From the Guidelines
Rotavirus infection is typically diagnosed through clinical evaluation and laboratory testing of stool samples, with enzyme immunoassay (EIA) tests and polymerase chain reaction (PCR) tests being the most common diagnostic methods. The diagnosis of rotavirus infection is crucial for reliable surveillance and can be useful in clinical settings, especially for infection-control purposes 1.
Diagnostic Approaches
The most widely used diagnostic laboratory method is antigen detection in the stool by an enzyme immunoassay (EIA) directed at an antigen common to all group A rotaviruses 1. Other techniques, including electron microscopy, RNA electrophoresis, reverse transcription--polymerase chain reaction (RT-PCR), sequence analysis, and culture, are used primarily in research settings.
Treatment Options
Treatment is primarily supportive, focusing on preventing dehydration through oral rehydration therapy using solutions like Pedialyte or WHO-formulated oral rehydration salts (ORS) 1. For mild to moderate dehydration, ORS should be administered at 50-100 mL/kg over 4 hours, while severe dehydration requires intravenous fluids such as lactated Ringer's solution or normal saline at 20 mL/kg boluses.
- Zinc supplementation (10-20 mg daily for 10-14 days) can reduce symptom severity and duration in children.
- Antiemetics like ondansetron may be used for persistent vomiting, but antidiarrheal medications should be avoided, especially in children.
- Probiotics such as Lactobacillus GG or Saccharomyces boulardii might help reduce symptom duration.
Prevention
Prevention through rotavirus vaccination is highly effective, with vaccines like Rotarix and RotaTeq recommended for infants 1. Strict hygiene practices, including handwashing and disinfection of contaminated surfaces with bleach-based cleaners, are essential for preventing transmission, as rotavirus is highly contagious and resistant to many common disinfectants. The implementation of rotavirus vaccines has significantly reduced the burden of acute gastroenteritis, hospitalizations, and deaths, especially in infants and young children 1.
Key Considerations
- The clinical spectrum of rotavirus illness in children ranges from mild, watery diarrhea of limited duration to severe diarrhea with vomiting and fever that can result in dehydration with shock, electrolyte imbalance, and death 1.
- Initial infection after age 3 months is most likely to cause severe gastroenteritis and dehydration 1.
- The risk of death from diarrhea is increased among certain populations, including African Americans, those with prematurity, low birth weight, less maternal education, and low income 1.
From the Research
Diagnostic Approaches for Rotavirus Infection
- Rotaviruses are routinely diagnosed by detection of rotavirus antigen in stools using an enzyme immunoassay (EIA) 2
- Reverse transcription polymerase chain reaction (RT-PCR) is a sensitive method that may reveal more rotaviruses than EIA, but the clinical significance of such findings is not well established 2
- Immunochromatographic rotavirus antigen tests have high sensitivity and specificity for the diagnosis of rotavirus infection in children with acute gastroenteritis (AGE) 3
- Real-time quantitative PCR has advantages in specificity, sensitivity, genotyping, and quantitative accuracy for the detection of group A rotavirus 4
Comparison of Diagnostic Tests
- A comparative analysis of three commercially available enzyme immunoassay kits (Premier™ Rotaclone®, ProSpecT™, and RIDASCREEN®) showed that all three kits are suitable for use by rotavirus surveillance programs, with sensitivities ranging from 75% to 82.1% and specificity of 100% 5
- A comparison of enzymatic immunoassay and rapid chromatographic test with two quantitative RT-PCR assays showed that RT-qPCR is more sensitive for surveillance of rotavirus gastroenteritis than routinely used EIA or RDT methods 6
- The sensitivity of EIA and RDT was assessed as 84.2% and 82.5%, respectively, while the specificity was calculated as 97.8% for EIA and 96.4% for RDT 6
Treatment Options
- There are no specific treatments for rotavirus infection, but supportive care such as hydration and electrolyte replacement can help manage symptoms
- Vaccination is the most effective way to prevent rotavirus infection, and several vaccines are available, including the rhesus-human reassortant rotavirus tetravalent (RRV-TV) vaccine 2
Clinical Significance
- Clinically, cases of rotavirus gastroenteritis diagnosed by RT-PCR were much milder than those diagnosed by EIA, with a median severity score of 6 compared to 11 2
- The use of RT-PCR as a gold standard lowered the observed sensitivity of EIA kits, but helps to reduce equivocal results that can be seen when another EIA or other non-molecular methods are used as the reference assay in comparison studies 5