Rotavirus symptoms

August 12, 2017 17:50 | Symptoms Of Disease

Rotavirus - an acute intestinal disease caused by rotavirus, characterized by lesions of the gastrointestinal tract by type of gastroenteritis. This infection in recent years has increased significantly among acute intestinal infectio

ns of viral nature.The use of modern techniques allows us to prove the role of viral agents in the development of OCI (acute intestinal infection) in 50-60% of children.

In the structure of viral diarrhea dominated rotavirus gastroenteritis , which are registered in 35-40% of patients, and in children aged up to three years, their frequency is higher than 60%.Noroviruses cause acute intestinal infections in 18-20% of children, adenoviruses - 10%.The prevalence of other viruses (astroviruses, salovirusy, caliciviruses) is much lower - from 0.3 to 3%.

Viral agents OCI dominate in all seasons.But the most frequent rotavirus detectable ™ in the winter and spring months.In autumn most distinguished noroviruses that cause up to 1/4 of all cases of acute intestinal infections registered in this time of year.The incidence of adenocarcinoma and less susceptible to infections astroviral significant fluctuations during the year.

Etiology .Rotavirus is one of the etiologic agents of diarrhea in children and young animals, including calves, pigs, mice, rabbits, deer, sheep, monkeys.

Name "rotaviruses» (rota - wheel) based on electron microscopic image of the outer edge of the capsid in the shape of a wheel rim surrounding the radial spokes emanating from the inner core.Viral particles sizes - 65-75 nm.Contains RNA and the hemagglutinin glycoprotein.

Rotaviruses are relatively stable.Resistant to physical and chemical factors.

in feces at room temperature to preserve properties of infectious 7 months, which is lost when the temperature warming to 50 ° C and above, during freezing, treatment with surfactants.Infectivity increases during processing by proteolytic enzymes (pancreatin, trypsin).

experimentally established the existence of cross-species infection, but in vivo infection with this data available.Infected animals develop human rotavirus causes diarrhea in newborn animals (pigs, monkeys).

Rotavirus penetrates and infects enterocytes in the villi of the small intestine.It replicates in the cytoplasm, damaging the suction cells, leading ultimately to a violation of the digestive function of the intestine.Lysis of infected cells promotes virus yield in the intestinal lumen, leading to accumulation of its large amount of feces.

Diarrhea associated with absorption disorders including malabsorption of glucose and sodium.High-grade suction cells of the villi are replaced by immature cells of the crypts, unable to immediately compensate malabsorption process.

source and reservoir of infection is the only person (patient or carrier).The patient selects the pathogen into the environment for 2-3 weeks.For children, the source of infection are mostly adults.Carriage recorded as in children, including neonates and adults.

The pathogen is transmitted through contact-household are possible nosocomial, food and water outbreaks.

susceptibility to rotavirus general, the disease can occur at any age, but the highest incidence is recorded in children 6-12 months.In children, the first six months of life, rotavirus infection is rare.

In infants rotavirus gastroenteritis often occurs in the form of a mixed infection (in combination with salmonellosis, shigellosis, opportunistic intestinal infection).

for rotavirus gastroenteritis is characterized by an increased incidence in winter and spring season, due to better preservation of the virus at low temperatures.

After this illness is formed unstable immune system, and therefore the possible recurrence of the disease.

pathogenesis. Although rotavirus occurs syndrome characterized as acute gastroenteritis, it is believed that only viruses penetrate into the epithelium of the small intestine, mainly in the epithelial cells of the duodenum and upper jejunum sections.

penetration of the virus in epithelial cells is accelerated promotion of epithelial cells of the villi from the base to the top of them.The cells do not have time to differentiate shortens their lifetime, reduced content of enzymes, thereby disturbed splitting disaccharides is their accumulation in the intestinal lumen, which attracts water and prevent its absorption, osmotic diarrhea develops.Completion

infection due to a virus-sensitive disappearance of epithelial cells of the villi and their replacement by immature virus insensitive to epithelial cells.Possible role of interferon in blocking infection.

Pathoanatomical picture. Microscopic examination of the small bowel mucosa identified areas with a smoothed surface, shorter fibers, there is infiltration of the mucous membrane of mononuclear cells.After 4-8 weeks of the mucous membrane of the small intestine is completely normal.

