Download - Rot a Viruses
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ROTAVIRALROTAVIRAL
diarrheasdiarrheas
Dr.T.V.Rao MDDr.T.V.Rao MD
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Importance of RotavirusesImportance of Rotaviruses
Rotaviruses are major cause of diarrhealRotaviruses are major cause of diarrheal
illness in Human infants in the worldillness in Human infants in the world Adults too can get infectedAdults too can get infected
Young animals, calves, piglets can alsoYoung animals, calves, piglets can also
infectedinfected
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Rota virus SeasonalRota virus Seasonal
ImpactImpact Rotavirus infections spread easily.Rotavirus infections spread easily.
Outbreaks usually occur in the winter andOutbreaks usually occur in the winter and
early spring, between about Novemberearly spring, between about Novemberand April. Rotavirus infections oftenand April. Rotavirus infections often
spread in settings where many childrenspread in settings where many children
are together, such as daycare centres.are together, such as daycare centres.
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Global Impact of RotavirusGlobal Impact of Rotavirus
InfectionsInfections
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Characters of RotavirusCharacters of Rotavirus
A rotavirus has a characteristic wheel-likeA rotavirus has a characteristic wheel-like
appearance when viewed by electronappearance when viewed by electron
microscopy (the name rotavirus is derived frommicroscopy (the name rotavirus is derived fromthe Latin rota, meaning "wheel"). Rotavirusesthe Latin rota, meaning "wheel"). Rotaviruses
are non enveloped, double-shelled viruses.are non enveloped, double-shelled viruses.
The genome is composed of 11 segments ofThe genome is composed of 11 segments of
double-stranded RNA, which code for sixdouble-stranded RNA, which code for sixstructural and five nonstructural proteins. Thestructural and five nonstructural proteins. The
virus is stable in the environmentvirus is stable in the environment
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Rotavirus resembles a wheelRotavirus resembles a wheel
( Rota = Wheel )( Rota = Wheel )
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Classification ofClassification of
RotavirusesRotaviruses
Rota viruses are classified as FiveRota viruses are classified as Five
species ( A- E )species ( A- E ) Two other species are tentativelyTwo other species are tentatively
identifiedidentified
( F and G )( F and G )
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Structure of RotavirusesStructure of Rotaviruses
Antigenic classificationAntigenic classification
mainly dependent onmainly dependent on
structural protein VP6structural protein VP6
Group A is importantGroup A is important
human pathogenhuman pathogen
Outer capsid protein VP4Outer capsid protein VP4
and VP7 carry epitopesand VP7 carry epitopes
important in neutralizingimportant in neutralizingantibodiesantibodies
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Structural configuration ofStructural configuration of
RotavirusRotavirus
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PathogenictyPathogenicty
The virus infect the villi of the small intestineThe virus infect the villi of the small intestine (Gastric(Gastricand colonic mucosa are not infected)and colonic mucosa are not infected)
They multiply in the cytoplasam of the enterocytes andThey multiply in the cytoplasam of the enterocytes and
damage their transport mechanisms.damage their transport mechanisms. The Rota viral encoded particle NSP4 is a viralThe Rota viral encoded particle NSP4 is a viral
enterotoxin and induces secretions by triggering aenterotoxin and induces secretions by triggering asignal transduction pathwaysignal transduction pathway
Damaged cell may show into lumen of the intestinalDamaged cell may show into lumen of the intestinaland release large quantities of virus which appear inand release large quantities of virus which appear inthe stool.the stool.
