Diagnosis Treatment and Prevention of Norovirus acute gastroenteritis
Noroviruses are a group of caliciviruses that were previously
referred to as "Norwalk-like viruses". Norovirus mutates quickly, has
strong environmental resistance, low infection dose, short incubation period
after infection, long detoxification time, short immune protection time, and
multiple transmission routes. The ability to spread quickly.
Norovirus infection affects the stomach and intestines, causing gastroenteritis or "gastrointestinal flu". The main manifestations are diarrhea and / or vomiting, which we usually call acute gastroenteritis.
TCM disease name: Norovirus acute
gastroenteritis
Visiting department: Gastroenterology
Common locations: Intestine, stomach
Common symptoms: Diarrhea or
vomiting
Contagious: Strong
Way for spreading: People, food,
water, etc.
How Norovirus Propagates?
Propagation Mechanism of Norovirus Acute Gastroenteritis: Norovirus is highly contagious and susceptible to all
populations. Norovirus can be detected in the feces before the onset of the
patient and up to 2 weeks after recovery, but the period of illness and three
days after recovery are the most infectious periods.
The fecal-oral route is the main mode of transmission and can
also be transmitted through contaminated water, food, items, air, etc. Because
the patient's vomit and feces can form aerosols, contact with the patient can
be contagious.
Both occult infections and healthy carriers can be the source of
infection.
Patients' vomit and feces contaminate water or indirectly
contaminate food in nature, which can easily cause an outbreak.
Air and
pollutants are also non-negligible mediators during the outbreak.
The foods
involved in the outbreak were extensive, mainly direct foods such as shellfish,
salads, sandwiches, cakes, frost, ice cubes, drinking water, and raspberries.
Among them, shellfish are likely to come from contaminated waters.
Norovirus
can be found in shellfish. It accumulates in organisms, and cannot be purified
by the method of eliminating E. coli, and raspberries are also polluted by
sewage irrigation.
Infection is usually obtained by:
1. Eating or drinking food or water contaminated with
norovirus;
2. Touch an object or surface contaminated with Norovirus and
put your finger in your mouth;
3. Patients who have been exposed to Norovirus infection,
such as taking care of patients, sharing food with patients or sharing
tableware.
4. Norovirus spreads quickly in confined places (such as
childcare institutions, kindergartens, schools, nursing homes, cruise ships,
etc.) and easily causes outbreaks.
Clinical Manifestations and Diagnosis of Norovirus
What is the Clinical Manifestation of Norovirus?
The incubation period is mostly 24-48 hours, with the
shortest 12 hours and the longest 72 hours. Sudden onset of infection, the main
symptoms are nausea, vomiting, fever, abdominal pain and diarrhea.
Vomiting is
common in children, diarrhea is more common in adult patients, diarrhea 4 to 8
times within 24 hours, stool is watery stool or watery stool, no mucus pus and
blood. Stool routine microscopy WBC <15, no RBC was seen.
Patients with
primary infection have significantly more vomiting symptoms than those with
secondary infection, and some patients only show symptoms of vomiting.
In
addition, headaches, fever, chills, and muscle pain are also common symptoms,
with severe symptoms of dehydration.
What is the diagnosis of Norovirus Acute Gastroenteritis?
1. Clinical diagnosis cases: Diagnosis is mainly based on
epidemiological data such as epidemic season, regional characteristics, age of
onset, clinical manifestations, and routine laboratory test results.
Norovirus
infection can be preliminarily diagnosed if one meets the following criteria in
an epidemic of diarrhea:
- Incubation period of 24 to 48 hours
- Vomiting of more than 50%
- Duration of disease of 12 to 60 hours
- Stool and blood. No special findings were found in routine inspections
- Exclude common bacterial, parasitic and other pathogenic infections.
2. Confirmed cases: In addition to meeting the conditions of
clinical diagnosis, norovirus was detected in stool samples or vomit.
What is the Treatment of Norovirus Acute Gastroenteritis?
There are no effective antiviral drugs. Symptomatic or
supportive treatment is needed. No antibiotics are needed. The prognosis is
good.
Dehydration is the main cause of death of norovirus gastroenteritis, so
in severe cases, especially young children and frail people, timely infusion or
oral rehydration should be done to correct water, electrolyte disorders and
acid-base balance disorders.
What are the Preventive control measures for Norovirus Acute Gastroenteritis?
