Rotavirus infection natural history, complications and prognosis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Natural History
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 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.)
Complications
Repeated rotavirus infections may increase the risk of celiac disease in genetically susceptible children. A case-control study of infants with a genetic predisposition for celiac disease observed that the risk of developing the disease increased twofold in children who were infected with rotavirus once and almost fourfold for those who were infected with it multiple times (American Journal of Gastroenterology, October 2006.)