Pathogenesis and clinical presentation

Rotavirus particles were first visualized in humans by thin-section electron microscopy (EM) of the duodenal mucosa of an infant with acute watery diarrheal illness [48]. The distinctive viral particles were soon identified in the feces of infants and young children with gastroenteritis worldwide [49]. Rotaviruses were found to be an important etiological agent of acute infantile diarrhea, and were soon recognized as the most important of the known etio-logical agents of severe diarrheal illness in infants and young children [18].

Rotavirus particles are shed in large numbers in the feces during the acute infection and are transmitted by the fecal-oral route. The viral particles are relatively stable in the environment [50], which exacerbates the rapid and efficient transmission of the infection. Speculation on the respiratory transmission of rotaviruses, due to the seasonality and rapid transmission of the infection [29], has not been substantiated by clinical or laboratory studies, although rotavirus has occasionally been recovered from the respiratory tract [51, 52]. Nevertheless, aerosol droplet and person-to-person spread does seem to be a primary mode of transmission.

Rotavirus infection has a short incubation period of between 1 and 3 days. The disease is characterized by the sudden onset of acute watery diarrhea, often accompanied by fever and vomiting [53, 54]. Although most rotavirus infections are relatively mild, approximately 1 in every 5 children will develop symptoms and dehydration severe enough to warrant a visit to a medical facility, and as many as 1 in 65 will be admitted to hospital and approximately 1 in every 293 children will die of rotavirus infection [8]. Rotavirus infection is often accompanied by serious fluid and electrolyte loss with dehydration, especially in small infants, which is related to severe damage to the intestinal epithelial cells [55]. Typically, the acute infection lasts for 3-5 days with diarrhea and fever, and vomiting is a predominant early symptom of rotavirus infection, which may undermine the effectiveness of ORT.

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