Rotavirus

entericadenovirus, astrovirus and calicivirus [1].

• Rotaviruses: PCR of the stool is method of choice

• Noroviruses: RT-PCR of stool samples is used for diagnostic and epidemiologic purposes

 

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In case of infectious AG, pathogens are excreted with stools and may take a number of different routes towards new hosts. Direct contact and fecal-oral transmission is one of the main forms of spread of disease and particularly occurs among children in all parts of the world. Ingestion of contaminated water or food is the other way of contracting AG and does not require direct contact to an infected person. This may largely be prevented by application of appropriate hygienic measures in the food industry and, on a personal level, by avoiding consumption of unboiled water or food of unknown quality. The incubation period usually lasts a few days.

 

 

 

Treat dehydration if present

 

In any case, such tests are very helpful to assess water and electrolyte imbalances and to recognize acidosis.

In cases of severe dehydration, kidney function should be monitored by repeated measurements of urea and creatinine.]

Especially in cases of prolonged gastroenteritis, i.e., if diarrhea does persist for more than four days, detection of blood in stool samples may serve as an additional hint at bacterial or parasitic genesis. Such analysis may be followed by bacterial culture, molecular biological exams or immunoassays to identify the etiologic agent of the disease.

The latter may also be carried out to specify the causative pathogen in case of viral infection, if this information is of interest due to clinical or epidemiological reasons. Serological tests may yield positive findings after more than 24 hours of illness and for up to two weeks after infection.

Establish etiology

• Rotaviruses: PCR of the stool is method of choice

• Noroviruses: RT-PCR of stool samples is used for diagnostic and epidemiologic purposes

• Rotaviruses

  • Treatment is symptomatic, with fluid and electrolyte replacement

  • Local intestinal immunity gives protection against successive infection

  • Adjunctive therapies such as oral odansetron shorten the median duration of diarrhea and hospitalization

  • Two oral rotavirus vaccines are available in the United States: a live, oral pentavalent human-bovine reassortment rotavirus vaccine (PRV, RotaTeq; to be given at 2, 4, and 6 months of age) and live, oral attenuated human rotavirus vaccine (HRV, Rotarix; to be given at 2 and 4 months of age)

  • A trial with nitazoxanide was attendant with moderate success among a small cohort of patients with gastroenteritis from Egypt with efficacy in both the rotavirus and norovirus subgroups

  • The enkephalinase inhibitor racecadotril (also known as acetorphan, given 1.5 mg/kg every 8 hours orally)

    • Available in many countries but not the United States

    • Appears to be clinically effective in reducing diarrheal symptoms

• Noroviruses: Treatment is largely symptomatic

• Prevention

  • Strict adherence to general hygienic measures

  • Cohorting of sick patients

  • Contact precautions for symptomatic hospitalized patients

  • Exclusion from work of symptomatic staff until symptom resolution (or 48–72 h after this for norovirus disease)

  • Proper decontamination procedures

  • An intranasally delivered norovirus particle vaccine has showed protection against infection with a homologous virus strain

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There's no effective treatment for viral gastroenteritis, so prevention is key. In addition to avoiding food and water that may be contaminated, thorough and frequent hand-washings are your best defense.