Rotavirus gastroenteritis is a digestive infection caused by the invasion of a virus called "rotavirus" extremely contagious. Rotavirus gastroenteritis by changing seasonal epidemics, with a peak in winter, and mainly affects young children. It is also a nosocomial disease, by definition, hospital-acquired, as many children are infected while in hospital for another reason: bronchiolitis example.
Health risks and challenges of rotavirus gastroenteritis
Any diarrhea and / or vomiting is a risk of acute dehydration; it is especially important that the person is more fragile (very young or very old) and malnourished (importance of malnutrition in developing countries). Acute dehydration of a fragile person puts his life at risk. *
In a study published in 2005, Melliez and colleagues assessed morbidity and cost of digestive rotavirus infections in children under 5 years: they attribute to it every year 300,000 180,000 acute diarrhea and city consultations, 18,000 hospitalizations and death of ten.
The study Shrik * published in 2009 shows that nearly half (49.1%) of children admitted to the emergency for acute gastroenteritis suffer from rotavirus. They are very young: nearly 90% have less than 2 years and almost 20% less than 6 months.
For InVS, 43% to 51% of viral gastroenteritis in hospitalized under 5 are due to rotavirus. Complications, first dehydration occur in 20% of cases and cause thirty deaths annually. They are more common with rotavirus, particularly among infants less than 6 months.
In the city, only 20% of gastroenteritis due to rotavirus would, because of many "competitors" viral, including calicivirus (including the principal, Norovirus, may be more common than rotavirus), adenoviruses ... But gastro Rotavirus -entérites are most severe.
In people over 75 years, the mortality of viral gastroenteritis (all virus) is around 350 deaths annually. But the deaths are probably more because dehydration causes very poorly tolerated blood disorders in these individuals often malnourished, with several diseases and treatments delicate to handle: antihypertensive and cardiovascular drugs first.
Causes and mechanisms of gastroenteritis
The virus penetrates the intestinal cells and blocks its operation. The cells do not absorb water and food, the movement is reversed: they reject the intestine water and minerals essential to good blood balance. This digestive cell leakage is called "entero-toxigenic" it causes diarrhea and vomiting.
This viral invasion can permanently change the bacterial flora; and install a milk intolerance (sugar and protein) unwelcome in children.
Contagiousness is extreme: the stool of a baby can issue up to one billion viral particles of the 3rd day of the 5th day illness. Sometimes shedding continues for 15 days!
Symptoms and signs of gastroenteritis due to rotavirus
Rotavirus, like other gastrointestinal viruses, multiplies for two to three days after infection. The first symptom (usually but not always) has a high fever (up to 40 ° C) at the same time as diarrhea (from 3 stools / day more or less liquid) and sometimes vomiting. Vomiting is an unfavorable factor because they prevent food so rehydration. Any diarrhea carries a risk of dehydration, which made its danger.
Mild diarrhea does not give signs of dehydration, there is no vomiting or weight loss.
Serious diarrhea dehydrates. The symptoms are high fever, thirst (careful, toddlers do not know how to express it), a fold of skin (skin does not come back up immediately when pinched in the arm for example), the weight loss (5%), vomiting, loss of appetite ...
Severe diarrhea sees signs of marked dehydration: persistent skin fold, sunken eyes,
dry mouth, crying without tears, gray complexion, significant weight loss +++ (10%), loss of consciousness leading to coma and death if no resuscitation is taken urgently.
With what should we be confused?
Any viral diarrhea is not: food poisoning bacteria (staphylococcus, E. coli, Salmonella) are not uncommon. The notion of a suspect food and similar cases in the entourage after the same meal referrals diagnosis. The presence of blood or mucus in the stool is a strong indication of bacterial infection.
Any diarrhea is not infectious: then there is no fever (except in special cases). The intolerance to cow's milk, gluten intolerance are causes to evoke systematically, especially when diarrhea persists.
Some diarrhea is associated with other infections or disorders: otitis, appendicitis, intussusception (occlusion) or deep UTI ...
Will it possible prevention?
The integral partial breastfeeding protects children against rotavirus gastroenteritis.
Hand hygiene and food (kitchen) is essential to limit epidemics and the number of people in a community (family, nursery).
Vaccination against rotavirus is 100% effective against the serious forms and hospitalizations. But it is not recommended in the general population by the Board of Public Hygiene since it protects against that half (at best) officials gastroenteritis virus. The oral vaccine is administered at the 6th week of life, especially to infants exposed to harsh conditions and / or random surveys. Two vaccines are licensed. One requires two doses to be taken by mouth and the other three doses.
When to consult?
Any liquid sudden diarrhea with vomiting requires rapid consultation of a doctor. Hospital emergency if the stools are continuous.
How to prepare for the consultation of doctor?
Immediately begin oral rehydration with "oral rehydration salts (ORS)" counter in pharmacies. In small regular amounts or even the syringe to the beginning if the child refuses solute bottle (1 sachet in 200ml of water).
Note the number of stools per day and their liquid or soft nature, presence or absence of blood and mucus.
Recall the context: current epidemic in the family, school, nursery, home nanny ...
But also other ongoing illnesses that make it very fragile person, heart and kidney disease in particular.
What does the doctor?
It checks the intensity of dehydration (weight, etc.), it evaluates the difficulty of re-hydrate and nourish the patient.
It identifies the exact cause as much as possible to develop the relevant treatment.
According to the condition, he decides to no supervision or hospitalization for intensive care.
It prescribes rehydration with oral rehydration solution (ORS) that restores blood and intestinal balance and recharge during illness. This resolves spontaneously within a week in mild cases. He explains the isolation of infants (out of the crib, or in the nanny) and hygiene rules to limit the spread of gastrointestinal virus. It adapts the current drugs, diarrhea and dehydration.
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