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. 2004 Sep 14;9:9–21. doi: 10.1016/S0168-7069(03)09002-5

I, 1.Viral causes of gastroenteritis

Umesh D Parashar 1, Roger I Glass 1
PMCID: PMC7134077  PMID: 32287598

Publisher Summary

This chapter discusses the causative viral agents, pathophysiology, and immunology of gastroenteritis. Acute gastroenteritis is among the most common illnesses of humans and is caused by a variety of agents, including bacteria, viruses, parasites, toxins, and chemicals. The clinical spectrum ranges from asymptomatic or mild infection to severe dehydrating illness with a fatal outcome; the latter occurs primarily in young children and in the elderly. The chapter concludes with a discussion on the prevention and treatment of gastroenteritis. For the prevention of epidemic viral gastroenteritis, efforts need to be focused on caliciviruses. No specific antiviral therapy is recommended for childhood viral gastroenteritis, emphasizing the importance of distinguishing it from the selected forms of bacterial and parasitic gastroenteritis that require treatment. Other than pertinent epidemiologic information, certain clinical features of illness may provide etiologic clues, but they are not highly discriminating. Standard therapy of viral enteric infections relies on maintenance of adequate hydration and electrolyte balance. Oral rehydration therapy (ORT) is the main treatment.

References

  1. Ball J.M., Tian P., Zeng C.Q.-Y., Morris A.P., Estes M.K. Age-dependent diarrhea induced by a rotaviral nonstructural glycoprotein. Science. 1996;272:101–104. doi: 10.1126/science.272.5258.101. [DOI] [PubMed] [Google Scholar]
  2. Bern C., Martines J., de Zoysa I., Glass R.I. The magnitude of the global problem of diarrhoeal disease: a ten year update. Bull World Health Organ. 1992;70:705–714. [PMC free article] [PubMed] [Google Scholar]
  3. Bishop R.F., Davidson G.P., Holmes I.H., Ruck B.J. Virus particles in epithelial cells of duodenal mucosa from children with viral gastroenteritis. Lancet. 1973;i:1281–1283. doi: 10.1016/s0140-6736(73)92867-5. [DOI] [PubMed] [Google Scholar]
  4. Bon F., Fascia P., Dauvergne M., Tenenbaum D., Planson H., Petion A.M., Pothier P., Kohli E. Prevalence of group A rotavirus, human calicivirus, astrovirus, and adenovirus type 40 and 41 infection among children with acute gastroenteritis in Dijon, France. J Clin Microbiol. 1999;37:3055–3058. doi: 10.1128/jcm.37.9.3055-3058.1999. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Brandtzaeg P. Development and basic mechanisms of human gut immunity. Nutr Rev. 1998;56:S5–18. doi: 10.1111/j.1753-4887.1998.tb01645.x. [DOI] [PubMed] [Google Scholar]
  6. Bresee J., Glass R.I., Ivanoff B., Gentsch J. Current status and future priorities for rotavirus vaccine development, evaluation, and implementation in developing countries. Vaccine. 1999;17:2207–2222. doi: 10.1016/s0264-410x(98)00376-4. [DOI] [PubMed] [Google Scholar]
  7. Centers for Disease Control and Prevention Intussusception among recipients of rotavirus vaccine, United States, 1998–1999. Morb Mortal Wkly Rep. 1999;48:577–581. [PubMed] [Google Scholar]
  8. Chiba S., Nakata S., Numata-Kinoshita K., Honma S. Sapporo virus: history and recent findings. J Infect Dis. 2000;181(suppl 2):S303–S308. doi: 10.1086/315574. [DOI] [PubMed] [Google Scholar]
