John E. Monaco, M.D.
The season has begun. It starts in Mexico and the Southwest and slowly but steadily spreads across the continental U.S. until it reaches the Northeast by spring. It is the single most common cause of severe diarrhea in children under age 2-years-old.
In developing countries, it can be a huge cause of dehydration and death. By the age of three, practically every child in the U.S. has been infected by this group of viruses.
What are they? They are called the rotaviruses, and they are the least well known, yet one of the most common causes for children to be admitted to the hospital with diarrhea.
We have begun to see many children infected with these viruses on our service as we approach the cooler months in our part of the country. It is always amazing to me how similar these children are in the symptoms that cause their parents to bring them to the doctor or hospital. It usually begins with fever. It seems the younger the patient the more often the fever is not associated with any other symptoms.
Vomiting, however, is commonly the first sign after fever. And this vomiting can be quite violent and profuse. One toddler we cared for vomited dozens of times and was seen in the emergency room twice before it was decided he would require admission to the hospital.
Within a couple of days, sometimes after the child has already been admitted to the hospital for dehydration, the diarrhea begins. And it is impressive. Parents and nurses describe the stools as consisting almost entirely of water. They are frequent and voluminous and are associated with tremendous water and electrolyte losses, particularly bicarbonate and potassium.
Without intervention with IV fluids, this condition can, indeed, be life threatening due to the severe dehydration, acidosis (blood becoming more acid) and electrolyte losses. Ironically, the infant mortality rate worldwide would be considerably less simply with increased availability of IV fluids to successfully resuscitate these children until the virus runs its course.
Symptoms can last anywhere from three to eight days. Parents sometimes become impatient as their child's hospitalization drags on past the third or fourth day and the only treatment required is IV fluids.
It is hard to believe that what sometimes stands between their child's healthy recovery and severe, life threatening dehydration and shock is a simple IV line with fluids, but in this case it is definitely true.
This time of the year we will invariably have two or three children on our service with rotavirus enteritis. It's that common. Yet, 90% of parents of these infected children, when told that their child has a rotavirus infection, swear that they have never heard of it.
True, it is not a very romantic infection, it does not come from exotic locations and it has little chance of being used as a weapon of bioterrorism. Yet it is a cause of considerable worldwide childhood morbidity and mortality.
Several years ago an immunization for rotavirus was made available but it was quickly pulled off the market because of the high frequency of associated complications. No other vaccine is in the works at the present time.
So when your child has severe, profuse diarrhea that was preceded by vomiting and fever, think of rotavirus. But you can rest assured. The test for it is quite simple, and can be done in most labs. The treatment is even simplerÉ fluids, that's all.
Just remember the disease that gets little respect. Those of you who have experienced it, will respect it, just as your child's doctor undoubtedly does.s, suggestions, and thoughts on his observations.
John E. Monaco, M.D., is board certified in both Pediatrics and Pediatric Critical Care. He lives and works in Tampa, Florida. He welcomes your comment
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