Monsoons bring with themselves a slew of infections, amongst them are gut infections and these include viral infections like Rotavirus, Salmonella or Typhoid infections and other infections that come out of eating and drinking contaminated food and contaminated water. Dr Om Srivastav, Director, Department of Infectious diseases, Jaslok Hospital, Mumbai talks about rotavirus and how it affects all age group.
Rotavirus as the name suggests is a viral infection that goes through the faeco-oral route which means food affected by the virus is consumed by healthy individuals who demonstrate the infection.
Rotavirus is a particularly severe infectious agent that affects all ages but mostly children below the age of 14 years. To put things into perspective, one sample of stool can have anywhere from a 100 million to 10 billion copies of virus, yet only a 100 copies in a stool sample and sufficient to cause devastating infection.
Children get easily affected because their immune system is weak. The commonest presentation is copious amount of vomiting and equal amounts of diarrhoea, this is accompanied by cramps in the abdomen, cramps in the muscle and in severe cases intestinal obstruction.
In the most dreaded complications system goes into shock and in a percentage of patients this will culminate into mortality. The virus can be identified by a number of investigations in the laboratory that are mostly inexpensive and accurate. While the clinical presentation may mimic other infections the diagnosis of a Rotavirus infection is straight forward.
The treatment of Rotavirus infection is supportive but crucially is must be commenced early so that complications do not occur. The loss of volume of body fluids is accompanied by loss of key electrolytes such as potassium and magnesium.
These lead to profound fatigue, severe muscle weakness, pseudo and partial obstruction of the intestine and in severe cases heart conduction abnormalities and convulsions. Low blood sugars and altered mental behaviour are also seen when these abnormalities are not corrected in the early part of the infection.
In vomiting that is persistent and refractory to the treatment, a tube may be required to be inserted from the nose into the stomach of patient until such time as the vomiting stops and feeding may be restored. Severely ill patients may require to be treated in intensive-care units and may time to time require ventilatory support.
There is no role for antivirals and antibiotics in rotaviral infections. There is anecdotal evidence of use of immunoglobulins but this requires to be validated with larger clinical trials.
The introduction of vaccines has made dramatic impact on the outcomes of rotaviral infections. In the developed world the use of vaccines over last 20 years has reduced the mortality with rotaviral infections from 35-40 per cent to single digit figures, and this has been one of the biggest accomplishments of the vaccine program.
Unfortunately the biggest burden of rotaviral infections still remain clustered in the developing world where sanitation, water contamination and public health hygiene while continually improving due to efforts of the World Health Organization and United Nations are still work in progress and continue to have pockets of self-limiting outbreaks from time to time. The best measures therefore, are preventive in nature including vaccination and immunisation and public health surveillance to determine the best future strategies of such preventable infections.
