Rotavirus disease (rotavirus gastroenteritis) is an acute viral infection that mainly affects babies, characterized by symptoms of gastroenteritis and dehydration.
Rotaviruses are one of the leading causative agents of diarrhea in babies, often in the first 2 years of life. In developing countries, they are considered the main cause of death from diarrhea. Diseases of rotavirus infection are registered in all parts of the world, including in our country. Especially often rotavirus diarrhea occurs in babies of the second half of the year and the second year of life. Usually, by the age of 3-5, children already have immunity to this infection due to the fact that they had previously had a rotavirus infection that proceeded with varying degrees of severity, from mild, erased to extremely severe. Despite the prevalence of rotavirus infection, various incidence rates are known. The latter is more likely to be associated with the probabilities of the laboratory test used to detect the pathogen.
The source and reservoir of infection is only man. The causative agent is excreted with feces (up to 10 viral particles are found in 1 g of feces) for up to 3 weeks (usually 7-8 days from the onset of the disease).
Infection occurs by the fecal-oral route. The airborne mechanism of infection transmission has not been proven. In tropical countries, rotavirus infection occurs all year round with some increase in incidence during the cool rainy season. In states with a temperate climate, seasonality is quite pronounced with the highest incidence in the winter months. A person becomes infected through the alimentary route.
Reproduction and accumulation of reovirus occurs in the upper gastrointestinal tract, in particular in the epithelium of the duodenum. The absence of severe fever and symptoms of general intoxication (in the absence of information about viremia) suggests that the hematogenous route of spread of rotaviruses is not significant. Rotaviruses kill mature cells in the small intestine and are replaced by immature absorptive cells unable to adequately absorb carbohydrates and other nutrients, resulting in osmotic diarrhea.
The incubation period lasts from 15 hours to 7 days (usually 1-2 days). The disease begins acutely. A detailed picture of the disease is formed within 12-24 hours from the onset of the disease. Most hospitalized babies have a body temperature of 37.9°C or more, and some can rise to 39°C or more. In mild forms of the disease, both in adults and in children, there is no pronounced fever. Patients report pain in the epigastric region, nausea, vomiting. On examination, hyperemia of the pharynx, signs of rhinitis, and an increase in cervical lymph nodes are not often noted. However, the most typical manifestations of the disease are the symptoms of lesions of the digestive system.
Abundant liquid watery stools without admixture of mucus and blood are characteristic. A more severe course is traditionally due to the layering of a secondary infection. Half of the patients vomit. In adult cases, against the background of moderately severe intoxication and subfebrile temperature, pain in the epigastric region, vomiting and diarrhea are found. Only in some patients, vomiting is repeated on the 2-3rd day of the disease. In adults, hyperemia and granularity of the mucous membrane of the soft palate, palatine arches, uvula are not often detected, as well as hyperemia of the sclera. Signs of general intoxication are observed only in 10% of the total number of patients, they are weakly expressed.
Large loose stools can lead to dehydration. Dehydration develops quite often (in 75-85% of hospitalized babies), but in the majority of cases (in 95%) it is not pronounced (I and II degrees of dehydration according to V. I. Pokrovsky). Only in some cases develops severe dehydration with decompensated metabolic acidosis. In these cases, acute renal failure and hemodynamic disorders are possible.
On palpation of the abdomen, pain in the epigastric and umbilical regions, rough rumbling in the right iliac region are noted. The liver and spleen are not enlarged. During sigmoidoscopy, most patients have no changes, only some patients have moderate hyperemia and swelling of the mucous membrane of the rectum and sigmoid colon. Signs of damage to the digestive organs persist for 2-6 days.
The amount of urine in the acute period of the disease is reduced, in some patients there is albuminuria, leukocytes and erythrocytes in the urine, an increase in the content of residual nitrogen in the blood serum. At the beginning of the disease, there may be leukocytosis, which in the period of peak is replaced by leukopenia. ESR is not changed.
When recognizing, the clinical symptoms of the disease and epidemiological conditions are taken into account. Characterized by an acute onset, copious watery stools without pathological impurities with a frequency of up to 10-15 times a day, vomiting, dehydration with a moderately severe temperature reaction and symptoms of general intoxication. The winter seasonality of the disease, the group nature, and the absence of positive findings in conventional bacteriological studies for the intestinal group of viruses are important.
The diagnosis is confirmed by the detection of rotaviruses in feces by various methods (immunofluorescence, etc.). Less important are serological methods (RSK, etc.). For examination, feces are collected with a sterile wooden spatula in a penicillin vial (1/4 of the vial), the rubber stopper is fixed with adhesive tape, and delivered to the laboratory in containers with ice.
There are no specific and etiotropic products. The basis is pathogenetic methods of treatment, primarily the restoration of fluid and electrolyte losses. With dehydration I or II degree, a glucose electrolyte solution is administered orally. According to WHO recommendations, the following solution is used: sodium chloride – 3.5 g, potassium chloride – 1.5 g, sodium bicarbonate – 2.5 g, glucose – 20 g per 1 liter of drinking water. An adult patient is allowed to drink the solution in small doses (30-100 ml) after 5-10 minutes. You can give Ringer’s solution with the addition of 20 g of glucose per 1 liter of solution, also solution 5, 4, 1 (5 g of sodium chloride, 4 g of sodium bicarbonate, 1 g of potassium chloride per 1 liter of water) with the addition of glucose. In addition to solutions, other liquids are given (tea, fruit drink, mineral water). The amount of fluid depends on the degree of dehydration and is controlled by clinical data, upon reaching rehydration, replenishment of body fluid is carried out in accordance with the amount of fluid lost (volume of stool, vomit). In severe degrees of dehydration, rehydration is carried out by intravenous administration of solutions (see Cholera).
In babies under the age of 1.5 years, the water and electrolyte balance is restored by oral administration of 400 ml of a solution (recommended by WHO) and 200 ml of water in separate sips. When normal skin turgor is restored, the introduction of the solution is stopped and milk is given, diluted in half with water, 200 ml each, after 4-5 hours.
When prescribing a diet for adults, it will be necessary to exclude milk and dairy products and limit carbohydrates. Polyenzyme products (mexase, etc.), also pancreatin are shown. Antibiotics are not indicated, as they can cause dysbacteriosis.