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Clinical manifestations and diagnosis of rotavirus infection

Authors
Miguel G O'Ryan, MD
David O Matson, MD, PhD
Section Editor
Morven S Edwards, MD
Deputy Editor
Mary M Torchia, MD

INTRODUCTION

Rotaviruses were among the first viral agents identified as important causes of viral gastroenteritis, particularly in children between the ages of six months and two years. Extensive surveys have established rotavirus as the single most important viral cause of severe gastroenteritis in children worldwide [1-4]. However, this pattern is changing in countries implementing rotavirus vaccination [5,6].

The pathogenesis, clinical manifestations, and diagnosis of rotavirus gastroenteritis will be reviewed here. The epidemiology, transmission, and prevention are discussed separately. (See "Epidemiology and pathogenesis of viral gastroenteritis in adults", section on 'Rotavirus' and "Rotavirus vaccines for infants".)

The clinical management of rotavirus infection is as described for other types of viral gastroenteritis; these are discussed separately. (See "Acute viral gastroenteritis in adults", section on 'Treatment' and "Acute viral gastroenteritis in children in resource-rich countries: Management and prevention".)

PATHOGENESIS

At least three factors are thought to play a role in the pathogenesis of rotavirus-induced diarrhea: loss of brush border enzymes, the direct effect of the rotavirus enterotoxin NSP4, and activation of the enteric nervous system.

Acute rotavirus infection is associated with decreased levels of intestinal brush border enzymes such as maltase, sucrase, and lactase [7], leading to malabsorption of D-xylose and lactose in the setting of acute infection [8-10]. Osmotic diarrhea likely occurs as a result of villous epithelial cell destruction with resulting brush border enzyme deficiency and complex sugar malabsorption [11,12]. The success of oral rehydration under these circumstances may reflect the patchy nature of mucosal involvement [10].

                 

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Literature review current through: Nov 2016. | This topic last updated: Thu Dec 01 00:00:00 GMT+00:00 2016.
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