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Rotaviruses
 

Rotaviruses

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    Rotaviruses Rotaviruses Presentation Transcript

    • ROTAVIRUSES Dr.T.V.Rao MD
    • Importance of Rotaviruses
      • Rotaviruses are major cause of diarrheal illness in Human infants in the world
      • Adults too can get infected
      • Young animals, calves, piglets can also infected
    • Rota virus –Seasonal Impact
      • Rotavirus infections spread easily. Outbreaks usually occur in the winter and early spring, between about November and April. Rotavirus infections often spread in settings where many children are together, such as daycare centres.
    • Global Impact of Rotavirus Infections
    • Characters of Rotavirus
      • A rotavirus has a characteristic wheel-like appearance when viewed by electron microscopy (the name rotavirus is derived from the Latin rota, meaning "wheel"). Rotaviruses are non enveloped, double-shelled viruses. The genome is composed of 11 segments of double-stranded RNA, which code for six structural and five nonstructural proteins. The virus is stable in the environment
    • Rotavirus resembles a wheel ( Rota = Wheel )
    • Classification of Rotaviruses
      • Rota viruses are classified as Five species ( A- E )
      • Two other species are tentatively identified
      • ( F and G )
    • Structure of Rotaviruses
      • Antigenic classification mainly dependent on structural protein VP6
      • Group A is important human pathogen
      • Outer capsid protein VP4 and VP7 carry epitopes important in neutralizing antibodies
    • Structural configuration of Rotavirus
    • Pathogenicty
      • The virus infect the villi of the small intestine (Gastric and colonic mucosa are not infected)
      • They multiply in the cytoplasam of the enterocytes and damage their transport mechanisms.
      • The Rota viral encoded particle NSP4 is a viral enterotoxin and induces secretions by triggering a signal transduction pathway
      • Damaged cell may show into lumen of the intestinal and release large quantities of virus which appear in the stool.
      • Viral excretion usually lasts for 2 – 12 days in otherwise healthy patients
    • Why Diarrhea in Rota viral Infections
      • Diarrhea caused by Rotaviruses may be due to impaired sodium and glucose absorption as damaged cell on villi are replaced by non absorbing immature crypt cell
    • Immunity in Rota viral Infections
      • By age 3 years, 90% of the children have serum antibodies to one or more types
      • Young children suffer upto to five reinfections by 2 years of age
      • Secretary IgA or Interferon are important in protection against Rota viral infections .
    • Impact of Rota viral Infections
      • Rotavirus is the most common cause of severe diarrhea among children, resulting in the hospitalization of approximately 55,000 children each year in the United States and the death of over 600,000 children annually worldwide. The incubation period for rotavirus disease is approximately 2 days. The disease is characterized by vomiting and watery diarrhea for 3 - 8 days, and fever and abdominal pain occur frequently. Immunity after infection is incomplete, but repeat infections tend to be less severe than the original infection.
    • Rota viral infection damages Intestines
      • Pathogens, e.g., rotavirus, may strip the tips of the villi from large patches of the intestinal wall thus decreasing the surface area and decreasing by more than 50% the specific absorptive capacities of the intestine. The result is malabsorption which can cause malnutrition - most especially in a child already nutritionally compromised by repeated previous attacks of diarrhea.
    • Clinical Findings
      • Rotavirus cause major events of diarrheal diseases in children and infants worldwide
      • Incubation period is 1 – 3 days.
      • Present with
      • Watery diarrhea
      • Fever
      • Abdominal pain
      • Vomitting leading to dehydration
      • Loss of electrolytes and fluids
      • May be fatal unless treated
      • Patients with milder disease recovers promptly in 3 – 8 days
    • Dehydration is leading cause in Morbidity and Mortality
    • Rotavirus have great impact on Infants and Children
    • Rota viral infection in Immunosuppresed and others
      • In children with immunodeficienes , Rotavirus cause sever and prolonged disease.
      • Adults seroconvert but not manfiest with diarrhea
      • However in closed wards sever disease can occur.
      • In India and China large outbreaks of severe gastroenteritis have occured
    • Laboratory Diagnosis
      • Microscopy ( EM )
      • Demonstration of Virus in stool helps in early disease
      • Electron Microscopy has made the identification simpler
    • Other Methods in Diagnosis
      • Virus can be demonstrated by IEM
      • Latex agglutination tests
      • ELISA can detect antibodies and establishing raise in titers
    • Genotyping
      • Genotyping is most sensitive method for detection of Rotavirus nucleic acid from stool specimens
    • Treatment
      • Treatment of Gastroenteritis is supportive
      • Correction of Loss of water and electrolytes
      • Failure for prompt correction of dehydration leads to
      • Acidosis
      • Shock
      • Death
      • Correction Electrolyte remain the goal treatment in Rota viral infections.
      • Lesser deaths if effective replacement therapy is initiated
    • UNICEF/WHO O.R.S
      • Sodium Chloride 3.5 grams
      • Sodium Bicarbonate 2.5 grams
      • Potassium Chloride 1.5 grams
      • Glucose 20 grams
      • To be dissolved in one liter of clean drinking water
    • Fluid Replacement
      • Management consists of replacement of fluids ( ORS ) and restoration of Electrolyte balance
      • Oral rehydration Therapy is highly effective in reducing morbidity and mortality
      • Severe dehydration needs parental administration of fluids.
    • Basic measures in Rota viral prevention
      • Keep your hands clean. Wash hands often with soap and warm water after using the toilet, diapering and before preparing or eating food.
    • Epidemiology
      • Rotaviral infections continue to be most important cause of Gastroenteritis in young children
      • Estimates range 3 billion – 5 billion infections
      • Children > 5 years age highly susceptible to infections
      • Results in 1 million deaths
    • Impact on Hospitals
      • Upto 50 % of cases of Acute Gastroenteritis of the Hospitalized children throught the world are caused by Rotavirus
      • Winter season highly predisposing
      • Nosocomial infections need attention
    • Prevention and Control
      • In view of fecal oral route of transmission waste water management, safe water supplies sanitation are significant control measurers.
      • Vaccine – In 2006 an Oral Bovine based Rota viral vaccine was licensed in USA
    • Educational material on Rota viral Diarrhea for Graduate Medical Students Dr.T.V.Rao MD Email [email_address]