Prevention of Norovirus Disease: There are no specific antiviral drugs and vaccines against
Norovirus. T
he main prevention and control measures are non-drug preventive
measures, including case management, hand hygiene, environmental disinfection,
food and water safety management, and health education.
1. Case management
In view of the highly contagious nature of Norovirus,
standardized management of Norovirus-infected persons is an effective control
method to block transmission and reduce environmental pollution.
In the
childcare institution, strict morning inspections and daily inspections should
be passed to detect the children in time and isolate them in a timely and
effective manner.
2. Hand hygiene
Maintaining good hand hygiene is the most important and
effective measure to prevent norovirus infection and control transmission. Wash
your hands properly, using soap and running water for at least 20 seconds.
It
is important to note that sanitizing paper towels and hands-free sanitizers are
not a substitute for standard hand-washing procedures. Care should also be taken
not to touch the ready-to-eat food directly with bare hands.
3. Environmental disinfection
Collective units and medical institutions such as schools,
childcare institutions, old-age care institutions and medical institutions
should establish a daily environment cleaning and disinfection system. Chemical
disinfectants are one of the main methods to block the spread of Norovirus
through a contaminated environment or the surface of an item. Chlorine-based
disinfectants are the most commonly used.
When an epidemic of epidemics occurs,
the surface of environmental objects, daily necessities, food processing tools,
and drinking water, etc., contaminated by pollutants such as vomit and feces of
patients should be focused on disinfection.
4. Food safety management
Strengthen the health management of food practitioners.
Patients with acute gastroenteritis or recessive infection should be
temporarily removed from work and isolated.
There should be thoroughly clean and disinfect
disinfection of canteen utensils, facilities and equipment, and production and
processing environment. Avoid all aspects of food preparation
Cross-contamination.
5. Water safety management
Suspend the use of contaminated water sources or secondary
water supply facilities, and sterilize by appropriately increasing the amount
of chlorine input; suspend the use of contaminated barrel water and direct
drinking water, and immediately disinfect the barrel water machine and direct
drinking water machine.
Relevant drinking water can only be used after passing
the hygienic evaluation.
6. Health education
Make full use of radio, television, newspapers, Internet,
WeChat, mobile phone text messages, leaflets / bulletins, etc. to carry out the
promotion of Norovirus infection prevention and control knowledge, improve the
community's awareness of prevention and control, and develop hand washing and
not drinking.
Separate raw water from raw food, avoid cross-contamination and
other healthy living habits.
What causes gastrointestinal virus infections?
Enteroviruses include poliovirus, Cooksaki virus, and orphan
virus (ECHO virus) that causes cytopathic changes in the human intestine.
These viruses belong to the Enterovirus genus of the
Picornaviridae family in 1970.
Enteroviruses discovered after the 67 types of the three
enteroviruses named above are named after the enterovirus ordinal number, that
is, enteroviruses 68, 69, 70, 71, 72, etc.
Enterovirus particles are small, 20-hedron, diameter 24-30nm,
lipid-free, core with single-stranded ribonucleic acid, resistant to ether and
other lipid solvents, acid resistant and resistant to various antibiotics,
antivirals, detergent Resistance.
Most viruses develop cytopathic effects in cell culture.
Enteroviruses are usually parasitic in the intestine and, in rare cases, enter
the bloodstream or nervous tissue.
Normal virus carriers are rare, recessive
infections are very common, and clinical symptoms after infection are few.
Humans are the only
natural host of human enteroviruses. The virus spreads through close contact
between humans (through fingers, tableware and food).
Viruses are present in the throat and intestines of infected
people, and it takes longer to remove the virus from feces, which can last for
several weeks.
Fecal-mouth is the main route of transmission. It can also be
spread by droplets by accident. The virus lives in sewage for a long time.
Onset and clinical manifestations
After ingestion of the virus in humans, after 7 to 14 days,
the virus that is present in lymphoid tissues of the pharynx and intestine
passes through the bloodstream to proliferate into mononuclear phagocytes, and
finally reaches the target organ (such as spinal cord, brain, Meninges, heart,
liver, skin, etc.), cause corresponding clinical symptoms in different organs.
Type 70 enterovirus-induced acute hemorrhagic conjunctivitis
usually occurs suddenly, with severe eye pain, photophobia, blurred vision,
subconjunctival bleeding, and the degree of bleeding ranges from small bleeding
points to large bleedings.
