The neurovirulence of human and animal rotaviruses in cercopithecus monkeys

Histologic distribution of fatal rotaviral pneumonitis: an immunohistochemical and RT in situ PCR analysis

Rotaviral infection is a common cause of gastroenteritis and pharyngitis; to our knowledge, infection has not been associated with severe pneumonia. We report on two cases of fatal pneumonitis in 49-and 54-year-old men; the latter was on long-term steroid treatment of multiple sclerosis. In the latter case, the histologic examination after a several week history of symptoms showed severe organizing interstitital pneumonitis and necrotizing bronchiolitis with extensive squamous metaplasia. The other case, which was fatal several days after the onset of symptoms, showed marked septal capillaritis with denudement of the alveolar pneumocytes, extravascated red blood cells, and intravascular thrombi formation. In each case, rotaviral RNA was localized by reverse transcription (RT) in situ PCR to the endothelial cells of the alveolar capillaries, macrophages, and pneumocytes as well as, in the second case, to the squamous metaplastic cells. Immunohistochemical analysis for the virus demonstrated an equivalent histologic distribution. It is concluded that rotaviral infection can lead to fatal pneumonitis and that the mechanism of this complication is centered on a diffuse septal endothelialitis with concomitant tissue damage.

Histologic distribution of fatal rotaviral infection: an immunohistochemical and reverse transcriptase in situ polymerase chain reaction analysis

Rotaviral infection is the most common cause of gastroenteritis in young children. Although rotavirus infection has a high morbidity and mortality rate in animals, in most cases in the United States the disease appears to be self-limited in humans. We report on 2 cases of fatal rotaviral infection in a 1 year old and a 4 year old. In each case, the illness showed a rapid systemic course dominated by cardiac and central nervous system involvement; in one case, rotaviral infection was documented by stool culture. Viral RNA was localized by reverse transcriptase in situ polymerase chain reaction to the mucosal cells of the small and large intestine and to many other tissues, including the heart and central nervous system, where it was noted in the endothelial cells of the microvasculature. Immunohistochemical analysis for the virus showed an identical histologic distribution in the intestinal epithelial cells and the systemic microvasculature. It is concluded that rotaviral infection can lead to a fatal disseminated infection in humans and the mechanism of this complication is based on a diffuse endothelialitis and concomitant tissue damage.

Infantile convulsions with mild gastroenteritis

The development of sensitive new molecular genetic techniques has led to the detection of rotavirus in cerebrospinal fluid, stools and throat swabs from patients with gastroenteritis with accompanying clinical symptoms similar to infantile benign convulsions. Small round structured virus (SRSV) has also been found in stools of patients with similar clinical symptoms by a new procedure. However, the mechanism by which these viral infections induce benign convulsions remains to be elucidated. The present paper reviews recent virological and clinical studies of seizures probably caused by gastroenteritis viruses including rotavirus, SRSV and other viruses.

Haemorrhagic shock and encephalopathy associated with rotavirus infection

We report on a 21-month-old girl with a haemorrhagic shock and encephalopathy who survived. Rotavirus genomic ribonucleic acid was detected by reverse transcription polymerase chain reaction in stool, blood and cerebrospinal fluid. Serum antibody titres of the rotavirus were also high. Plasmapheresis had a stabilizing effect on the course of the disease. This case indicates that rotavirus infection may play an important role in the devastating cascade that occurs in some patients with this syndrome. The findings suggest that extensive investigation for rotavirus infection, particularly infection of the central nervous system, should be carried out in patients with haemorrhagic shock and encephalopathy.

Rotavirus infection and bradycardia-apnoea-episodes in the neonate

Rotavirus (RV), a common cause of infectious enteritis in young children including neonates, has not been associated with central nervous symptoms in standard textbooks. However, involvement of the CNS has been reported recently in case reports and small series. From 786 neonatal admissions in 1991 we retrospectively analysed the records of 215 inpatient neonates (68 preterm and 147 term infants) who developed diarrhoea during their stay on the neonatal ward and in whom stools were investigated for RV antigen by ELISA. All 215 neonates were continuously monitored for bradycardia-apnoea-episodes (BAE) at least 2 days before and during the entire diarrhoeal period. In neonates with RV antigen in stools (n = 114) we found a higher incidence of BAE compared to neonates with RV negative stools (33% vs 8%, P < 0.001 for bradycardia; 7% vs 0%, P < 0.05 for apnoea). Furthermore, bradycardia episodes of RV positive neonates were more often followed by cyanosis (11 vs 0%, P < 0.05) and intervention was more often necessary (31 vs 14%, P < 0.05) than in the RV negative neonates.

CONCLUSION

RV infection was associated with a high incidence of BAE in neonates with diarrhoea during the acute phase of disease suggesting CNS involvement.