Classification of rotavirus infection:

I. The form:

1. Typical:

• gastroenteritis;

• gastritis;

• enteritis.

2. Atypical:

• erased;

• subclinical.

II.By severity:

1. Easy.

2. Moderate.

3. Heavy.

III.Adrift:

1. Acute.

2. Protracted.

3. With complications.

4. Mixed infection.

The incubation period lasts from 10 hours to 3 days.Disease begins acutely.By the early signs of the disease include diarrhea syndrome.Chair with rotavirus copious, watery, yellow, foamy appearance, with a pungent odor.

In mild form of the disease can be mushy stool and frequency of less than 5 times a day.

In moderate form of the disease stool frequency may reach 10 times a day.

Vomiting occurs simultaneously with diarrhea, but usually for a few hours ahead of her.Often at the beginning of the disease observed nausea.

In mild disease or no single vomiting.

In moderate form rotavirus repeated vomiting (3-4 times), but the majority of patients completed within days.

In mild form of the disease the body temperature is usually normal, intoxication absent or weakly expressed.

moderate forms of the infection are accompanied by short-term (1-3 days) increase in body temperature, moderately severe symptoms of intoxication.Perhaps the development of exsicosis.

for rotavirus infection is characterized by abdominal pain, bloating, rumbling along the intestine.this symptomatology is poorly developed, with moderate In less severe disease - more clearly.

In 20-60% of patients with symptoms of catarrh of the upper respiratory tract are recorded.At the same time revealed hyperemia and granularity of the mucous membrane of the soft palate, palatal handles, the rear wall of the pharynx.Patients complain of cough, sore throat, shortness of nasal breathing.In some cases, catarrhal symptoms precede gastrointestinal manifestations in the majority appear later.The degree of catarrhal symptoms depends on the severity of rotavirus infection.

The course of rotavirus gastroenteritis in infants and children in the first year of life.Rotavirus infection in infants is rare.It is possible to develop both sporadic cases and outbreaks of group in maternity hospitals.Infection occurs from mothers or staff.

In children the first 6 months of life, the disease is also rare.The highest incidence is recorded in children aged 6 to 12 months.

disease often runs hard through the development of dehydration and complications.This is especially true for young children from "risk groups" (perinatal damage of the nervous system, feeding, exudative diathesis, IUI, etc.).

90% of infants with rotavirus formed secondary lactase deficiency.This is evident in the increase in the duration and intensity of diarrhea, emergence of pain and anxiety, worse after eating, more profound violation vodnosolevogo balance.In some patients lactase deficiency disappears during convalescence, but 50% of them are written with this pathology, which requires appropriate corrective therapy, sometimes - rehospitalization.

In infants rotavirus gastroenteritis often occurs in the form of a mixed infection (in combination with salmonellosis, shigellosis, opportunistic intestinal infection).

Due to the formation of mixed infection changes the clinical manifestations of the disease.In particular, the chair becomes even enterokolitichesky gemokolitichesky character.Fever was more pronounced (38-39 ° C) and stored long-term (5-7 days).Develop and exsicosis toxicosis.Recovery occurs within 2-3 weeks.There is a possibility of death.

diagnosis of rotavirus infection is carried out on the basis of epidemiological data, taking into account the leading syndrome "secretory diarrhea" as well as the results of laboratory examination - virological and serological.

Support diagnostic criteria for rotavirus gastroenteritis:

• part of the registration in the winter season;

• acute onset;

• repeated vomiting (within 1-2 days), often precedes the appearance of diarrhea;

• stools thin, watery, copious, without pathological impurities, often frothy;

• abdominal pain, often intense, preferentially localized in the epigastric and umbilical areas;

• rumbling along the bowel, mild bloating;

• rise in body temperature in the range of 38 ° C, short-term;

• intoxication insignificant or non-existent;

• dehydration may develop;

• lean respiratory syndrome;

• Fast positive changes.

Laboratory diagnosis of rotavirus infection.

specific research methods aimed at detection of viruses in feces using RIF, ELISA, PCR

rotavirus gastroenteritis - antropoonoznaya intestinal infection that affects mainly children (90%) between the ages of 6 months.up to 2 years.Diseases for weakened newborns are especially dangerous.

