A 3-year-old female patient presented with severe abdominal pain that had been recurring for 8 days.
She had already visited the paediatric emergency department twice in the previous 4 days, a urine test and an ultrasound examination of the abdomen were unremarkable. Suspecting constipation, the patient was sent home with a laxative (Macrogol) and painkillers. 2 weeks before the current event, the patient had diarrhoea and fever for 2 days.
The patient suffered from abdominal pain, especially at night. She woke up approx. 2-3 times per night with severe pain and, according to her parents, a hard tummy. Painkillers such as ibuprofen and paracetamol brought no improvement. There was no fever, no vomiting, no diarrhoea, no mucousy or bloody stools. There was no pain between the events. Eating and drinking behaviour was unremarkable. The girl is fully immunised according to German recommendations except for the second measles, mumps, rubella and chickenpox vaccination. The rotavirus vaccination was also carried out as a baby.
The physical examination revealed an active and cheerful child. The physical examination findings were unremarkable, in particular the abdomen was soft and deep to the touch, only increased bowel sounds were noticeable when listening.
An ultrasound scan showed plenty of bowel loops filled with faeces and fluid as well as a small amount of free fluid in the right lower abdomen.
Gastroenteritis, i.e. gastrointestinal infection, was suspected. A PCR stool examination for intestinal pathogens was initiated, which yielded a positive result for rotaviruses. This confirmed the gastrointestinal infection.
Rotaviruses are transmitted via various routes:
- contaminated water and food
- faecal-oral smear infection
- droplet infection.
The viruses are very resistant and can remain active on surfaces for days. A few pathogens are enough to trigger an infection. On the other hand, infected persons excrete large quantities.
The disease is particularly prevalent in Europe in the months of February to April. In western industrialised countries, it is mainly infants and children between 6 months and 2 years of age who fall ill; in developing countries, it is estimated that more than 100 million children (mostly under the age of five) fall ill every year. Overall, 90 per cent of all children worldwide have had at least one rotavirus infection.
As there are different types, children and adults can fall ill several times in a lifetime.
The incubation period of rotaviruses is one to three days.
The infection can go almost unnoticed, with only mild diarrhoea, but it can also be a serious illness requiring treatment. Fever and abdominal pain may then occur.
In infants and young children, however, rotaviruses are usually more severe than other intestinal diseases. The usually sudden onset of watery diarrhoea is often initially accompanied by a slightly elevated temperature and vomiting. In around half of cases, a cold or cough is also present, and rarely the brain is affected (encephalitis).
The diarrhoea usually lasts for 5 days, accompanied by vomiting for 2 days.
On average, infants and small children are more severely affected by rotavirus than by other diarrhoeal diseases.
Because vomiting often occurs together with diarrhoea in the case of a rotavirus infection, it is often difficult to provide the sick person with sufficient fluids in good time. This is especially true for infants and small children – they become dehydrated particularly quickly.
In industrialised countries with their good nutritional situation and good medical care, serious complications or even deaths are very rare. Nevertheless, around half of all children up to the age of 5 have to be hospitalised with a rotavirus infection.
Worldwide, the annual number of deaths caused by rotavirus infections in children up to the age of 5 is estimated at 440,000 to 600,000!
Diagnosis can be made by detecting the virus in the stool.
There is no causal therapy. There is a risk of rapid dehydration, especially in infants and small children. Hospitalisation is therefore often necessary to provide young patients with fluids via the vein.
An effective oral vaccination with a live oral vaccine has been available in Germany since 2013. It is intended for infants from 6 weeks to 6 months of age.
After a complete vaccination, protection can be expected to last for two to three years.
General reactions to the vaccination such as irritability, sleep disorders and tiredness, fever, loss of appetite, diarrhoea, vomiting, abdominal symptoms, skin rash, crying and, in individual cases, middle ear infections and shortness of breath can occur.
A severe course of the symptoms observed in connection with the vaccination has rarely been reported. It should be noted that most of these symptoms occurred to approximately the same extent not only in vaccinated persons, but also in control persons who had received placebo.
As a rule, the general reactions mentioned are of a temporary nature and subside quickly and without consequences.
Data suggest that infants have a slightly increased risk of invagination after rotavirus vaccination. This is an intestinal invagination into the subsequent section of the intestine, with a risk of intestinal obstruction and vascular constriction. Sometimes the invagination resolves itself, sometimes it can be resolved by means of an intestinal enema, but sometimes the affected section of bowel has to be surgically removed. If an invagination occurs, the risk of recurrence in the next week is 15%.
However, invagination occurs much more frequently with true rotavirus disease, so that vaccinated infants are protected against invaginations during the course of the disease.
The above-mentioned patient recovered completely from her abdominal pain.
Dr. Med. Laura Schrörs – Adolescent Medicine and Paediatrics
