Tuesday, February 26, 2013

Rotavirus Infection: All You Need To Know




Rotavirus infection is an acute contagious disease of men and animals that is caused by Rotavirus, is passed by a fecal-oral mechanism, and is characterized by the damage of gastro-intestinal tract (as gastroenteritis).

Etiology:  an agent is Rotavirus from Rheoviridae.
 
Epidemiology:
·                     the source of infection is patient or virus carrier;
·                     the mechanism of transmission  is fecal-oral (through the infected water, food, direct contact);
·                     receptivity is high in case of decreased immunity.

Pathogenesis
1. Virus invasion to the thin intestine epithelial cells (enterocytes).
2. Replication of virus and destruction of enterocytes.
3. Increased growth of immature cells.
4. Enzyme insufficiency.
5. Violation of digestion and suction, accumulation of disaccharides.
6. Overabundance of liquid and electrolytes in the intestine.
7. Diarrhea.

Diagnostic criteria

1.     Latent period is 1-4 days.
2.     DVF-syndrome (diarrhea, vomiting, fever):
ü     diarrhea (gastroenteritis, enterocolitis) during 3-6 days stools are «sprinkling», colorless, watery;
ü     Vomits (precedes or appears together with diarrhea) during 1-3 days;
ü     Fever (moderate) - 2-4 days.

Features of Rotavirus infection in new-born
ü     Often is hospital infection.
ü     Acute beginning with the refuse of breast feeding, vomits, diarrhea, development of the dehydration ІІ-ІІІ stage
ü     Possible gradual beginning with growth of degree of dehydration.
Often is lethal.

Confirmation of diagnosis
ü     Virology by immune-electronic microscopy, IEА, diffuses precipitation in a gael.
ü     Serological - NR, CBR, DHAR.
ü     In koprogram - lymphocytes, impaired enzyme intestinal function.

Diagnosis example:
Rota-viral infection typical form, severe degree.
Complication: hypotonic dehydration, 2nd degree.
A differential diagnosis is performed with cholera, salmonellosis, enterotoxigenic escherichiosis; acute intestinal infections caused by relative pathogenic bacteria.


Primary Prophylaxis:
ü     Sanitary disposal of human feces
ü     Protection, purification and boiling of water
ü     Correct preparing and saving of foodstuffs 
ü     Person hygiene

Secondary Prophylaxis
Ill Person
ü     Isolation period –until  the stool culture taken 3 days after stopping treatment is negative
ü     Current and terminal disinfection
ü     Medical supervision for 1-3 mo
Contact children   
Stool culture

For the specific prophylaxis of rotavirus infection there are two vaccines . Both accepted oral and contain a weak living virus of 1-4th types.




References:
Main:      
1.      Ambulatory pediatric care/ edited by Robert A. Derchewitz; - 2nd ed. – Lippincot – Raven, 1992. – p. 404-411, P.425-429.
2.      Current therapy in pediatric infections disease – 2/ edited by John D. Nelson, M.D. – B.C. Decker Inc. Toronto, Philadelphia, 1988. – p.74-77, 80-81.
3.      Principles and Practice of Pediatric Infectious Diseases. / Edited by Saran S. Long, Larry K. Pickering, Charles G. Prober, PhiladelphiaPa: Churchill Livingstone; 1997. – 1921 p.

Additional:
1.                         Cleary TG: Yersinia. In: Behrman RE, Kliegman RM, Jenson HB, eds. Nelson Textbook of Pediatrics. 16th ed. Philadelphia: WB Saunders; 2000: 857-859.
2.                         Pickering L, ed: Yersinia enterocolitica and Yersinia pseudotuberculosis infections. In: Red Book: Report of the Committee on Infectious Diseases. 25th ed. Elk Grove VillageIllAmerican Academy of Pediatrics; 2000: 642-643.
3.                         Textbook of Pediatric Nursing.  Dorothy R. Marlow; R. N., Ed. D. –London, 1989.-661p.
4.                         Pediatrics ( 2nd edition, editor – Paul H.Dworkin, M.D.) – 1992. – 550 pp.
5.                         Behrman R.E., Kliegman R.M., Jenson H.B. Nelson nextbook of Pediatrics. - Saunders. - 2004. - 2618 p.
6.                         Castaneda C. Effects of Saccharomyces boulardii in children with Chronic Diarrhoea, Especially Due to Giardiasis // Revista Mexicana de Puericultura y Pediatria. - 1995. - V. 12. - P. 1462-1464.
7.                         Guidelines for control of shigellosis, icluding epidemics due to Shigella type 1/-World Health Organisation, 2005.
8.                         Implementing the New Recommendation on the Clinical Management of Diarrhoea. - World Health Organisation, 2006.
9.                         Klein J.D., Zaoutis T.E. Pediatric Infectious Disease Secrets. - Philedelphia: Hanley & Belfus Inc, 2003. - P. 142.

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