Pediatric rotavirus enteritis

Introduction to pediatric rotavirus enteritis Before the cause is unclear, the change of stool characteristics and the number of stools are more common than usual. It is collectively called diarrheal disease. Diarrhea is a group of diseases caused by multiple causes and multiple factors. It is one of the diseases with the highest incidence in childhood. Worldwide public health problems, diarrhea occurs at least 1 billion people worldwide each year. According to the World Health Organization, about 10,000 people die every day from diarrhoea. In China, diarrhoeal diseases are also common diseases in children. According to relevant data, the annual incidence rate of diarrhea in children under 5 years old in China is 201%, with an average of 2.01 cases per child per year, and the mortality rate is 0.51%. Therefore, the prevention and treatment of diarrhea in children is very important. The most important virus causing viral enteritis is rotavirus, followed by adenovirus, nornov virus, enterovirus, coronavirus, small round virus, star. Virus, etc., but far less than rotavirus. This section focuses on enteritis caused by rotavirus. basic knowledge The proportion of the disease: the child with multiple diseases, the infection rate is high, 80% of the children have infection experience Susceptible people: children Mode of infection: fecal mouth spread Complications: metabolic acidosis electrolyte imbalance dehydration

Causes of pediatric rotavirus enteritis

(1) Causes of the disease

Rotavirus is the main pathogen of diarrhea in infants and young children in autumn and winter. The virus consists of inner and outer capsids and a double-stranded RNA core containing 11 fragments. According to the main protein that constitutes the inner capsid (VP6, virus No.6 protein) The antigenicity is different. The enzymes can be divided into A, B, C, D, E and other genus by enzyme-linked immunosorbent assay (ELISA) and complement fixation. The rotavirus causing diarrhea in infants in autumn and winter is A. Genus, adult rotavirus diarrhea is B genus; B and other rotaviruses are associated with animal infections. Rotavirus can be divided into four groups according to the different antigenicity of its outer capsid proteins VP4 and VP7. Several serotypes cause infant diarrhea to be serotype 1 to 4; animal rotavirus is limited to 3 to 7 serotype.

(two) pathogenesis

Rotavirus mainly invades the duodenal and jejunal proximal mucosal epithelial cells, causing the apical epithelium of the villi to fall off, the villi to become shorter, and the exfoliated epithelium to be replaced by the newly produced epithelium of the crypt. These new epithelial cells are not mature enough and lack disaccharidase. Therefore, the mechanism of diarrhea and the impact of villus destruction, disaccharidase deficiency and epithelial cell damage, increased secretion into the intestinal lumen, recent studies have found that rotavirus receptors, rotavirus shells exist on the intestinal epithelial cell membrane Protein VP4 is an adsorbent protein of virus-infected cells. It enters epithelial cells by binding to target cell receptors. After the virus invades the intestine, it mainly replicates in the columnar epithelial cells of the duodenum and jejunum villi, causing the cells to degenerate. Necrosis, microvilli swelling, irregularity and shortening, affected intestinal mucosal epithelial cells fall off, lymphocytes infiltrate in the lamina propria, therefore, the small intestinal mucosa absorbs water and electrolytes to impair diarrhea, on the other hand, secondary Insufficient secretion of disaccharidase causes the sugar in the food to be incompletely digested and accumulates in the intestinal lumen, and is broken down into small bacteria by bacteria. Child short-chain organic acids, increased intestinal osmotic pressure, increased vomiting and diarrhea.

Prevention of pediatric rotavirus enteritis

The rotavirus vaccine has been under development and has not reached the stage of universal promotion.

1. Maintain good personal, food and environmental hygiene.

2. Wash hands before going to the toilet after handling food or eating.

3. Wear gloves when cleaning vomit, feces and diapers, and wash your hands thoroughly.

4. Clean and disinfect contaminated items and surfaces.

5. If the child has vomiting or diarrhea, he should seek treatment as soon as possible, rest and not go to school.

Complications of pediatric rotavirus enteritis Complications metabolic acidosis electrolyte disorder dehydration

Often complicated by dehydration, acidosis and electrolyte imbalance, individual can cause convulsions due to high fever.

1. Sodium salt (NaCl, NaHCO3) is the main inorganic salt that determines the osmotic pressure of extracellular fluid. Therefore, serum sodium concentration is the main factor determining the osmolality of plasma. Different ratios of water and sodium deficiency lead to different plasma sodium concentrations. Changes and changes in osmotic pressure. When dehydration, dehydration is often divided into three types according to the level of serum sodium: clinical isotonic dehydration, hypotonic dehydration and hypertonic dehydration.

2. Acidosis: Endocrine disease, accumulation of acidic substances in the blood and tissues of the body, the essence of which is the increase of hydrogen ion concentration in the blood and the decrease of pH.