  9. Coulson B.S., Grimwood K., Masendycz P., Lund J., Mermelstein N., Bishop R., Barnes G. Comparison of rotavirus immunoglobulin A coproconversion with other indices of rotavirus infection in a longitudinal study in childhood. J Clin Microbiol. 1990;28:1367–1374. doi: 10.1128/jcm.28.6.1367-1374.1990. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Coulson B.S., Grimwood K., Hudson I.L., Barnes G.L., Bishop R.F. Role of coproantibody in clinical protection of children during reinfection with rotavirus. J Clin Microbiol. 1992;30:1678–1684. doi: 10.1128/jcm.30.7.1678-1684.1992. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Cunliffe N.A., Gondwe J.S., Kirkwood C.D., Graham S.M., Nhlane N.M., Thindwa B.D.M., Dove W., Broadhead R.L., Molyneux M.E., Hart C.A. Effect of concomitant HIV infection on presentation and outcome of rotavirus gastroenteritis in Malawian children. Lancet. 2001;358:550–555. doi: 10.1016/s0140-6736(01)05706-3. [DOI] [PubMed] [Google Scholar]
  12. Cunningham A.L., Grohmann G.S., Harkness J., Law C., Marriott D., Tindall B., Cooper D.A. Gastrointestinal viral infections in homosexual men who were symptomatic and seropositive for human immunodeficiency virus. J Infect Dis. 1988;158:386–391. doi: 10.1093/infdis/158.2.386. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Desselberger U. Rotavirus infections: guidelines for treatment and prevention. Drugs. 1999;58:447–452. doi: 10.2165/00003495-199958030-00005. [DOI] [PubMed] [Google Scholar]
  14. de Wit M.A., Koopmans M.P., Kortbeek L.M., van Leeuwen N.J., Bartelds A.I., van Duynhoven Y.T. Gastroenteritis in sentinel general practices, The Netherlands. Emerg Infect Dis. 2001;7:82–91. doi: 10.3201/eid0701.010113. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Duggan C., Santosham M., Glass R.I. The management of acute diarrhea in children: oral rehydration, maintenance, and nutritional therapy. Morb Mortal Wkly Rep. 1992;41(RR-16):1–20. [PubMed] [Google Scholar]
  16. Fankhauser R.L., Noel J.S., Monroe S.S., Ando T.A., Glass R.I. Molecular epidemiology of “Norwalk- like viruses” in outbreaks of gastroenteritis in the United States. J Infect Dis. 1998;178:1571–1578. doi: 10.1086/314525. [DOI] [PubMed] [Google Scholar]
  17. Flewett T.H., Beards G.M., Brown D.W., Sanders R.C. Vol. 128. 1987. The diagnostic gap in diarrhoeal aetiology; pp. 238–249. (Ciba Found Symp). [DOI] [PubMed] [Google Scholar]
  18. Flewett T.H., Bryden A.S., Davies H. Virus particles in gastroenteritis. Lancet. 1973;ii:1497. doi: 10.1016/s0140-6736(73)92760-8. [DOI] [PubMed] [Google Scholar]
  19. Franco A.A., Greenberg H.B. Role of B cells and cytotoxic T lymphocytes in clearance of and immunity to rotavirus infection in mice. J Virol. 1995;69:7800–7806. doi: 10.1128/jvi.69.12.7800-7806.1995. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Gilger M.A., Matson D.O., Conner M.E., Rosenblatt H.M., Finegold M.J., Estes M.K. Extraintestinal rotavirus infections in children with immunodeficiency. J Pediatr. 1992;120:912–917. doi: 10.1016/s0022-3476(05)81959-6. [DOI] [PubMed] [Google Scholar]
  21. Giordano M.O., Martinez L.C., Rinaldi D., Guinard S., Naretto E., Casero R., Yacci M.R., Depetris A.R., Medeot S.I., Nates S.V. Detection of picobimavirus in HIVinfected patients with diarrhea in Argentina. J Acqu Imm Defic Syndr Hum Retrovirol. 1998;18:380–383. doi: 10.1097/00042560-199808010-00010. [DOI] [PubMed] [Google Scholar]
  22. Giordano M.O., Martinez L.C., Espul C., Martinez N., Isa M.B., Depetris A.R., Medeot S.I., Nates S.V. Diarrhea and enteric emerging viruses in HIV-infected patients. AIDS Res Hum Retroviruses. 1999;15:1427–1432. doi: 10.1089/088922299309937. [DOI] [PubMed] [Google Scholar]
