Rotavirus and other Viral

Diarrheal Agents
 Diarrheal Agents

Jawetz
 Rotaviruses
• Family: Reoviridae
• ds segmented RNA virus
• Particles have outer layer like the
spokes of a wheel
• This distinguishes RV from other
Reoviruses
Human Rotavirus Particles in a Stool Filtrate
From an Infant with Gastroenteritis
 Rotaviruses
• Most common cause of severe infantile
diarrhea
• Seven groups of rotaviruses (A to G)
• Group A viruses  major cause of severe
dehydrating gastroenteritis in young
humans and animals
• Virus has an inner and outer capsids
• Genome  11 segmented genes
 Rotaviruses
• Outer capsid  2 structural proteins (VP7
and VP4)
• VP7 designated G  glycoprotein (outer
capsid antigens)
• VP4 designated P  it is activated by
protease cleavage
• These 2 proteins are involved in virus
neutralization and hemagglutination
• Serotypes designated G1 to G10 (G1-G4
most common; >80% of strains)
Resistance to physical and chemical
agents
• Inactivated by chelating agents after
incubation or freezing with
–MgCl
–CaCl
–NaCl
–15min at 50ºC
 Resistance to physical and chemical
agents
• Most effective disinfectant is 95%
ethanol
• Formalin and Lysol are also effective
• Shown to survive chlorine treatment
in community water supply
• Resistant to commonly used hard-
surface disinfectants
 Ingestion

Infect cells of the villi of the small
intestine
(multiply in the cytoplasm of
enterocytes)

Damaged cells on villi are replaced by
non-absorbing immature crypt cells
 
Damaged cells may slough into the
lumen of intestine

Diarrhoea due to impaired sodium
and glucose absorption

Excrete in stool
 Clinical symptoms
• Incubation period of 1-3 days
• Acute onset of viral gastroenteritis
include:
–Watery diarrhoea, abdominal pain,
fever, nausea, vomitting
• Nausea, vomitting, and fever often
precede onset of diarrhoea
 Epidemiology
• Most important cause of infantile
gastroenteritis globally
• RV are responsible for 20% diarrheal
deaths
• Also for 6% of all diarrheal episodes
in children under 5 years
• Symptomatic infections common in
children between 6 and 24 months old
 Epidemiology
• Neonates → some shed virus in stool yet
symptom free

• Transmission is faeco-oral

• Nosocomial infections common

• Outbreaks in crowded environments

 Epidemiology
• Severe dehydration may result and
could be fatal if not properly handled
• Cause more severe and prolonged
diarrhoea than those with non-RV
etiology
• RV infections are common in both
developed and developing countries ,
but bacterial infections are also
important in our tropical environment
Jawetz
 Epidemiology
• Adults infected but rarely show
symptoms
• Gp A is common in Ghana
• Gp C has been detected in the North
• Most common cause of hospitalization=
group A
• Groups B associated with outbreaks in
China
 Epidemiology
• Group C associated with sporadic
cases and occasional outbreaks of
diarrhoeal illness in children
• B and C not important causes of
hospitalization
• Maximum incidence of rotavirus
gastroenteritis is commonly at age 6-
24 months
 Epidemiology
• Early exposure may produce
some protection against disease in
later life
• Susceptibility to infection and
disease continues throughout life
 Some things to consider –
epidemiology?
• Explanation of age susceptibility
• Seasonality of disease
• Inter-epidemic reservoirs
 Diagnosis
• Clinical symptoms not enough
• Techniques
–Detection of antigen of RV and
adenoviruses by ELISA & LA
–Detection of virus by EM: distinct
morphology
–Other tests for research are available
(nucleic acid testing)
 Diagnosis
• Keep stool at 4ºC if need be before
sending to the lab
• Don’t freeze thaw; why?
Treatment of viral gastroenteritis
• Supportive treatment directed at the
loss of
–Water
–Electrolytes
–To prevent death
• Fluids are replaced to restore
electrolyte balance
–Oral rehydration solution (ORS)
Treatment of viral gastroenteritis
• Note that malnutrition is a
predisposing factor for severe, life
threatening dehydration
 Prevention & Control
• Hand washing before attending to
different patients to prevent
nosocomial infections
• Good sanitary habits prevents
contamination of water and food
 Family: Adenoviridae
• ds DNA with classical icosahedral
structure
• Diarrhoea causing adenoviruses belong to
group F (serotypes 40 & 41)
• Enteric adenoviruses are fastidious
• Serologically distinct from respiratory
strains
• 2nd most important viral agent
gastroenteritis
Adenovirus
 Adenoviridae
• Important cause of hospitalization
 Family: Astroviridae
• ss RNA
• Six-pointed star surface structure
• Associated with sporadic cases and
occasional outbreaks of diarrhoeal
illness in infants, young children, and
the elderly
• Not an important cause of
hospitalization
Astrovirus
 Family: Caliciviridae
• ss RNA genome
• Prototype: Norwalk virus
• First viral agent identified as cause of
diarrhoeal diseases.
• Fecal-oral transmission like others
• Also referred to as “small round
structured viruses (SRSVs) or
Norwalk-like viruses
 Caliciviridae
• Outbreaks associated with shell fish
and water
• Outbreaks also in hospitals and
residential homes for the elderly
Norwalk
QUESTIONS