• A 2-year old boy in daycare presents to the pediatrician with two-day history of severe watery diarrhea, vomiting, and fevers. While previously healthy, his parents have opted to place him on a delayed vaccination schedule. Per mom, multiple other kids at daycare have had similar symptoms. On exam he is febrile to 39.5 degrees Celsius, listless, pale, and has dry mucous membranes.
  • Classification
    • virus
      • RNA
        • double-stranded
          • reovirus
  • Pathogenesis
    • transmission
      • fecal-oral
    • molecular biology
      • replication in epithelium of small intestine
      • destruction and atrophy of intestinal villi
      • leads to ↓ absorption of Na+ and water (isotonic diarrhea)
  • Gastroenteritis
    • the most important cause of severe gastroenteritis in infants worldwide
      • leading cause of infant mortality (500,000 diarrheal deaths/year)
      • near universal infection by age 5 
    • acute diarrhea in U.S. during winter months
      • epidemics in daycares, kindergartens
    • symptoms include
      • fever
      • severe dehydrating diarrhea
      • vomiting
    • GI symptoms typically resolve in 3-7 days
    • first infection is typically most severe
    • complications may include
      • dehydration
      • metabolic acidosis
      • persistent disease in immunodeficient children
  • Characteristics
    • RNA
      • double-stranded
      • linear
      • 10-11 segments
    • naked capsid
    • icosahedral
      • double shelled
    • contains polymerase
  • Diagnose with ELISA (stool sample)
  • Self-limiting illness
    • IV fluids and electrolytes may be required, depending on the severity of dehydration
  • Vaccine
    • given routinely (oral administration)
      • first dose given at 2 months of age
      • minimum interval between doses is 4 weeks
      • maximum age for any dose is 8 months of age
    • past versions of vaccine associated with intussusception
      • condition where the intestine collapses on itself

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