What is the treatment for Astrovirus infection?

Treatment of Astrovirus Infection

The primary treatment for astrovirus infection is oral rehydration therapy (ORT) to manage dehydration and electrolyte imbalances, as the infection is typically self-limiting with symptoms resolving within 1-4 days. 1, 2

Clinical Presentation and Epidemiology

Astrovirus is a common viral cause of gastroenteritis, particularly affecting:

• Children under 7 years of age (primary risk group)
• Elderly individuals
• Immunocompromised patients

The infection presents with:

• Incubation period of 24-36 hours
• Illness duration of 1-4 days
• Symptoms including vomiting, diarrhea, fever, and abdominal pain 1
• Winter peak seasonality in some regions 1

Treatment Algorithm

1. Assessment of Dehydration

• Evaluate for signs of dehydration:
  • Abnormal capillary refill time (>2 seconds)
  • Abnormal skin turgor
  • Tachycardia (>90 bpm)
  • Fever (>37.8°C)
  • Altered mental status (in severe cases) 2

2. Rehydration Therapy

• Mild to Moderate Dehydration:

  • Oral rehydration solution (ORS) is the mainstay of treatment 1, 2
  • Continue normal feeding during illness
  • Resume age-appropriate diet during or immediately after rehydration

• Severe Dehydration:

  • Intravenous fluid therapy for patients with:
    • Severe dehydration
    • Inability to tolerate oral fluids
    • Altered mental status
    • Signs of shock 2

3. Supportive Care

• Maintain normal feeding during illness
• Avoid foods high in simple sugars (can exacerbate diarrhea)
• Consider ondansetron to facilitate oral rehydration in children >4 years with significant vomiting 2
• Monitor for electrolyte imbalances

4. Special Considerations for High-Risk Populations

• Immunocompromised Patients:

  • More vigilant monitoring for complications
  • Extended symptom duration may occur
  • Rare cases of astrovirus encephalitis have been reported in immunocompromised pediatric cancer patients 3

• Elderly in Care Facilities:

  • Implement strict infection control measures
  • Standard precautions plus transmission-based precautions to contain spread 4

Prevention Strategies

• Rigorous handwashing with soap and water for at least 20 seconds
• Alcohol-based hand sanitizers (≥70% ethanol) as an adjunct
• Food hygiene measures
• Exclusion of ill individuals from food handling until 48-72 hours after symptom resolution 2

Important Clinical Pearls

• Astrovirus is the second most common cause of viral gastroenteritis in hospitalized children after rotavirus 5
• Astrovirus infection typically causes less severe disease than rotavirus, with less dehydration and lower symptom severity scores 5
• Person-to-person transmission is most common, but contaminated water and shellfish have been implicated in outbreaks 1
• In adults, symptoms are typically mild with median hospital stay of only 6 hours 6
• No specific antiviral therapy is currently recommended for astrovirus infection 1, 2

Pitfalls to Avoid

• Don't administer antimotility drugs (e.g., loperamide) to children <18 years with acute diarrhea
• Avoid unnecessary antibiotic use, as this is a viral infection
• Don't delay oral rehydration while awaiting laboratory confirmation
• Don't overlook the possibility of co-infections, which occur in approximately 24% of cases 6