Rotavirus – the most common cause of diarrhea in children and infants

Rotavirus – the most common cause of diarrhea in children and infants

Rotavirus – the most common cause of diarrhea in children and infants


The autumn-winter season is not only a period conducive to developing infections of the respiratory tract, but also a time of more frequent occurrence of viral infections in the gastrointestinal tract.


Commonly, intestinal infections with diarrhea are referred to by patients (and sometimes also by doctors) as “intestinal flu”, although they have nothing to do with influenza or influenza viruses.


In the cold months of the year the predominant etiologic factors causing acute diarrhea are primarily rotaviruses and, less commonly, adenovirus y and caliciviruses. What connects viral gastrointestinal infections with influenza, which is an acute respiratory viral disease, is similar seasonality. Rotaviruses, adenoviruses and caliciviruses cause severe diarrhea.


Rotaviruses are responsible for 50 to 70% of cases of acute diarrhea, especially in children under 2 years of age. With respect to these infections, in countries with temperate climates such as Poland, a clear seasonality of cases is observed, consisting in an increase in the frequency of infections in the autumn and spring season.


Infection is spread through direct contact: most often via the faecal-oral route (and can be transmitted further through contaminated hands, dishes, other objects or food), but also through infected water and through a droplet route.


The peak incidence of rotavirus diarrhea falls in the winter months of the year and is often epidemic, causing infections in children’s clusters, e.g. nurseries, kindergartens and hospital departments.


Usually, the disease has an acute course: symptoms last for 3 to 8 days and can lead to dehydration, electrolyte imbalance and a significant deterioration in the child’s general condition.



Adenoviruses are another important etiological factor in acute diarrhea. They play an important role in the pathogenesis of respiratory diseases, while infections in the gastrointestinal tract are caused by infections with strains 40 and 41.


The infection mainly affects infants and young children and can occur throughout the year. Symptoms of the disease affect the gastrointestinal tract and respiratory system in the form of rhinitis, pharyngitis or otitis.


Calicivirus infection is similar to rotavirus infection, although the severity of symptoms is usually lower. In addition to acute diarrhea, patients may have flimsy rashes.


Regardless of the etiology, the clinical picture of viral gastrointestinal infection is dominated by vomiting and diarrhea, sometimes accompanied by fever and signs of respiratory tract infection. Some patients have anorexia, abdominal pain or bloating.


As a result of passing numerous watery or semi-liquid stools and vomiting of varying intensity, dehydration and metabolic disorders occur, which may require hospitalization and parenteral hydration.


Symptoms of viral gastrointestinal infection


The younger the child or the older the adult, the greater the risk of rapid dehydration and associated complications of acute diarrhea. in children This is due to a larger proportion of body surface area to body fluid volume and a faster metabolic rate. In both groups at risk: lower fluid reserve and dependence on caregivers. Increasing dehydration may be indicated by a change in behavior: irritability, drowsiness or apathy.


Management during diarrhea of infants and children


Management of acute viral diarrhea is symptomatic – there is no drug that would act directly on the causative agent of infection, but you should try to compensate for existing water and electrolyte deficiencies and maintain a proper hydration state.In all patients, regardless of age, who are in good general condition and have mild or moderate symptoms of dehydration, the treatment of choice should be oral irrigation based on so-called oral rehydration therapy (ORT).


It is the most physiological and safe way of irrigation that can be used in any situation without necessity

detaining a patient in hospital.


ORT can be given from the first moment diarrhea symptoms occur. An ideal ORT should guarantee proper absorption of water and electrolytes. For this purpose, the fluid osmolarity must be in the range 210-250 mOsm / l, and the sodium concentration about 60 mmol / l.

ORT should be given often, in small portions (depending on the child’s age: dropper, spoon or small sips) as this minimizes the risk of vomiting. It is also worth remembering that cool liquid is better tolerated and after preparation, and before serving, you can cool it in the fridge.

It should be noted that other liquids (e.g. fruit juice, chicken broth, coca-cola) have high osmolarity, high sucrose content and have incorrect electrolyte proportions. Therefore, they should not be used to hydrate patients with acute diarrhea.


An oral irrigation attempt can sometimes fail despite complying with all rules and recommendations. This happens when, for example, the patient experiences persistent vomiting. Also severe dehydration is an indication to start intravenous irrigation, which can then be continued with DPN.


Dr. Kinga Kowalska, MD, Duplaga