ROTA VIRUS INFECTIONS : CLINICAL ASPECTS
After an incubation period of 1 to 3 days, there is usually an abrupt onset of vomiting, followed within hours by frequent, copious, watery, brown stools. In severe cases, the stools may become clear; the Japanese refer to the disease as hakuri, the “white stool di-arrhea.” Fever, usually low grade, is often present. Vomiting may persist for 1 to 3 days, and diarrhea for 4 to 8 days. The major complications result from severe dehydration, oc-casionally associated with hypernatremia.
Diagnosis of acute rotavirus infection is usually by detection of virus particles or antigen in the stools during the acute phase of illness. This can be accomplished by direct exami-nation of the specimen by electron microscopy or, more conveniently, by immunologic detection of antigen with EIA methods .
There is no specific treatment. Vigorous replacement of fluids and electrolytes is required in severe cases and can be life-saving. The rotaviruses are highly infectious and can spread quickly in family and institutional settings. Control consists of rigorous hygienic measures, including careful hand washing and adequate disposal of enteric excretions. Live attenuated reassortant vaccines have been developed, as noted previously. The find-ings to date indicate that such an approach to control or amelioration of the natural infec-tion is feasible. However, there remains some concern about safety, particularly with regard to reports of an increased risk of intussusception among recently immunized in-fants. Until this issue is resolved, vaccine will not be made available for routine use.
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