Rotavirus infection natural history, complications and prognosis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Nature of acute disease
Rotaviruses cause acute gastroenteritis. "Infantile diarrhea", "winter diarrhea", "stomach flu", "acute nonbacterial infectious gastroenteritis", and "acute viral gastroenteritis" are other names applied to this disease.
Rotavirus gastroenteritis is a self-limiting, mild to severe disease characterized by vomiting, watery diarrhea, and low-grade fever. The infective dose is presumed to be 10-100 infectious viral particles. Because a person with rotavirus diarrhea often excretes large numbers of virus (108-1010 infectious particles/ml of feces), infection doses can be readily acquired through contaminated hands, objects, or utensils. Asymptomatic rotavirus excretion has been well documented and may play a role in perpetuating endemic disease.
The virus infects enterocytes of the villi of the small intestine, leading to structural changes of the epithelium and diarrhea.
The incubation period ranges from 1-3 days. Symptoms often start with vomiting followed by 4-8 days of diarrhea. Temporary lactose intolerance may occur. Recovery is usually complete. However, severe diarrhea without fluid and electrolyte replacement may result in death. Childhood mortality caused by rotavirus is relatively low in the U.S., with an estimated 100 cases/year, but reaches over 500,000 cases/year worldwide (as of 2005). Association with other enteric pathogens may play a role in the severity of the disease.
Clinically, the most severe disease occurs in children under two years of age (Mandell, Bennett & Dolin: Principles and Practice of Infectious Diseases, 6th ed.)