Rotavirus

Snapshot

A 2-year-old girl presents to the emergency room for diarrhea and abnormal behavior. Her mother reports that she had been having watery diarrhea for the past 2 days with some nonbloody vomiting. Although she has been encouraging the patient to drink more fluids, she has been resistant. Today, the patient is sleepier than usual, and her urine output is also less than usual. On physical exam, she has sunken eyes and dry mucous membranes. She has an episode of diarrhea while in the emergency room. She is given intravenous hydration.

Introduction

Classification
- rotavirus
  - a segmented double-stranded RNA virus
  - a reovirus
  - causes gastroenteritis
  - transmitted via fecal-oral
    - highly contagious
Epidemiology
- incidence
  - high in the winter
- demographics
  - most common in infants and children
- risk factors
  - daycare center
  - kindergarten
  - contact with children
Pathogenesis
- the virus causes gastrointestinal villous atrophy, leading to decreased absorption of sodium and loss of potassium
- this causes a nonbloody diarrhea
Associated conditions
- rotavirus vaccine is associated with intussusception
Prevention
- vaccination
  - live-attenuated vaccine
  - recommended for all infants
  - contraindicated in those with intussusception or severe combined immunodeficiency
Prognosis
- can be fatal in children
- usually resolves within a week

Presentation

Studies

Labs
- stool rotavirus antigen
  - not always needed
Making the diagnosis
- based on clinical presentation
- definitive diagnosis is usually not needed

Differential

Norovirus
- distinguishing factors
  - typically lasts only 1-3 days rather than a week

Treatment

Complications