Norovirus infection resident survival guide: Difference between revisions
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* [[Common cause 5]] | * [[Common cause 5]] | ||
== | ==Approach to Norovirus Outbreak== | ||
Shown below is an algorithm summarizing the approach to [[norovirus]] infection outbreak. | Shown below is an algorithm summarizing the approach to [[norovirus]] infection outbreak. | ||
{{familytree/start |summary=PE diagnosis Algorithm.}} | {{familytree/start |summary=PE diagnosis Algorithm.}} | ||
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{{familytree | | | | E01 | | | | E02 | | | | | | | | | | | | | | | | | | | | | |E01='''[[Norovirus]]''' '''positive'''|E02='''[[Norovirus]]''' '''negative'''}} | {{familytree | | | | E01 | | | | E02 | | | | | | | | | | | | | | | | | | | | | |E01='''[[Norovirus]]''' '''positive'''|E02='''[[Norovirus]]''' '''negative'''}} | ||
{{familytree | | | | |!| | | | | |!| | | | | | | | | | | | | | | | | | | | | | | }} | {{familytree | | | | |!| | | | | |!| | | | | | | | | | | | | | | | | | | | | | | }} | ||
{{familytree | | | | F01 | | | | F02 | | | | | | | | | | | | | | | | | | | | | | F01=<div style="float: left; text-align: left; height: 5em; width: 15em; padding:1em;">❑ '''Take measures to prevent and control outbreak''' (see below)<br>❑ Treat [[acute gastroenteritis]]</div>|F02=<div style="float: left; text-align: left; height: 2em; width: 15em; padding:1em;">❑ Treat as [[Acute diarrhea resident survival guide|acute | {{familytree | | | | F01 | | | | F02 | | | | | | | | | | | | | | | | | | | | | | F01=<div style="float: left; text-align: left; height: 5em; width: 15em; padding:1em;">❑ '''Take measures to prevent and control outbreak''' (see below)<br>❑ Treat [[acute gastroenteritis]]</div>|F02=<div style="float: left; text-align: left; height: 2em; width: 15em; padding:1em;">❑ Treat as [[Acute diarrhea resident survival guide|acute gastroenteritis]]</div>}} | ||
{{familytree | {{familytree/end}} | ||
{{familytree | | ==Initial Management of Acute Gastroenteritis== | ||
{{familytree/start |summary=PE diagnosis Algorithm.}} | |||
{{familytree | | | | | | | C01 | | |C01 = '''Assess of volume status'''<br> | {{familytree | | | | | | | C01 | | |C01 = '''Assess of volume status'''<br> | ||
<table class="wikitable"> | <table class="wikitable"> | ||
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{{familytree | | | D01 | | D02 | | D03 | D01 = '''No dehydration''' | D02 = '''Some dehydration''' | D03 = '''Severe dehydration'''}} | {{familytree | | | D01 | | D02 | | D03 | D01 = '''No dehydration''' | D02 = '''Some dehydration''' | D03 = '''Severe dehydration'''}} | ||
{{familytree | | | |!| | | |!| | | |!| |}} | {{familytree | | | |!| | | |!| | | |!| |}} | ||
{{familytree | | | E01 | | E02 | | E03 | E01 = <div style="float: left; text-align: left; | {{familytree | | | E01 | | E02 | | E03 | E01 =<div style="float: left; text-align: left; height: 25em; width: 15em; padding:1em;"> '''Start altered diet''' | ||
❑ Stop lactose products <br> ❑ Avoid [[alcohol]] and high osmolar supplements <br> ❑ Drink 8-10 large glasses of clear fluids (Fruit juices, soft drinks etc) <br> ❑ Eat frequent small meals (Rice, potato, banana, pastas etc) <br> | ❑ Stop lactose products <br> ❑ Avoid [[alcohol]] and high osmolar supplements <br> ❑ Drink 8-10 large glasses of clear fluids (Fruit juices, soft drinks etc) <br> ❑ Eat frequent small meals (Rice, potato, banana, pastas etc) <br> | ||
---- | ---- | ||
Can start [[oral rehydration therapy]] (ORT) for replacement of stool losses </div> | E02 = <div style="float: left; text-align: left; | Can start [[oral rehydration therapy]] (ORT) for replacement of stool losses </div> | E02 = <div style="float: left; text-align: left; height: 25em; width: 15em; padding:1em;">❑ Start [[ORT]] at a volume of 50-100 mL/kg <br> ❑ Start altered diet <br> ❑ Reassess status every 4 hr </div>| E03 = <div style="float: left; text-align: left; height: 25em; width: 15em; padding:1em;">❑ Start IV fluids: Ringer lactate at 30ml/kg in the first 1/2hr and 70ml/kg for the next 2 1/2 hr, if unavailable use normal saline <br> ❑ [[CBC]]<br> ❑ [[Electrolytes]] <br> ❑ Assess status every 15 mins until strong pulse felt and then every 1 hr </div>}} | ||
