Viral Gastroenteritis • Viruses probably cause up to 3/4 of all infective diarrhoeas. • The second most common viral illness after upper respiratory tract infection. • In developing countries, a major killer of undernourished infants. • Rotaviruses cause of half a million deaths per year. • Only some gut-associated viruses cause gastroenteritis. Gastroenteritis Viruses
• 50-80% of all cases of viral gastroenteritis. • Responsible for occasional outbreaks. • Severe symptoms in neonates and young children. And elderly • Symptomatic infections again common in people over 60. • Up to 30% mortality rate in malnourished children, responsible for up to half a million deaths per year. Rotavirus Rotavirus Pathogenesis
• Outbreaks occur primarily in winter months in
temperate zones and year around in the tropics • Spread by oral-fecal route • I.P. 2-3 days • Rotaviruses replicate in the epithelial cells in the tips of the microvilli of the small intestine • The microvilli are stunted and absorption is reduced Global Distribution of Rotavirus Gastroenteritis Enteric Adenoviruses
•Naked DNA viruses, 75 nm in
diameter.
•Types 40 and 41are associated
with gastroenteritis. Enteric Adenoviruses • Cause occasional outbreaks in young children and neonates.
• Possibly the second most common viral cause of
gastroenteritis (7-15% of all endemic cases).
• Similar disease to rotaviruses
• Most people have antibodies against enteric
adenoviruses by the age of 3.
• Diagnosed by electron microscopy or by the
detection of adenovirus antigens in faeces by ELISA or other assays. Astroviruses
• 30 nm in diametr • Seen in stools from young children up to 7 Y • 7 serotypes • Shed in large quantities in feces • Are minimally pathogenic Caliciviruses
• 27-38 nm • Five groups • Norwalk-like viruses • Sapporo viruses • Hepatitis E virus • Marine calcivirus • Rabbit haemorrhagic disease • Relatively common cause of gastroenteritis in Southeast Asia • Outbreaks can be endemic or epidemic and a peak in winter Diagnosis of Calicivirus Infection
• Specific diagnosis of calicivirus infection usually is
not possible.
• In epidemics, save stool and emesis specimens for
evaluation
• Enzyme immunoassays for serum antibody and
stool antigen
• PCR Norwalk-like Viruses Norwalk-like Viruses
• Small RNA viruses, 35 nm in diameter.
• Associated with epidemic outbreaks of gastroenteritis in adults
• Due to consumption of shellfish and other contaminated foods.
• Aerosol spread possible as well as faecal-oral spread.
• Also named "winter vomiting disease", with vomiting being the
prominent symptom, diarrhoea usually mild.
• Antibodies acquired later in life, in the US, only 50% of adults
are seropositive by the age of 50.
• Diagnosis is made by electron microscopy and by PCR.
Treatment & Prevention
• Rehydration • Patient Education • Vaccination: in developmental stages • Rotavirus vaccine is available ( under trial, approved in Latin America)