Viral excretion usually lasts for 2 12 days inViral excretion usually lasts for 2 12 days inotherwise healthy patientsotherwise healthy patients
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Why Diarrhea in Rota viralWhy Diarrhea in Rota viral
InfectionsInfections
Diarrhea caused byDiarrhea caused by
Rotaviruses may beRotaviruses may bedue to impaireddue to impaired
sodium and glucosesodium and glucose
absorption asabsorption as
damaged cell on villidamaged cell on villiare replaced by nonare replaced by non
absorbing immatureabsorbing immature
crypt cellcrypt cell
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Immunity in Rota viralImmunity in Rota viral
InfectionsInfections By age 3 years, 90% ofBy age 3 years, 90% of
the children have serumthe children have serumantibodies to one orantibodies to one or
more typesmore types Young children sufferYoung children suffer
upto to five reinfectionsupto to five reinfectionsby 2 years of ageby 2 years of age
Secretary IgA orSecretary IgA or
Interferon are importantInterferon are importantin protection againstin protection againstRota viral infectionsRota viral infections..
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Impact of Rota viralImpact of Rota viral
InfectionsInfections Rotavirus is the most common cause of severeRotavirus is the most common cause of severe
diarrhea among children, resulting in the hospitalizationdiarrhea among children, resulting in the hospitalizationof approximately 55,000 children each year in theof approximately 55,000 children each year in the
United States and the death of over 600,000 childrenUnited States and the death of over 600,000 childrenannually worldwide. The incubation period for rotavirusannually worldwide. The incubation period for rotavirusdisease is approximately 2 days. The disease isdisease is approximately 2 days. The disease ischaracterized by vomiting and watery diarrhea for 3 - 8characterized by vomiting and watery diarrhea for 3 - 8days, and fever and abdominal pain occur frequently.days, and fever and abdominal pain occur frequently.
Immunity after infection is incomplete, but repeatImmunity after infection is incomplete, but repeatinfections tend to be less severe than the originalinfections tend to be less severe than the originalinfection.infection.
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Rota viral infectionRota viral infection
damages Intestinesdamages Intestines Pathogens, e.g., rotavirus, may strip the tips ofPathogens, e.g., rotavirus, may strip the tips of
the villi from large patches of the intestinal wallthe villi from large patches of the intestinal wallthus decreasing the surface area andthus decreasing the surface area and
decreasing by more than 50% the specificdecreasing by more than 50% the specificabsorptive capacities of the intestine. Theabsorptive capacities of the intestine. Theresult is malabsorption which can causeresult is malabsorption which can causemalnutrition - most especially in a child alreadymalnutrition - most especially in a child already
nutritionally compromised by repeated previousnutritionally compromised by repeated previousattacks of diarrhea.attacks of diarrhea.
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Clinical FindingsClinical Findings
Rotavirus cause major events of diarrheal diseases inRotavirus cause major events of diarrheal diseases inchildren and infants worldwidechildren and infants worldwide
Incubation period is 1 3 days.Incubation period is 1 3 days. Present withPresent with
Watery diarrheaWatery diarrhea
FeverFever
Abdominal painAbdominal pain
Vomitting leading to dehydrationVomitting leading to dehydrationLoss of electrolytes and fluidsLoss of electrolytes and fluids
May be fatal unless treatedMay be fatal unless treated
Patients with milder disease recovers promptly in 3 Patients with milder disease recovers promptly in 3 8 days8 days
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Dehydration is leading causeDehydration is leading cause
in Morbidity and Mortalityin Morbidity and Mortality
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Rotavirus have great impactRotavirus have great impact
on Infants and Childrenon Infants and Children
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Rota viral infection inRota viral infection in
Immunosuppresed andImmunosuppresed and
othersothers
In children with immunodeficienes , RotavirusIn children with immunodeficienes , Rotaviruscause sever and prolonged disease.cause sever and prolonged disease.