  23. Glass R.I., Bresee J., Jiang B.-M., Gentsch J., Ando T., Fankhauser R., Noel J., Parashar U., Rosen B., Monroe S.S. Vol. 238. 2001. Gastroenteritis viruses: an overview; pp. 5–19. (Novartis Found. Symp). [DOI] [PubMed] [Google Scholar]
  24. Gonzalez G.G., Pujol F.H., Liprandi F., Deibis L., Ludert J.E. Prevalence of enteric viruses in human immunodeficiency virus seropositive patients in Venezuela. J Med Virol. 1998;55:288–292. doi: 10.1002/(sici)1096-9071(199808)55:4<288::aid-jmv6>3.0.co;2-x. [DOI] [PubMed] [Google Scholar]
  25. Gordon I., Ingraham H.S., Kors R.F. Transmission of epidemic gastroenteritis to human volunteers by oral administration of fecal filtrates. J Exp Med. 1947;86:409–422. doi: 10.1084/jem.86.5.409. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. Graham D.Y., Jiang X., Tanaka T., Opekun A.R., Madore H.P., Estes M.K. Norwalk virus infection of volunteers: new insights based on improved assays. J Infect Dis. 1994;170:34–43. doi: 10.1093/infdis/170.1.34. [DOI] [PubMed] [Google Scholar]
  27. Gray J.J., Cunliffe C., Ball J., Graham D.Y., Desselberger U., Estes M.K. Detection of immunoglobulin M (IgM), IgA, and IgG Norwalk virus-specific antibodies by indirect enzyme-linked immunosorbent assay with baculovirus-expressed Norwalk virus capsid antigen in adult volunteers challenged with Norwalk virus. J Clin Microbiol. 1994;32:3059–3063. doi: 10.1128/jcm.32.12.3059-3063.1994. [DOI] [PMC free article] [PubMed] [Google Scholar]
  28. Greenberg H.B., Clark H.F., Offit P.A. Rotavirus pathology and pathophysiology. In: Ramig R.F., editor. Rotaviruses. Springer-Verlag; Berlin: 1994. pp. 255–283. [Google Scholar]
  29. Grohmann G.S., Glass R.I., Pereira H.G., Monroe S.S., Hightower A.W., Weber R., Bryan R.T. Enteric viruses and diarrhea in HIV-infected patients. N Engl J Med. 1993;329:14–20. doi: 10.1056/NEJM199307013290103. [DOI] [PubMed] [Google Scholar]
  30. Johnson P.C., Mathewson J.J., Dupont H.L., Greenberg H.B. Multiple-challenge study of host susceptibility to Norwalk gatroenteritis in US adults. J Infect Dis. 1990;161:18–24. doi: 10.1093/infdis/161.1.18. [DOI] [PubMed] [Google Scholar]
  31. Kaljot K.T., Ling J.P., Gold J.W.M., Laughon B.E., Bartlett J.G., Kotler D.P., Oshiro L.S., Greenberg H.B. Prevalence of acute enteric viral pathogens in acquired immunodeficiency syndrome patients with diarrhea. Gastroenterology. 1989;97:1031–1032. doi: 10.1016/0016-5085(89)91516-3. [DOI] [PMC free article] [PubMed] [Google Scholar]
  32. Kapikian A.Z., Wyatt R.G., Dolin R., Thornhill T.S., Kalica A.R., Chanock R.M. Visualization by immune electron microscopy of a 27 nm particle associated with acute infectious nonbacterial gastroenteritis. J Virol. 1972;10:1075–1081. doi: 10.1128/jvi.10.5.1075-1081.1972. [DOI] [PMC free article] [PubMed] [Google Scholar]
  33. Kapikian A.Z., Estes M.K., Chanock R.M. Norwalk group of viruses. In: Fields B.N., Knipe D.M., Howley P.M., Chanock R.M., Melnick J.L., Monath T.P., Roizman B., Straus S.E., editors. Fields Virology. 3rd ed. Lippincott-Raven; Philadelphia: 1976. pp. 783–810. [Google Scholar]
  34. Koopmans M., Petric M., Glass R.I., Monroe S.S. Enzyme-linked immunosorbent assay reactivity of torovirus-like particles in fecal specimens from humans with diarrhea. J Clin Microbiol. 1993;31:2738–2744. doi: 10.1128/jcm.31.10.2738-2744.1993. [DOI] [PMC free article] [PubMed] [Google Scholar]