Rotavirus humans and animals belong to the genus Rotavirus Reoviridae family.The generic name is derived from the Latin word for the Rota - the wheel, as in the electron micrograph of the outer capsid shape resembles a wheel rim and inner capsid capsomers - wheel spokes.Genome virion presented a double-stranded (!!) RNA.

There are 4 variants of serological (serovar) rotavirus humans and animals, in addition to the common descent of the antigen, they are associated with each variant type-specific antigens in the outer capsid.

Rotaviruses are cultivated with great difficulty, to stimulate their reproductive use special techniques that increase the susceptibility of cells to viruses: trypsin solution is added to the cell culture is centrifuged.Out of mature virions from cells is accompanied by explosive cytolysis.

Rotaviruses are resistant to the low values ​​of pH (up to 3.0), the ordinary disinfectants, air, and detergents.Long-term (several months) remain infectious activity in feces, even at room temperature in the cold - even longer.Sensitive to heat - boiling kills them instantly, in the presence of detergents, they have killed at 500 S.

tropic to the epithelium of the villi of the small intestine.It breeds in terminal villi cells, resulting in their destruction in the gut contents of enzymes that break down disaccharides significantly reduced - maltose, sucrose and lactose.Receipt

chyme with excess concentration of disaccharides in the colon results in a dramatic increase in the volume of water: from impaired intestinal absorption, moreover, the water enters into the lumen of the tissue due to increased osmotic pressure.At the same time rapidly developing inflammation in the mucous membrane.In sum this leads to functional impairment with profuse diarrhea and loss of body fluids large and salts.

from the destroyed villi viruses enter the lumen of the intestine and are excreted in the faeces into the environment, where they can persist for a long time.

transmission mechanism - fecal-oral infection of children occurs most often through contact-household through the hands of adults, linens, and other items.In patient 1 g of feces contains up to 10 billion. Virus particles.Passive antiviral immunity due to antibodies of class Ig G - after 3 months.life diminishes, after it is supported only antibody class IgA, contained in breast milk.Therefore, the infectious dose for infants may be small.

Source rotavirus infection - a sick man with symptoms of diarrhea, which usually lasts for about 1 week.The rise of the incidence observed in the winter due to outbreaks of group child care centers and maternity homes.

incubation period is an average of 2 days (range from 12 hours to 3 days).There are acute (20% of cases of infection), and erased clinical forms of asymptomatic infection.Classical symptoms of acute viral gastroenteritis is characterized by a clinical triad:

• fever to 38-39 ° C;

• vomiting;

• diarrhea with abundant fluid loss.

Patients concerned about pain in the abdomen, sometimes joined by signs of inflammation of the respiratory tract.With the rapid development of acidosis may be fatal.

Clinical symptoms observed up to 7 days, then comes the stage of convalescence due to a protective effect of active factors of humoral immunity - neutralizing antibody IgA and IgM classes.A feature of the flow of rotavirus infection in 50% of young children is a long-term (up to 3 weeks) virus isolation from faeces after the disappearance of clinical signs of disease.This fact is of great epidemiological importance, if the child is returned after an illness in the children's collective.

Postinfectious immunity is strong enough and long as it supports the natural antigenic stimulation with periodic entry of rotaviruses into the intestine from the outside.

Practical laboratory diagnosis is based on the early detection in faeces coprofiltrates rotavirus antigen, a little later - serum specific IgM class antibodies.In both cases, the enzyme immunoassay is used most often with the appropriate test systems.To display the virus in the scientific epidemiological studies sometimes use the technique immunoelectron microscopy (IEM), molecular hybridization tests, and others.

detection of rotaviruses in environmental objects suggests a preliminary concentration rotavirov using adsorption chromatography on macroporous glass.

Treatment involves a pathogenetic therapy to restore electrolyte balance and acid-base balance in the body of the patient.Applied oral or parenteral rehydration salt solutions.

Specific prophylaxis held rotavirus immunoglobulin for enteral application.It is necessary to perform normal transmission interruption techniques pathogen intestinal infections from patients, based on the strict observance of rules of personal hygiene of staff and mothers in maternity hospitals and health standards of childcare.