Rotavirus infection differential diagnosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Ahmed Elsaiey, MBBCH [2]

Overview

Rotavirus infection most commonly causes watery diarrhea and it is the leading cause of death in the children and infants. Rotavirus infection should be differentiated from other pathogens and diseases that cause diarrhea. In the below table it is differentiated from the other viruses that can cause the diarrhea like adenovirus, bacteria like the E. coli and shigella, and parasites like the protozoa.

Differentiating rotavirus infection from other diseases

Rotavirus must be differentiated from other diseases and pathogens that cause watery diarrhea. In the below table it is differentiated from the other viruses that can cause the diarrhea like adenovirus, bacteria like the E. coli, and parasites like the taenia spp.

Organism		Age predilection	Travel history	Incubation size	Incubation time	History and symptoms			Food source	Specific consideration
						Fever	N/V	Abdominal cramps
Viral	Rotavirus	<2 y	-	<102	<48 h	+	+	-	-	Mostly in day cares, most common in winter.
	Norovirus	Any age	-	10 -103	24-48 h	+	+	+	-	Most common cause of gastroenteritis, abdominal tenderness,
	Adenovirus	<2 y	-	105 -106	8-10 d	+	+	+	-	No seasonality
	Astrovirus	<5 y	-		72-96 h	+	+	+	Seafood	Mostly during winter
Bacteria	ETEC	Any age	+	108 -1010	24 h	-	+	+	-	Causes travelers diarrhea, contains heat-labile toxins (LT) and heat-stable toxins (ST)
	EPEC	<1 y	-	10†	6-12 h	-	+	+	Raw beef and chicken	-
	Vibrio cholera	Any ages	-	106-1010	24-48 h	-	+	+	Seafoods, including molluscan shellfish (oysters, mussels, and clams), crab, lobster, shrimp, squid, and finfish.	Hypotension, tachycardia, decreased skin turgor. Rice-water stools
Parasites	Cryptosporidium parvum	Any ages	-	10-100 oocysts	7-10 d	+	+	+	Juices and milk	May cause copious diarrhea and dehydration in patients with AIDS especially with 180 > CD4
	Cyclospora cayetanensis	Any ages	+	10-100 oocysts	7-10 d	-	+	+	Fresh produce, such as raspberries, basil, and several varieties of lettuce.	More common in rainy areas
	Taenia spp	Any ages	-	1 larva or egg	2-4 m	-	+	+	Undercooked beef and pork	Neurocysticercosis: Cysts located in the brain may be asymptomatic or seizures, increased intracranial pressure, headache.
	Diphyllobothrium latum	Any ages	-	1 larva	15 d	-	-	-	Raw or undercooked fish.	May cause vitamin B12 deficiency