{{familytree | | | | | | | | | | | |!| |}} | {{familytree | | | | | | | | | | | |!| |}} | ||
{{familytree | | | | | | | | | | | F01 | | F01 = '''Patient stable and able to drink'''<br><div style="float: left; text-align: left; line-height: 150%">❑ Start ORT at a volume of 100 mL/kg over 4 hour <br> ❑ Calculate the continuing stool and emesis losses every hour for additional maintenance ORT therapy<br> ❑ Reassess status every 4 hr</div>}} | {{familytree | | | | | | | | | | | F01 | | F01 = '''Patient stable and able to drink'''<br><div style="float: left; text-align: left; line-height: 150%">❑ Start ORT at a volume of 100 mL/kg over 4 hour <br> ❑ Calculate the continuing stool and emesis losses every hour for additional maintenance ORT therapy<br> ❑ Reassess status every 4 hr</div>}} |
Revision as of 01:04, 10 February 2014
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Twinkle Singh, M.B.B.S. [2]
Definition
Norovirus is one of the extremely contagious viruses leading to 50% of the gastroenteritis outbreaks worldwide.[1] An outbreak of norovirus is defined as an occurrence of 2 or more similar illnesses resulting from a common exposure that is either suspected or laboratory-confirmed to be caused by norovirus.[2]
Causes
Life Threatening Causes
Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.
Common Causes
Approach to Norovirus Outbreak
Shown below is an algorithm summarizing the approach to norovirus infection outbreak.
Characterize the symptoms ❑ Non bloody diarrhea ❑ Vomiting ❑ Nausea ❑ Abdominal cramps ❑ Low grade fever ❑ Body aches ❑ Necrotising enterocolitis (in neonates) ❑ Chronic diarrhea (in immunosuppressed) ❑ Irritable bowel syndrome | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Collect samples | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
❑ Whole stool sample
Storage:
Transportation:
| ❑ Vomitus sample
| ❑ Environmental samples:
(Pursued in consultation with CDC) | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Diagnostic tests: ❑ Enzyme immunoassays | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Norovirus positive | Norovirus negative | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
❑ Take measures to prevent and control outbreak (see below) ❑ Treat acute gastroenteritis | ❑ Treat as acute gastroenteritis | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Initial Management of Acute Gastroenteritis
Assess of volume status
† Some dehydration = At least two signs, including at least one key sign (*) are present. | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
No dehydration | Some dehydration | Severe dehydration | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Start altered diet
❑ Stop lactose products Can start oral rehydration therapy (ORT) for replacement of stool losses | ❑ Start IV fluids: Ringer lactate at 30ml/kg in the first 1/2hr and 70ml/kg for the next 2 1/2 hr, if unavailable use normal saline ❑ CBC ❑ Electrolytes ❑ Assess status every 15 mins until strong pulse felt and then every 1 hr | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Patient stable and able to drink ❑ Start ORT at a volume of 100 mL/kg over 4 hour ❑ Calculate the continuing stool and emesis losses every hour for additional maintenance ORT therapy ❑ Reassess status every 4 hr | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Do's
- Settings prone to outbreaks:
❑ Health care settings
❑ Restraunts
❑ Cruise ships
❑ Schools and other institutional settings
References
- ↑ Patel MM, Hall AJ, Vinjé J, Parashar UD (2009). "Noroviruses: a comprehensive review". J Clin Virol. 44 (1): 1–8. doi:10.1016/j.jcv.2008.10.009. PMID 19084472.
- ↑ "CDC - Norovirus - Reporting and Surveillance for Norovirus". Retrieved 10 February 2014.