract, characterized by hyperemia of the mucous membrane of the soft palate, rhinitis, sore throat, pharyngitis. Changes on the part of the kidneys are usually short-term; they may include albuminuria, microhematuria, cylindruria, oliguria. In some cases, decompensated metabolic acidosis and acute renal failure develop.
The total duration of rotavirus gastroenteritis is 7-10 days. The fever-intoxication syndrome is expressed in the first 2-3 days, the duration of the diarrheal syndrome is 3-6 days, vomiting is noted in the first 2 days. In people with immunodeficiency, including HIV-infected, rotavirus gastroenteritis can be complicated by hemorrhagic gastroenteritis or necrotic enterocolitis.
A combination of epidemiological, clinical and laboratory data allows to confirm the diagnosis of rotavirus gastroenteritis. In favor of viral diarrhea, family or collective outbreaks, winter-spring seasonality, rapid development of symptoms (copious watery stools, paroxysmal abdominal pain, imperative urge to defecate, short-term fever, etc.) testify.
Diagnostic rectoromanoscopy does not reveal any specific changes, except for mild hyperemia and swelling of the intestinal mucosa. The criterion for laboratory diagnosis of rotavirus gastroenteritis is the detection of the pathogen antigen in feces using PCR or RLA. A fourfold increase in the titer of antibodies to rotavirus, detected by ELISA, IFT and HI methods, makes it possible to verify the correctness of the diagnosis only after 2 weeks.
The absence of findings in the bacteriological examination of feces on the intestinal group is the basis for excluding salmonellosis, dysentery, escherichiosis and other intestinal infections. It is also necessary to carry out differential diagnostics with food poisoning, enterovirus infection, yersiniosis, giardiasis, cryptosporidiosis, balantidiasis, cholera.
In mild and moderate cases, treatment of rotavirus gastroenteritis is carried out on an outpatient basis under the supervision of a district pediatrician or an infectious disease specialist; young children and persons with severe exicosis will be hospitalized. In the acute period of rotavirus gastroenteritis, patients are shown rest, a diet with the exclusion of dairy products, restriction of carbohydrates and an increase in protein. The use of enzyme preparations (pancreatin), enterosorbents, probiotics is indicated. Rehydration and detoxification therapy in mild cases is performed orally; in severe cases – parenterally in accordance with the volume of lost fluid. It is recommended to drink tea, fruit drinks, mineral water; intravenous administration of solutions of sodium chloride, potassium chloride, sodium bicarbonate, glucose, etc. Antibacterial drugs for rotavirus gastroenteritis are not indicated; umifenovir, alpha interferon are prescribed as etiotropic therapy.
Prognosis and prevention
The prognosis of the course of rotavirus gastroenteritis is almost always favorable. Extremely rarely, mainly in infants, fatal outcomes are observed due to cardiovascular insufficiency, acute renal failure or the addition of bacterial infection. Preventive measures consist in early detection and isolation of the patient, compliance with the sanitary and hygienic regime in the preschool institution, and final disinfection. For children of the first year of life, the prevention of rotavirus gastroenteritis is breastfeeding. In the older age group, additional vaccination against rotavirus infection is offered.