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Rotavirus Gastroenteritis

By

Jonathan Gotfried

, MD, Lewis Katz School of Medicine at Temple University

Last full review/revision Sep 2021| Content last modified Sep 2021
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Rotavirus is the most common cause of sporadic, severe, dehydrating diarrhea in young children worldwide (peak incidence, 3 to 15 months). Diagnosis is based on clinical suspicion, but polymerase chain reaction testing as part of a multiplex panel for a variety of causes of acute gastroenteritis can be done. Treatment is supportive with oral fluids, but occasionally IV fluids are needed.

Rotavirus incidence has decreased by about 80% in the US since the introduction of routine rotavirus immunization Rotavirus Vaccine The rotavirus vaccine is recommended for infants to protect against gastroenteritis caused by rotavirus disease. For more information, see Rotavirus Advisory Committee on Immunization Practices... read more . Rotavirus is highly contagious; most infections occur by the fecal-oral route. Adults may be infected after close contact with an infected infant. In temperate climates, most infections occur in the winter. Each year in the US, a wave of rotavirus illness begins in the Southwest in November and ends in the Northeast in March. Incubation period is 1 to 3 days.

Symptoms and Signs of Rotavirus Gastroenteritis

Rotavirus gastroenteritis in infants and young children may last 5 to 7 days. Vomiting occurs in 90% of patients, and fever > 39° C (> 102.2° F) occurs in about 30%. Diarrhea is watery and non-bloody. In adults the symptoms of rotavirus gastroenteritis are usually mild. In children, the diarrhea is more likely to cause severe dehydration Dehydration in Children Dehydration is significant depletion of body water and, to varying degrees, electrolytes. Symptoms and signs include thirst, lethargy, dry mucosa, decreased urine output, and, as the degree... read more and even death.

Diagnosis of Rotavirus Gastroenteritis

  • Immune-based assays

  • Polymerase chain reaction (PCR) testing

Diagnostic testing is not routinely done except to diagnose an outbreak; when done, it involves tests to identify rotavirus in the stool. Enzyme-linked immunosorbent assay (ELISA) and latex agglutination are two commonly used tests. Nucleic acid testing (PCR) is very sensitive and is often done in a multiplex PCR panel, including a number of causes of gastroenteritis.

Treatment of Rotavirus Gastroenteritis

  • Oral or IV fluids

  • Sometimes antidiarrheal drugs and/or antiemetics

Supportive care including rehydration with fluids and electrolytes is the mainstay of treatment and is all that is needed for most adults. Oral glucose-electrolyte solutions, broth, or bouillon may prevent dehydration or treat mild dehydration. Children may become dehydrated more quickly and should be given an appropriate rehydration solution (several are available commercially—see Oral Rehydration Oral Rehydration Oral fluid therapy is effective, safe, convenient, and inexpensive compared with IV therapy. Oral fluid therapy is recommended by the American Academy of Pediatrics and the WHO and should be... read more ). An antiemetic (eg, ondansetron) may be given if vomiting makes oral rehydration difficult.

Isotonic IV fluids such as Ringer’s lactate and normal saline solution should be given when there is severe dehydration, shock, or altered mental status and failure of oral rehydration therapy or ileus (see also the Infectious Diseases Society of America's [IDSA] 2017 clinical practice guidelines for the diagnosis and management of infectious diarrhea). In severe dehydration, IV rehydration should be continued until pulse, perfusion, and mental status normalize.

Antidiarrheal agents should not be given to children < 18 years of age with acute diarrhea (see the IDSA guidelines). Antidiarrheals can be considered in adult patients with watery diarrhea (as shown by heme-negative stool), especially during an outbreak, suggesting a viral cause is likely. However, antidiarrheals may cause deterioration of patients with Clostridioides difficile or E. coli O157:H7 infection and thus should not be given to any patients in whom the cause of diarrhea has not been identified and in whom these disorders may be suspected (ie, based on recent antibiotic use, bloody diarrhea, heme-positive stool, or diarrhea with fever).

Prevention of Rotavirus Gastroenteritis

Key Points

  • Rotavirus gastroenteritis has significantly decreased in countries where the rotavirus vaccine is widely used, but it remains a significant cause of serious and potentially fatal diarrheal disease in children worldwide.

  • Clinical course may last 5 to 7 days.

  • Oral rehydration is usually adequate, but antiemetics and sometimes IV fluids may be needed.

  • Antidiarrheals are safe for adults with watery diarrhea but should be avoided in children < 18 years of age and in any patient with recent antibiotic use, bloody diarrhea, heme-positive stool, or diarrhea with fever.

More Information

The following is an English-language resource that may be useful. Please note that THE MANUAL is not responsible for the content of this resource.

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