3. Electrolyte disorders Common symptoms: fatigue, muscle cramps, weakness, irritability, nausea, dizziness, confusion, fainting, irritability, vomiting, dry mouth. Less peeing is one of the most common symptoms of electrolyte imbalance. The patient may have no awareness of urinating for more than 7-8 hours. In addition, the following are symptoms that can be observed with severe electrolyte imbalance: coma, slow heart rate, seizures, palpitations, hypotension, and lack of coordination of limbs.

Pediatric rotavirus intestine symptoms common symptoms diarrhea watery water loss dehydration high fever nausea and vomiting

More common in autumn and winter, more common in infants from 6 months to 2 years old, incubation period of 36 ~ 72h, typical sick children often accompanied by mild upper respiratory tract infection symptoms, fever, up to 39 ~ 40 ° C, the first 1-2 days of illness Vomiting can occur before diarrhea, diarrhea is watery stool, such as egg-flower soup, no pus, about 3 to 10 times a day, due to spit, diarrhea, can cause dehydration, acidosis and electrolyte imbalance, sick children in the stool The electrolyte concentration is significantly lower than bacterial enteritis, such as cholera, pathogenic Escherichia coli, etc.; and most of them are acute water loss, so it causes isotonic or isotonic high dehydration, the natural course of the disease is 3 to 8 days, the average About 5 days.

Examination of pediatric rotavirus enteritis

Fecal microscopy of white blood cells 0 ~ 3 / HP, bacterial culture without pathogenic bacteria, pathogenic diagnosis was first diagnosed by electron microscopy, immunoelectron microscopy from the duodenal drainage and feces directly to see rotavirus particles, but not suitable for clinical Conventional applications, currently using immunological or nucleic acid methods to detect antigen in feces, generally 4h can produce results, domestic enzyme-linked immunosorbent assay (ELISA) and extraction of viral RNA in feces for nucleic acid gel electrophoresis (PAGE) More commonly, rotavirus PAGE can be seen in 11 RNA fragments, integrated into 4 groups, each containing 4-2-3-2 fragments, and can be divided into long and short according to the distance between the last two fragments. At present, dot blot hybridization, oligonucleotide and polymerase chain reaction (PCR) methods have been used to detect VP7 protein molecules in the outer capsid of A gene rotavirus to diagnose rotavirus infection and its serotyping.

This method has strong specificity and high sensitivity, but it can only be carried out in some research institutes. In recent years, rotavirus tissue culture has also been successfully succeeded on trypsin-treated Mal04 cell line. Generally, special auxiliary examination is not necessary. Chest X-ray and ECG were performed to determine whether there were any lesions in the lungs. When there was electrolyte imbalance such as hypokalemia, the ST segment of the electrocardiogram was reduced, the T wave was flat, the two phases were inverted, and the u wave appeared and increased gradually. It often exceeds the T-wave of the same lead, or the T-wave is connected to the u-wave as a camel.

Diagnosis and diagnosis of pediatric rotavirus enteritis

diagnosis

Rotavirus enteritis mainly occurs in autumn and winter, mostly in infants and young children between 6 months and 2 years old. The onset is acute, vomiting occurs at the beginning of the disease, the amount of stool is high, yellow or light yellow, watery or egg-flower soup, no Odor smell, no other complications, naturally improved around 1 week, the diagnosis is mainly based on the detection of fecal rotavirus antigen.

Differential diagnosis

The identification of rotavirus enteritis and other viruses caused by diarrhea mainly depends on the pathogen examination. Patients with severe vomiting and diarrhea should be distinguished from gastrointestinal food poisoning and cholera.

1. The clinical manifestations of gastrointestinal food poisoning are mainly acute gastroenteritis, such as nausea, vomiting, abdominal pain, diarrhea, etc. Staphylococcal food poisoning vomiting is obvious, vomit contains bile, sometimes with blood and mucus, abdominal pain above the abdomen and More common in the umbilical cord, frequent diarrhea, mostly yellow loose stools and watery stools, food poisoning caused by invasive bacteria, may have fever, abdominal paroxysmal cramps and mucus pus and bloody stools, some cases of Vibrio parahaemolyticus food poisoning The stool is bloody, the type A bacteria of the genus Clostridium is mild, and a few types of C and F can cause hemorrhagic necrotic enteritis. Proteus mirabilis can also cause facial flushing, headache, urticaria and other allergic symptoms. Severe diarrhea can lead to dehydration, acidosis, and even shock.

2. Cholera (cholera) is a potent intestinal infectious disease caused by Vibrio cholerae. It is an acute and rapid spread. It is an important cause of diarrhea in most parts of Asia and Africa. It is an international quarantine infectious disease. In China, it belongs to Class A infectious diseases. Typical patients due to severe diarrhea and vomiting can cause dehydration, muscle spasm, severe cases of peripheral circulatory failure and acute renal failure, generally more common in mild cases, more carriers, but severe and typical patients can not be treated in time death.

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