Pathophysiological analysis of five severe cases with rotavirus infection

Abstract

Introduction: Rotavirus infection is usually localized to the intestine. Severe cases with extraintestinal symptoms are rare, and its pathogenesis remains unclear.Case presentation: We report severe rotavirus infections in five previously healthy, unvaccinated children that occurred in the 2011 season in Aichi Prefecture, Japan. All cases had short histories of recurrent diarrhoea and vomiting that preceded extraintestinal symptoms. Two cases with prolonged seizures and unconsciousness were diagnosed with encephalitis/encephalopathy; one case died and the other survived with severe neurological sequelae in spite of intensive treatment including anticytokine therapy. Another two cases had rapidly worsening cardiopulmonary dysfunction and seizures, and they died a few hours after admission despite cardiopulmonary support. The last case was transferred to hospital in cardiopulmonary arrest and resuscitation was unsuccessful. All cases had positive stool samples for rotavirus RNA, and the rotavirus antigen was also detected in the serum of four cases, but not in the cerebrospinal fluid (CSF). Serum IL-6 and IL-10 levels were significantly higher in the severe cases than in children with rotavirus gastroenteritis without extraintestinal symptoms, and serum IL-10 levels were significantly higher than CSF levels in the severe cases.Conclusion: Cytokines appear to mediate the pathogenesis of severe rotavirus infection with extraintestinal involvement. In conclusion, these cases highlight the need for a routine rotavirus immunization programme.

Rotavirus encephalopathy with concomitant acute cerebellitis: report of a case and review of the literature

“…Genotype variations of rotavirus, endotheliitis, cytokines such as interleukin 6 and 10 are emphasized. 13 Also cellular immunodeficiency is associated with severity of rotavirus infection. 14 In our patient, we did not identify the genotype of the virus.…”

Survey of rotavirus‐associated severe complications in Aichi Prefecture

“…Although RV gastroenteritis generates a large economic burden in developed countries, it is generally a self-limiting benign infectious disease in these countries. 1 It can, rarely, however, cause severe complications such as encephalopathy/ encephalitis, 2-4 myocarditis, 5,6 sudden death, 7,8 urinary stone, 9,10 and gastrointestinal (GI) bleeding. 11,12 In a previous nationwide questionnaire survey, annual cases of RV-associated encephalitis/encephalopathy and sudden death numbered 41.1 and 5.0 cases/year in Japan, respectively.…”

“…In a previous nationwide questionnaire survey, annual cases of RV‐associated encephalitis/encephalopathy and sudden death numbered 41.1 and 5.0 cases/year in Japan, respectively . The prognosis of RV encephalitis/encephalopathy was also unexpectedly poor, and accounted for 10 deaths …”

“…13 The prognosis of RV encephalitis/encephalopathy was also unexpectedly poor, and accounted for 10 deaths. 8,13 Two effective live attenuated RV vaccines (RotaTeqâ, Merck & Co., Whitehouse Station, NJ, USA; and Rotarixâ, GlaxoSmithKline Biologicals, Rixensart, Belgium) were licensed in 2006. These vaccines have been recommended for the national immunization program by the World Health Organization in 2009.…”