| Fact | Explanation |
|---|---|
| Diarrhoea | Rotavirus is a RNA virus, that causes most common form of acute diarrhoea in children less than 5 years of age. [4] After exposure to infected material, they develop diarrhoea following 1-3 months of incubation period. [5] Diarrhea is defined as the passage of three or more stools that are looser in consistency than normal within a 24-hour period. [3] Rotavirus usually causes watery diarrhoea. [5] |
| Fever [7] | Rotaviruses attach to cell surface receptors on mature enterocytes at the tips of villi in the small intestine and causes invasion. [5] Absorptive capacity is reduced, secretory mechanisms are stimulated, and ultimately Villous ischaemia occurs due to damaged intestinal microcirculation. [6] Releasing pyrogens during the inflammation might cause the fever. |
| Vomiting, nausea [7] | This is a much more common symptom. [5] |
| Lethargy, malaise | Though this is a mild disease, [6] patients might be having some constitutional symptoms. |
| Age | Age below 2 years is significantly associated with rotavirus infection. [4] |
| Social history: male gender, maternal smoking, maternal age < 20 years | Studies have shown that these factors are associated with increased risk of rotavirus diarrhoea. [2] |
| Fact | Explanation |
|---|---|
| Febrile | This may be a low grade fever. [2] |
| Sunken eyes, dry skin, dry mucous membrane, reduced skin turger | Rotavirus diarrhoea is one of the commonest cause of severe dehydration. [,2] |
| Low blood pressure | May be due to dehydration. [1] |
| Fact | Explanation |
|---|---|
| Watery diarrhoea | This can be due to vibrio cholerae and Toxigenic E. coli etc. There can be occasional passage of blood with stools. [1] |
| Shigella and enterohemorrhagic E. coli (EHEC) | These infection are different from rotaviral diarrhoea as shigella can have bloody diarrhea as the predominant symptom. Shigella dysenteriae is the one causes dysentery(bloody diarrhoea). [1] |
| Inflammatory bowel disease | Crohns disease and ulcerative colitis belong to this group. There is a dysregulated mucosal immune response to the normal commensal flora in a genetically susceptible host. [2]They will present with systemic features such as fever, weight loss, malaise etc associated per rectal bleeding. They usually have a long term history of diarrhoea. |
| Amebiasis | Entamoeba histolytica is the causative factor for the parasitic disease"amebiasis". Clinical features would be abdominal pain, watery, bloody, or mucoid diarrhea due to colitis. Stool microscopy will show red blood cells, macrophages and polymorphonuclear cells. Amoebic liver abscess is an extraintestinal manifestation of amoebiasis. [4] |
| Giardiasis | This is a waterborne infection. Diagnosis is made by detection of Giardia lamblia cysts and trophozoites on examination of the stool sample. [3] |
| Fact | Explanation |
|---|---|
| Enzyme-linked immunosorbent assay (ELISA) | Stool samples can be used to identify the virus. [1] |
| Polymerase-chain-reaction (PCR) | If the stool sample is positive for rotavirus, then it is assessed by PCR and next hybridization assay. [1] |
| Stool microscopy | Can be used to detect the organisms. [2,3] |
| Stool full report | Can be used to exclude other conditions like amoebic cysts, ova as these also can present with watery diarrhoea. [3] |
| Fact | Explanation |
|---|---|
| Full blood count | As this is a viral infection that can present with increased lymphocytes in the blood (lymphocytosis). As the patient is presenting with the fever, it is important to exclude other infections presenting with the fever. eg:- increased white cell count in bacterial infections and reduced platelets count in dengu [2] and other viral infections. |
| Serum electrolytes | Electrolyte loss can leads to hypokalaemia, hytponatraemia and hypochloraemia. [1] |
| Fact | Explanation |
|---|---|
| Serum electrolytes | Electrolyte imbalances are improving as infection settles. [2] |
| IgA antibody | After the rotaviral vaccine, blood samples are taken to assess the serum concentrations of antirotavirus IgA antibody. [1] |
| Fact | Explanation |
|---|---|
| Serum electrolytes | To see any electrolyte imbalances during diarrhoea. [1] |
| Fact | Explanation |
|---|---|
| Controlling pain, fever and vomiting | Analgesics and antipyretics can be used to control the any associated pain and fever. [5] Antiemetics can be used for vomiting. |
| Prevention | Proper hand hygiene is crucial in preventing the diarrhoeal infections. Arrangements to improve the hygiene, sanitation, and providing access to clean water are essential steps in prevention. [4] |
| Probiotics | Probiotics are important in shortening the duration of diarrhoea. S boulardii, L.acidophilus, L. rhamnosus, B. longum are some of the species used as probiotics. [1] |
| Vaccine | There is a rotavirus vaccine for infants, which causes significant reduction in severe rotavirus diarrhoea. [3] It is a live attenuated oral vaccine. Intussusception is a known to be a side effect of vaccination. [2] |
| Zinc therapy | Malnourished or zinc deficient children are benefited by zinc supplementation as it reduces the incidence, frequency, severity of diarrhoeal illnesses. [4] |
| Fact | Explanation |
|---|---|
| Rehydration | There is loss of fluid and electrolytes during the diarrhoea leads to dehydration, hyponatraemia, hypokalaemia, and metabolic acidosis. Prevention and management of dehydration is important to prevent deaths due to diarrhoea. [1] Currently recommended oral rehydration solution has a total osmolarity of 311 mmol/l with sodium (75 mmol/L), potassium, chloride, citrate and glucose anhydrous in adequate amounts. As The glucose-sodium co-transporter is preserved in diarrhoeal diseases, the ORS can provide the deficient fluids and electrolytes in diarrhoea. |
| Management of dehydration | Management of mild to moderate dehydration, requires rehydration with 50-100ml/kg over 3-4 hours. Usually around 60 ml of ORS per each stool is required for the replacement. Severe cases need intravenous fluid replacement with 0.9% normal saline/ringer's lactate. [1] |
| Diet and nutrition | Breast feeding should be continued during the episode. [2] No restriction for other food items. In developing countries, where recurrent Diarrhoea is common in undernourished children. It is like a vicious cycle: undernutrition causes diarrhoea and diarrhea then again leads to undernutrition. [3] |
| Antibiotic treatment | Antimicrobial therapy is not recommended for rotavirus infection. [4] |