Adults seroconvert but not manfiest withAdults seroconvert but not manfiest withdiarrheadiarrhea
However in closed wards sever disease canHowever in closed wards sever disease can
occur.occur. In India and China large outbreaks of severeIn India and China large outbreaks of severe
gastroenteritis have occuredgastroenteritis have occured
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Laboratory DiagnosisLaboratory Diagnosis
Microscopy ( EM )Microscopy ( EM )
Demonstration ofDemonstration ofVirus in stool helps inVirus in stool helps in
early diseaseearly disease
Electron MicroscopyElectron Microscopy
has made thehas made the
identification simpleridentification simpler
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Other Methods inOther Methods in
DiagnosisDiagnosis
Virus can beVirus can be
demonstrated by IEMdemonstrated by IEM
Latex agglutinationLatex agglutinationteststests
ELISA can detectELISA can detect
antibodies andantibodies and
establishing raiseestablishing raisein titersin titers
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GenotypingGenotyping Genotyping is mostGenotyping is most
sensitive method forsensitive method fordetection ofdetection of
Rotavirus nucleicRotavirus nucleic
acid from stoolacid from stool
specimensspecimens
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TreatmentTreatment
Treatment of Gastroenteritis is supportiveTreatment of Gastroenteritis is supportive
Correction of Loss of water and electrolytesCorrection of Loss of water and electrolytes
Failure for prompt correction of dehydration leads toFailure for prompt correction of dehydration leads to
AcidosisAcidosis
ShockShock
DeathDeath
Correction Electrolyte remain the goal treatment in RotaCorrection Electrolyte remain the goal treatment in Rota
viral infections.viral infections.Lesser deaths if effective replacement therapy is initiatedLesser deaths if effective replacement therapy is initiated
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UNICEF/WHO O.R.SUNICEF/WHO O.R.S
Sodium Chloride 3.5 gramsSodium Chloride 3.5 grams
Sodium Bicarbonate 2.5 gramsSodium Bicarbonate 2.5 grams
Potassium Chloride 1.5 gramsPotassium Chloride 1.5 grams
Glucose 20 gramsGlucose 20 grams
To be dissolved in one liter of cleanTo be dissolved in one liter of clean
drinking waterdrinking water
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Fluid ReplacementFluid Replacement Management consists of replacement ofManagement consists of replacement of
fluids ( ORS ) and restoration offluids ( ORS ) and restoration ofElectrolyte balanceElectrolyte balance
Oral rehydration Therapy is highlyOral rehydration Therapy is highlyeffective in reducing morbidity andeffective in reducing morbidity andmortalitymortality
Severe dehydration needs parentalSevere dehydration needs parentaladministration of fluids.administration of fluids.
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Basic measures in RotaBasic measures in Rota
viral preventionviral prevention
Keep your handsKeep your hands
clean. Wash handsclean. Wash handsoften with soap andoften with soap and
warm water afterwarm water after
using the toilet,using the toilet,
diapering and beforediapering and beforepreparing or eatingpreparing or eating
food.food.
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EpidemiologyEpidemiology
Rotaviral infections continue to be mostRotaviral infections continue to be most
important cause of Gastroenteritis inimportant cause of Gastroenteritis in
young childrenyoung children Estimates range 3 billion 5 billionEstimates range 3 billion 5 billion
infectionsinfections
Children > 5 years age highly susceptibleChildren > 5 years age highly susceptibleto infectionsto infections
Results in 1 million deathsResults in 1 million deaths
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Impact on HospitalsImpact on Hospitals
Upto 50 % of cases of AcuteUpto 50 % of cases of Acute
Gastroenteritis of the HospitalizedGastroenteritis of the Hospitalizedchildren throught the world are caused bychildren throught the world are caused by
RotavirusRotavirus
Winter season highly predisposingWinter season highly predisposing Nosocomial infections need attentionNosocomial infections need attention
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Prevention and ControlPrevention and Control
In view of fecal oral route of transmissionIn view of fecal oral route of transmissionwaste water management, safe waterwaste water management, safe water
supplies sanitation are significant controlsupplies sanitation are significant controlmeasurers.measurers.
Vaccine Vaccine In 2006 an Oral Bovine basedIn 2006 an Oral Bovine basedRota viral vaccine was licensed in USARota viral vaccine was licensed in USA
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Educational materialEducational material
on Rota viral Diarrheaon Rota viral Diarrheafor Graduate Medicalfor Graduate Medical
StudentsStudents Dr.T.V.Rao MDDr.T.V.Rao MDEmailEmail
doctortvrao@gmail comdoctortvrao@gmail com