  35. Krilov L.R., Rubin L.G., Frogel M., Gloster E., Ni K., Kaplan M., Lipson S.M. Disseminated adenovirus infection with hepatic necrosis in patients with human immunodeficiency virus infection and other immunodeficiency states. Rev Infect Dis. 1990;12:303–307. doi: 10.1093/clinids/12.2.303. [DOI] [PubMed] [Google Scholar]
  36. Lundgren O., Peregrin A.T., Persson K., Kordasti S., Uhnoo I., Svensson L. Role of the enteric nervous system in the fluid and electrolyte secretion of rotavirus diarrhea. Science. 2000;287:491–495. doi: 10.1126/science.287.5452.491. [DOI] [PubMed] [Google Scholar]
  37. Madeley C.R., Cosgrove B.P. 28 run particles in faeces in infantile gastroenteritis. Lancet. 1975;ii:451–452. doi: 10.1016/s0140-6736(75)90858-2. [DOI] [PubMed] [Google Scholar]
  38. Madeley C.R., Cosgrove B.P. Viruses in infantile gastroenteritis. Lancet. 1975;ii:124. doi: 10.1016/s0140-6736(75)90020-3. (letter) [DOI] [PubMed] [Google Scholar]
  39. Matson D.O., O'Ryan M.L., Herrera I., Pickering L.K., Estes M.K. Fecal antibody responses to symptomatic and asymptomatic rotavirus infections. J Infect Dis. 1993;167:577–583. doi: 10.1093/infdis/167.3.577. [DOI] [PubMed] [Google Scholar]
  40. McNeal M.M., Rae M.N., Ward R.L. Evidence that resolution of rotavirus infection in mice is due to both CD4 and CD8 cell-dependant activities. J Virol. 1997;71:8735–8742. doi: 10.1128/jvi.71.11.8735-8742.1997. [DOI] [PMC free article] [PubMed] [Google Scholar]
  41. Meeroff J.C., Schreiber D.S., Trier J.S., Blacklow N.R. Abnormal gastric motor function in viral gastroenteritis. Ann Intern Med. 1980;92:370–373. doi: 10.7326/0003-4819-92-3-370. [DOI] [PubMed] [Google Scholar]
  42. Miller M.A., McCann L. Policy analysis of the use of hepatitis B, Haemophilus influenzae type B-, Streptococcus pneumoniae-conjugate, and rotavirus vaccines in National Immunization Schedules. Health Econ. 2000;9:19–35. doi: 10.1002/(sici)1099-1050(200001)9:1<19::aid-hec487>3.0.co;2-c. [DOI] [PubMed] [Google Scholar]
  43. Murphy T.V., Gargiullo P.M., Massoudi M.S., Nelson D.B., Jumaan A.O., Okoro C.A., Zanardi L.R., Setia S., Fair E.L., LeBaron C.W., Schwartz B., Wharton M., Livingood J.R. Intussusception among infants given an oral rotavirus vaccine. N Engl J Med. 2001;344:564–572. doi: 10.1056/NEJM200102223440804. [DOI] [PubMed] [Google Scholar]
  44. Murray C.J., Lopez A.D. Global mortality, disability, and the contribution of risk factors: global burden of disease study. Lancet. 1997;349:1436–1442. doi: 10.1016/S0140-6736(96)07495-8. [DOI] [PubMed] [Google Scholar]
  45. Offit P.A. Host factors associated with protection against rotavirus disease: the skies are clearing. J Infect Dis. 1996;174(suppl 1):S59–S64. doi: 10.1093/infdis/174.supplement_1.s59. [DOI] [PubMed] [Google Scholar]
  46. Osborne M.P., Haddon S.J., Spencer A.J., Collins J., Starkey W.G., Wallis T.S., Clarke G.J., Worton K.J., Candy D.C.A., Stephen J. An electron microscopic investigation of time-related changes in the intestine of neonatal mice infected with murine rotavirus. J Pediatr Gastroenterol Nutr. 1988;7:236–248. doi: 10.1097/00005176-198803000-00014. [DOI] [PubMed] [Google Scholar]
  47. Oshitani H., Kasolo F.C., Mpabalwani M., Luo N.P., Matsubayashi N., Bhat G.H., Suzuki H., Numazaki Y., Zumla A., DuPont H.L. Association of rotavirus and human immunodeficiency virus infection in children hospitalized with acute diarrhea, Lusaka, Zambia. J Infect Dis. 1994;169:897–900. doi: 10.1093/infdis/169.4.897. [DOI] [PubMed] [Google Scholar]
  48. Pang X.-L., Honma S., Nakata S., Vesikari T. Human caliciviruses in acute gastroenteritis of young children in the community. J Infect Dis. 2000;181(suppl 2):5288–5294. doi: 10.1086/315590. [DOI] [PubMed] [Google Scholar]
