Case Study: Rotavirus
A 6 month-old child was seen in the emergency in January after two days of persistent watery diarrhea and vomiting accompanied by low-grade fever and mild cough. The infant appeared dehydrated and required hospitalization. The patient attended a day-care center.
1. In addition to rotavirus, what other viral agents must be considered in the differential diagnosis of this infant? If the patient had been a teenager or adult?
Rotavirus disease is characterized by fever, abdominal pain, vomiting, and watery diarrhea for three to eight days. Rotavirus mostly affects small children up to five years of age; therefore, if the patient had been a teenager or adult, rotavirus disease would not have been a very likely diagnosis because it would not have been as severe to cause hospitalization. In considering other viral agents for the diagnosis, we must look at those viruses that cause gastroenteritis (sickness of upper and lower bowels) and that cause fever. These include: Traveler’s Diarrhea (bacteria), Cholera (bacteria), Salmonella (bacteria), Campylobacter (bacteria), Common Cold (virus), Shigellosis (bacteria), Diphtheria (bacteria), Coxsackievirus (virus), and Norwalk virus (virus). All of these other diseases can be ruled out, however, despite displaying some similar symptoms.
First, our patient was not said to have traveled, therefore, it is not suspected to be Traveler’s diarrhea. Second, Cholera is not transmitted by human-to-human contact, and symptoms include leg cramps, this is not the case in our patient. Third, Salmonella and Campylobacter are primarily transmitted by way of raw meat; this was not mentioned in our case. Fourth, in the case of a common cold, it is uncommon that a patient would be vomiting and have diarrhea. Fifth, Shigellosis is not the probable diagnosis in this case because there is no blood in the stool, which is the most common symptom of Shigellosis. Sixth, Diphtheria is also unlikely to be the diagnosis in this case because it causes a grayish-white membrane around the throat and causes its victims to have difficulties breathing. Seventh, Coxsackievirus may have similar symptoms, however, it causes red blisters inside the mouth, on the hands and feet of its victims. Finally, Norwalk virus (or Norovirus) features the most similar symptoms to Rotavirus, however, it can be differentiated by its cause of muscle ache, and headache. Before official diagnosis is released, tests must be performed.
2. How would the diagnosis of rotavirus been confirmed?
Confirmation of a rotavirus diagnosis is primarily done with a Rapid Antigen detection from a sample of the patient’s stool. This test is a direct assay where In this case, the patient is only six months old; therefore, the sample can be easily obtained from diapers. Further characterization of the rotavirus diagnosis would come from Enzyme-Linked ImmunoSorbent Assay, Reverse transcriptase polymerase chain reaction (RTPCR), Polyacrylamide Gel Electrophoresis (PAGE), or Electron Microscopy (EM).
3. How was the virus transmitted? How long was the patient contagious?
Usually infection originates by way of a fecal-oral communication. This can include but is not limited to ingesting contaminated food and/or water and contact with contaminated surfaces. Other methods of transmission include intake of respiratory tract secretions and other bodily fluids, such as vomit. The Incubation period for rotavirus disease is about two days, which means the illness will begin about two days after exposure. The patient is contagious approximately two days before showing symptoms and two days after recovery.
4. Who was at risk for serious disease?
Rotavirus disease primarily affects children under five years of age. The most severe of cases have been in children up to two years of age. Anyone with a compromised immune system and have never been infected before, are the most at risk. However, most children are infected and subsequent infections tend to be less severe. Immunity after infection is incomplete, therefore, adults and teenagers can be infected as well, yet, these also tend to be less severe.
Sanitation and upkeep of hygiene is key in the prevention of gastroenteritis by rotavirus. Children tend to be the ones most commonly break these rules of cleanliness; therefore, they are the most commonly infected.
Recently, a vaccine was obtained and approved by the FDA that would prevent infection of rotavirus. It is a live oral vaccine, meaning it is given orally and it is recommended to for children as young as six weeks. Those without the vaccine are also more likely to be at risk for serious disease.
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