Updated: 11/18/2018

Rotavirus

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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
  • Symptoms
    • watery diarrhea
    • vomiting
  • Physical exam
    • low-grade fever
    • dehydration
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
  • Management approach
    • mainstay of treatment is supportive care
  • Conservative
    • supportive care
      • indication
        • all patients
      • modalities
        • hydration
        • antiemetics
        • isolation precautions
Complications
  • Shock
  • Intussusception
 

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