  49. Parrino T.A., Schreiber D.S., Trier J.S., Kapikian A.Z., Blacklow N.R. Clinical immunity in acute gastroenteritis caused by Norwalk agent. N Engl J Med. 1977;297:86–89. doi: 10.1056/NEJM197707142970204. [DOI] [PubMed] [Google Scholar]
  50. Qiao H., Nilsson M., Abreu E.R., Hedlund K.-O., Johansen K., Zaori G., Svensson L. Viral diarrhea in children in Beijing, China. J Med Virol. 1999;57:390–396. [PubMed] [Google Scholar]
  51. Rosen B.I., Fang Z.-Y., Glass R.I., Monroe S.S. Cloning of human picorbirnavirus gene segments and development of an RT-PCR detection assay. Virology. 2000;277:316–329. doi: 10.1006/viro.2000.0594. [DOI] [PubMed] [Google Scholar]
  52. Salazar-Lindo E., Santisteban-Ponce J., Chea-Woo E., Gutierrez M. Racecadotril in the treatment of acute watery diarrhea in children. N Engl J Med. 2000;343:463–467. doi: 10.1056/NEJM200008173430703. [DOI] [PubMed] [Google Scholar]
  53. Schmidt W., Schneider T., Heise W., Weinke T., Epple H.J., Stoffler-Meilicke M., Liesenfeld O., Ignatius R., Zeitz M., Riecken E.O., Ullrich R. Stool viruses, coinfections, and diarrhea in HIV-infected patients. J Acqu Imm Defic Syndr Hum Retrovirol. 1996;13:33–38. doi: 10.1097/00042560-199609000-00006. [DOI] [PubMed] [Google Scholar]
  54. Slutsker L., Ries A.A., Greene K.D., Wells J.G., Hutwagner L., Griffin P.M. Escherichia coli 0157:147 diarrhea in the United States: clinical and epidemiologic features. Ann Intern Med. 1997;126:505–513. doi: 10.7326/0003-4819-126-7-199704010-00002. [DOI] [PubMed] [Google Scholar]
  55. Szajewska H., Mrukowicz J.Z. Probiotics in the treatment and prevention of acute infectious diarrhea in infants and children: a systematic review of published randomized, double-blind, placebo-controlled trials. J Pediatr Gastroenterol Nutr. 2001;33:S17–W25. doi: 10.1097/00005176-200110002-00004. [DOI] [PubMed] [Google Scholar]
  56. Tompkins D.S., Hudson M.J., Smith H.R., Eglin R.P., Wheeler J.G., Brett M.M., Owen R.J., Brazier J.S., Cumberland P., King V., Cook P.E. A study of infectious intestinal disease in England: microbiological findings in cases and controls. Commun Dis Public Health. 1999;2:108–113. [PubMed] [Google Scholar]
  57. Tucker A.W., Haddix A.C., Bresee J.S., Holman R.C., Parashar U.D., Glass R.I. Costeffectiveness analysis of a rotavirus immunization program for the United States. J Am Med Ass. 1998;279:1371–1376. doi: 10.1001/jama.279.17.1371. [DOI] [PubMed] [Google Scholar]
  58. Velazquez F.R., Matson D.O., Calva J.J., Guerrero L., Morrow A.L., Carter-Campbell S., Glass R.I., Estes M.K., Pickering L.K., Ruiz-Palacios G.M. Rotavirus infections in infants as protection against subsequent infections. N Engl J Med. 1996;335:1022–1028. doi: 10.1056/NEJM199610033351404. [DOI] [PubMed] [Google Scholar]
  59. Wadell G., Allard A., Johansson M., Svensson L., Uhnoo I. Vol. 128. 1987. Enteric adenoviruses; pp. 63–91. (Ciba Found Symp). [DOI] [PubMed] [Google Scholar]
  60. Yamashita T., Kobayashi S., Sakae K. Isolation of cytopathic small round viruses with BS-C-1 cells from patients with gastroenteritis. J Infect Dis. 1991;164:954–957. doi: 10.1093/infdis/164.5.954. [DOI] [PubMed] [Google Scholar]
  61. Yamashita T. Biological and epidemiological characteristics of Aichi virus, as a new member of Picornaviridae. Uirusu. 1999;49:183–191. doi: 10.2222/jsv.49.183. [Japanese] [DOI] [PubMed] [Google Scholar]

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