Chapter

Virus infections causing diarrhoea and vomiting

Philip Dormitzer and Ulrich Desselberger

in Oxford Textbook of Medicine

Fifth edition

Published on behalf of Oxford University Press

ISBN: 9780199204854
Published online May 2012 | e-ISBN: 9780199570973 | DOI: http://dx.doi.org/10.1093/med/9780199204854.003.070509_update_001

Series: Oxford Textbooks

Virus infections causing diarrhoea and vomiting

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Gastroenteritis is frequently caused by rotaviruses, enteric adenoviruses (group F), human caliciviruses (noroviruses, sapoviruses), and astroviruses: these cause much disease worldwide and considerable mortality, mainly in developing countries. Other viruses found in the human gastrointestinal tract are not regularly associated with diarrhoeal disease, except in patients who are immunosuppressed and in whom herpes simplex virus, cytomegalovirus, and picobirnaviruses can cause diarrhoea, as can HIV itself.

Epidemiology—(1) Rotaviruses—the major cause of endemic infantile gastroenteritis worldwide; transmission is by the faeco-oral route; there is a strict winter peak of infections in temperate climates, but these occur year round in tropical and subtropical regions; many animals and birds harbour a large diversity of rotaviruses and may act as a reservoir for human infections. (2) Human caliciviruses—the most important cause of nonbacterial gastroenteritis outbreaks worldwide—frequently spread by contamination of food (oysters, green salads, fresh fruit, cold foods, and sandwiches) and water.

Clinical features and management—following an incubation period of 1 to 2 days, there is sudden onset of watery diarrhoea lasting between 4 and 7 days, vomiting, and varying degrees of dehydration. Other features include abdominal cramps, headache, myalgia and fever. Treatment is supportive, mainly with oral rehydration solutions or—in more severe cases—intravenous rehydration.

Diagnosis—viral infection can be demonstrated by passive particle agglutination tests, virus-specific enzyme-linked immunosorbent assays, and by viral genome detection using the polymerase chain reaction (PCR) (for adenoviruses) or reverse transcription-PCR (RT-PCR) (for rotaviruses, caliciviruses, and astroviruses).

Prevention and control: two live attenuated oral rotavirus vaccines have recently been licensed in numerous countries, in some of which universal mass vaccination of children as part of childhood vaccination schemes has been accepted. There are no vaccines against other viruses causing gastroenteritis in humans. Outbreak control measures relate mainly to calicivirus-associated gastroenteritis and focus on the interruption of person-to-person transmission and the removal of common sources of infection (food, water, etc).

Chapter.  5167 words.  Illustrated.

Subjects: Medical Microbiology and Virology ; Infectious Diseases

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