Dr. Abdulkarim Alhetheel / Dr. Malak Elhazmi Assistant Professor College of Medicine & KKUH
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Transcript of Dr. Abdulkarim Alhetheel / Dr. Malak Elhazmi Assistant Professor College of Medicine & KKUH
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Dr. Abdulkarim Alhetheel / Dr. Malak Elhazmi
Assistant Professor
College of Medicine & KKUH
VIRAL GASTROENTERITISVIRAL GASTROENTERITIS
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Objectives
• Def. of GE• Viral etiology of GE ( Structures )• Epidemiology• Clinical Features • Lab diagnosis• Treatment &Prevention (Vaccine)
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Gastroenteritis
• It is inflammation of the gastrointestinal tract which involve both stomach and small intestine and leading to acute diarrhea and vomiting.
• Viral etiology include:– Rotavirus. Rotavirus.
– Adenovirus serotype 40, & 41. Adenovirus serotype 40, & 41.
– Caliciviruses (Norovirus). Caliciviruses (Norovirus).
– Astrovirus.Astrovirus.
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Etiologic agents in severe diarrheal illnesses requiring hygiene and rehydration of infants & young children.
Other viruses;
Coronaviruses, Toroviruses, and Enteroviruses
Viruses associated with gastroenteritis
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Electron micrographs of VGE
RotavirusRotavirus AdenovirusAdenovirus
Caliciviruses Astrovirus
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VIRAL GASTROENTERITIS
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Distribution: Worldwide
in poor hygiene, overcrowding, and poverty
Age: Infants & young >> Older children
Transmission: Faecal-oral route
Season: Winter months
Endemic infection: Gp A rota & adeno 40,41
Epidemic infection: Norovirus
Epidemiology
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IP: Short
Symptoms: Diarrhea, Vomiting, Fever & abdominal cramps
Dehydration with Na Life threatening
Winter vomiting disease:
Vomiting > Diarrhea
Calicivirus
Clinical Features
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Cell culture (C/C): growing poorly not used
Electron microscopy (E.M):Many disadvantages not used
Specific test:ELISA for detection of viral Ag in stool samples.
[rota , adeno , astro & caliciviruses]
Lab diagnosis
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Treatment:
Self-limiting
Rehydration and supportive
Prevention:
Sanitation & hygiene measures
No vaccines except for rotavirus
Management
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ROTAVIRUS
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Family: Reoviridae [Respiratory & Enteric Orphan]
Description:
11 segments ds-RNA
Double-layered icosahedral capsid
Non-enveloped
~ 70 nm
RNA – dependent RNA polymerase
7 groups [A-G] ---- GpA most common
ROTAVIRUS
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Spread (or mode of transmission):
Faecal-oral route
Age: all age groups
Symptomatic infection
6 -24 ms.
Peak: Winter months
Infection: Endemic
Epidemiology
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Pathogenesis
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Intestinal infection:
Infants & young children
gastroenteritis or infantile GE
IP = 1-2 dys
Watery, non-bloody diarrhea,vomiting & fever
Dehydration
Outcomes Vary
~1/2 of all GE cases Admission
In developed count. Mortality is low
In developing count. Mortality is significant.
Deaths reported
Clinical featuresClinical features
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Intestinal infection:
Infants & young children GE
Older children + adults asymptomatic
Low Immune hosts chronic diarrhea
Extra-intestinal infection:
Encephalitis small number of cases.
Clinical featuresClinical features
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Sample: stool
Immunoassay Most used
ELISA , ICT& latex agglutination
EM
Gel electrophoresis
RT-PCR
Cell culture
Lab Diagnosis
Immunochromatography Tech.
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Treatment:
Self-limiting
Rehydration
Prevention:
Sanitation & hygiene measures
Vaccine: live attenuated vaccine, oral
Rotashield (withdrawn)
Rotarix
RotaTeq
Management
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ENTERIC ADENOVIRUSES
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Family: Adenoviridae
Description:
Non-enveloped, icosahedral capsid, ds-DNA
Only V with a fiber protruding from each of
the vertices of the capsid
– Fiber Attachment
Hemagglutinin
Type-specific Ag
ENTERIC ADENOVIRUSES
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Classification:
Adenovirus 6 subgenera[A-F]
51 serotypes
Grow in C/C
Enteric adenoviruses Subgenus F
40 & 41 serotypes
Fastidious
ENTERIC ADENOVIRUSES
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Clinical feature:
Longer IP
Less severe than rotavirus
Prolonged illness
Diagnosis:
Ag detection in stool samples by ELISA or Immunochromatography Tech.
ENTERIC ADENOVIRUSES
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Caliciviruses
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Family: Caliciviridae [Calyx =cup]
Description:
Non-enveloped
ss-RNA with +ve polarity
Icosahedral capsid
Two morphologic types
Typical caliciviruses (Sapoviruses)
Small Rounded Structured Viruses (Noroviruses)
Caliciviruses
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Epidemiology
Faecal-oral route [water, shellfish]
Outbreaks of GE in schools, camps & cruises
All age groups
Clinical features
Children vomiting [projectile]
Adults diarrhea
Diagnosis
Viral Ag in stool samples by ELISA
NOROVIRUS (Norwalk virus)
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Astroviruses
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Family: Astroviridae [astro= a star]
Description:
Non-enveloped
ss-RNA with +ve polarity
Icosahedral capsid
8 serotypes
Astroviruses
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Clinical features:
Mild GE
Outbreak of diarrhea <5 ys.
Lab Diagnosis:
Ag detection in stool by ELISA
Astroviruses
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Medical Microbiology.
By: David Greenwood ,Richard Slack,
John Peutherer and Mike Barer.
17th Edition, 2007.
Pages;545-551,565-571
Notes on Medical MicrobiologyBy ; Morag C. Timbury, A. Christine McCartney, Bishan Thakker and Katherine N. Ward
) 2002 (Pages; 338 - 344
Reference books Reference books &the relevant page numbers&the relevant page numbers
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Thank you for your attention !
Questions?
Thank you for your attention !
Questions?