Microbiology
Pathogens
A 3 year old girl is brought to ED with a 2 day history of diarrhoea and vomiting. Several other children at nursery have been off with the same illness. Which of the following pathogens is the most likely cause:
Answer:
Rotavirus is the most common virus causing gastroenteritis in children in the UK. Almost every child in the UK will have an infection before their fifth birthday.Rotavirus
Microbiology / Pathogens / Gastrointestinal Viruses
Last Updated: 8th November 2022
| Virus | Rotavirus |
|---|---|
| Epidemiology | Most common cause of gastroenteritis in childhood, peak in children aged 3 months - 3 years, seasonal peaks in winter |
| Transmission | Faecal-oral route |
| Incubation period | 1 - 2 days |
| Clinical features | Fever, vomiting, watery diarrhoea, lasting for about 3 - 8 days |
| Diagnosis | Clinical, can be confirmed with ELISA, NAAT or cell culture of stool sample |
| Treatment | Supportive, fluid replacement |
| Prevention | Infection control measures, childhood vaccine given at 2 and 3 months |
Epidemiology
Rotavirus is the most common virus causing gastroenteritis in children in the UK. Transmission occurs via the faecal-oral route. Infection in adults is uncommon because immunity is long lasting.
Clinical Features
Rotavirus is able to survive stomach acid, before infecting and replicating in small intestinal enterocytes. The damaged cells are sloughed into the lumen, causing release of the virus; poor sodium and glucose absorption by the immature cells that replace the damaged cells results in impaired fluid absorption and a resultant watery diarrhoea.
The onset of symptoms is abrupt, after a short incubation period of 1 - 2 days. Fever, vomiting and watery diarrhoea are seen in the majority of infected children, lasting for about 3 - 8 days.
Diagnosis
Diagnosis is usually clinical but it can be confirmed with ELISA, NAAT or virus cell culture of stool sample.
Treatment and Prevention
Treatment is supportive with fluid replacement. Risk of infection can be reduced by provision of adequate sanitation. A rotavirus vaccine was introduced to the routine childhood immunisation schedule in July 2013, given at 2 and 3 months.
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- Biochemistry
- Blood Gases
- Haematology
| Biochemistry | Normal Value |
|---|---|
| Sodium | 135 – 145 mmol/l |
| Potassium | 3.0 – 4.5 mmol/l |
| Urea | 2.5 – 7.5 mmol/l |
| Glucose | 3.5 – 5.0 mmol/l |
| Creatinine | 35 – 135 μmol/l |
| Alanine Aminotransferase (ALT) | 5 – 35 U/l |
| Gamma-glutamyl Transferase (GGT) | < 65 U/l |
| Alkaline Phosphatase (ALP) | 30 – 135 U/l |
| Aspartate Aminotransferase (AST) | < 40 U/l |
| Total Protein | 60 – 80 g/l |
| Albumin | 35 – 50 g/l |
| Globulin | 2.4 – 3.5 g/dl |
| Amylase | < 70 U/l |
| Total Bilirubin | 3 – 17 μmol/l |
| Calcium | 2.1 – 2.5 mmol/l |
| Chloride | 95 – 105 mmol/l |
| Phosphate | 0.8 – 1.4 mmol/l |
| Haematology | Normal Value |
|---|---|
| Haemoglobin | 11.5 – 16.6 g/dl |
| White Blood Cells | 4.0 – 11.0 x 109/l |
| Platelets | 150 – 450 x 109/l |
| MCV | 80 – 96 fl |
| MCHC | 32 – 36 g/dl |
| Neutrophils | 2.0 – 7.5 x 109/l |
| Lymphocytes | 1.5 – 4.0 x 109/l |
| Monocytes | 0.3 – 1.0 x 109/l |
| Eosinophils | 0.1 – 0.5 x 109/l |
| Basophils | < 0.2 x 109/l |
| Reticulocytes | < 2% |
| Haematocrit | 0.35 – 0.49 |
| Red Cell Distribution Width | 11 – 15% |
| Blood Gases | Normal Value |
|---|---|
| pH | 7.35 – 7.45 |
| pO2 | 11 – 14 kPa |
| pCO2 | 4.5 – 6.0 kPa |
| Base Excess | -2 – +2 mmol/l |
| Bicarbonate | 24 – 30 mmol/l |
| Lactate | < 2 mmol/l |
