ROTAVIRUS

MD . Mizanur Rahman
ID: 193-018-061
EPIDEMIOLOGY
o First identified as cause of diarrhea in
1973
o Most common cause of severe diarrhea
in infants and children
o Nearly universal in causing infection
by 5 years of age
o Spreads in settings where many
children are together, such as daycare
centres
o Winter season highly predisposing
o Estimated range 3 - 5 billion infections
o Responsible for up to > 1.0 million
diarrheal deaths each year
 ROTAVIRUS - STRUCTURAL
FEATURES
o Reovirus (RNA)
o 60-80nm in size
o Double stranded (ds) RNA
o Non-enveloped virus
o A rotavirus ha s a characteristic wheel-like appearance
when viewed by electron
microscopy
• The name rotavirus is derived from Latin, meaning "wheel"
o Group A is important human pathogen [7 Groups (A to
G)]
o 5 predominant strains (G l - G 4 , G 9 ), account for
90°/o of isolates
o Strain G1 accounts for 73°/o of infections
CHARACTER
So
The virus is stable in the environment
o Relatively resistant to hand-washing agents
o Susceptible to disinfection
• 95°/o ethanol, 'Lysol', formalin
o Very stable and may remain viable for weeks
or months if not disinfected
TRANSMISSION
o Transmission
• Mainly person to person via fecal-oral
rout e, fomites
• Poor hygiene
o Food and water-borne spread is
possible
o Spread via respiratory route is
speculated

'

I
PATHOGENESIS
o Reservoir Human-GI tract

o Communicability 2 days before to 10

days after onset

o Entry through mouth

o Replication in epithelium of small
intestine
o Viremia uncommon
o Infection leads to isotonic diarrhea
PATHOGENICITY
o The virus infect the villi of the small intestine
• Gastric and colonic mucosa are not infected
o Attach with the enterocytes by VP4
o They multiply in the cytoplasm of the enterocytes
and damage their transport mechanisms
o Damaged cell may show into lumen of the intestine
and release large quantities of virus which appear in
the stool
o Viral excretion usually lasts for 2 - 12
days in otherwise healthy patients
CLINICAL FEATURES
o Incubation period 1-3 days
o Clinical manifestations depend on whether it is the
first infection or reinfection
o Present with
Watery diarrhea (no blood or
leukocytes) Fever, can be high grade
Abdominal pain
Vomiting
Loss of electrolytes and fluids leading to
dehydration May be fatal unless treated
o First infection after age 3 months generally most
severe
• May be asymptomatic or result in severe
dehydrating diarrhea with fever and vomiting
o GI symptoms generally resolve in 3 to 7 days
CLINICAL SYNDROMES
o Asymptomatic carriers
o Childhood gastroenteritis
• Endemic in tropics
• High infectivity
o Outbreaks
• Day care centers
• Hospitals
o Immunocompromised adults
• Severe form of
diarrhea
COMPLICATIONS
o Severe chronic diarrhea
o Dehydration
o Electrolyte imbalance
o Metabolic acidosis
o Immunodeficient children may have
more severe or persistent disease
DIAGNOSIS
o Serology for epidemiologic studies
• Antigen detection in stool
• Antibody detection in serum
o Molecular methods
o Electron Microscopy
o Culture
• Group A Rotaviruses can be cultured in
monkey kidney cells
o Histopathology
 Serology
o Antigen detection in stool
• ELISA, LA (Group A Rotavirus), ICT

o Antibody detection
• ELISA can detect antibodies and establish rise in
titers
o Serology for epidemiologic studies

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 MICROSCOPY (EM)
o Demonstration of Virus in
stool helps in early disease
o Electron Microscopy has
made the identification
simpler
o Non-Group A viruses also
 HISTOPATHOLOGY
o Mature enterocytes lining the tips of
intestinal villi are affected
o Villous atrophy and blunting
o Infiltration of lamina propria
with mononuclear cells
o Death of the mature enterocytes
o Repopulation of the villous tips
with immature secretory cells
• Crypt hyperplasia
TREATMENT
o Treatment of Gastroenteritis is supportive
o Correction of loss of water and electrolytes
remain the goal treatment
o Failure for prompt correction of dehydration leads
to
Acidosis
Shock
Death
o Lesser deaths if effective fluid replacement therapy
is timely initiated
 FLUID REPLACEMENT
o Management consists of replacement of fluids
(ORS) and restoration of Electrolyte balance
o Oral rehydration therapy is highly
effective in reducing morbidity and mortality
o Severe dehydration needs parental administration
of fluids
PREVENTION AND CONTROL
o In view of fecal-oral route of transmission,
• significant control measures are
• Waste water management
• Safe drinking water supplies
• Sanitation

o Basic measures
• Keep your hands clean
• Wash hands often with soap and warm water after using the
toilet, diapering and before preparing or
, - - -
eating food

o Vaccine
 VACCINE
o A live, oral, pentavalent, human-bovine re-
assortant vacci ne
•

o Administered at 2, 4, and 6 months of age

• RotaTeq™
• Rotarix™ Human Animal

,...-::::::.,
o
Re-assortant
Tissue
Culture

Created by genetic re-

assortment of human and
bovine antigens
 COMPONENTS OF CONTROL

Rotavirus Zinc
vacc•ine treatment

Enhanced
Diarrheal
Disease
Control

ORT/
Water/san./ Nutrition/
hygiene breastfeeding
VIRUS TYPES
o Viral gastroenteritis
• Rotavirus
• Caliciviruses (Norovirus)
• Adenovirus
• Astrovirus
• Others (Torovirus, coronavirus,pestivirus)
o Viral colitis
• Cytomegalovirus
VIRAL AGENTS CAUSING
GASTROENTERITIS
Associated with gastroenteritis

• Rotaviruses
•Adenoviruses 4 0 / 4 1
•Caliciviruses
•Norwalk like viruses or SRSV
(Small Round Structured Viruses)
•Astroviruses
•SRV (Small Round Viruses)
•Coronaviruses
•Toroviruses
DIARRHEA
CLASSIFICATION

o Pathophysiology
• Osmotic
• Secretory
• Exudation
• Abnormal motility
o Duration
• Acute ( < 6
weeks)
• Chronic (> 6
weeks)
OSMOTIC DIARRHEA

o Def: Increased amounts of poorly

absorbed, osmotically active solutes in gut
lumen
o Interferes with reabsorption of water
o Solutes are ingested
• magnesium
• sorbitol
• malabsorption of food
o mucosa! injury, lactase deficiency
SECRETORY DIARRHEA
o Excess secretion of electrolytes, fluid across mucosa
o Usually coupled with decrease in absorption
o Watery, high-volume diarrhea with dehydration
o Enterotoxins
• Cholera, E. coli, food poisoning, Rotavirus, Norwalk
.
virus