Full recovery takes place within 10 days.
A rare neurological
complication can be associated with acute lumbar spinal spinal radiculopathy,
which is more common in adult men and occurs several weeks after eye disease.
The main symptoms are similar to polio and can lead to
sequelae such as paralysis and muscle atrophy. Another complication is facial
paralysis.
Enterovirus 71 mainly causes hand-foot-mouth disease and
aseptic meningitis. Enterovirus 72 can cause hepatitis A.
What is the distinction between bacterial and viral
gastroenteritis?
Bacterial gastroenteritis
Bacteria can be eliminated through diarrhea.
Bacterial gastroenteritis is mainly caused by bacterial
infections, including Staphylococcus aureus, E. coli, typhoid, and salmonella.
Dr. Lin said, "Salmonella is the most common in clinical practice."
As for gastroenteritis caused by Staphylococcus aureus, as this bacteria is
more acute, symptoms will appear in about 4 hours, usually in severe food
poisoning.
As for the main symptoms of bacterial gastroenteritis, in
addition to vomiting and diarrhea, the scope of abdominal pain is relatively
concentrated, unlike viral gastroenteritis, which includes pain in the large
and small intestines.
The excreta will carry mucus or blood, have a rotten
smell, and may be a bit green.
Transmission: fecal-oral infection
The cause may be unclean food. In addition, Staphylococcus
aureus also exists on the skin surface of the human body.
If hands and nails
are not cleaned, it will also contaminate food and cause severe food poisoning.
Treatment
Usually antibiotics are given as appropriate. If the
condition does not improve within 3 days and you have a high fever, vomiting,
or diarrhea, you must seek medical treatment immediately.
Dr. Lin Jianhong
pointed out that severe cases of bacterial gastroenteritis may lead to intestinal
perforation, peritonitis, and even toxic megacolon disease.
Clinically, it has
also experienced cases that progressed to systemic infections such as
meningitis and osteomyelitis.
The antidiarrheal effect is too strong, the intestines cannot
move
Therefore, the antidiarrheal medicine prescribed by the
doctor when taking the medicine should not be too strong.
If the antidiarrheal
effect is too strong, not only will the intestines not be able to move,
bacteria will continue to breed, but it will also cause severe flatulence and
even thin the intestines.
Therefore, the principle of medication is to prevent
the child from diarrhea to the point of dehydration, but not to prevent him
from having diarrhea at all.
Dr. Lin said: "Bacteria can be excreted only
through diarrhea."
Viral gastroenteritis
Prion gastroenteritis is mainly caused by viral infections.
Rotavirus and Norovirus are common. Although there are many infections in
autumn and winter, they still occur in summer.
The clinical symptoms are
vomiting, high fever, dehydration, and excreta without mucus.
In addition, the
range of abdominal pain is wide, including the large and small intestines.
The incubation period is about 1 to 3 days. If the amount of
virus is small, the incubation period may reach one week. Other viral
gastroenteritis, like Norovirus during the Chinese New Year period, can also
cause severe vomiting, fever, and abdominal pain.
However, Norovirus occurs in
autumn and winter.
Transmission: fecal-oral infection
Pupae are predominantly fecal-oral infections, however, some
viral gastroenteritis can be transmitted by flying droplets.
Treatment
Use supportive therapy to improve symptoms. If your child has
severe diarrhea and vomiting, you can add electrolyte water.
In particular for rotavirus infections, "Typical
symptoms are vomiting and then pulling, combined with poor appetite, and even
inability to drink water, which can lead to severe dehydration. Therefore, if
the symptoms have not resolved, hospitalization is recommended."
In addition, it is recommended that children be given a
rotavirus vaccine to prevent rotavirus infection.
Still in doubt? Please leave your question and answer you
within 15 minutes.
Don't confuse gastroenteritis virus with enterovirus
Many people confuse
viral gastroenteritis virus with enterovirus. Although both of them involve the
intestine and are viruses, they come from different pathogens, and their
pathogenesis and clinical symptoms are different, which ultimately leads to different
disease. The main lesions of gastroenteritis caused by viral gastroenteritis
virus are in the intestine, causing watery diarrhea, and the course of disease
is generally self-limiting.
Although enterovirus is also infected by feces and
mouth, the virus invades the whole body, and the main lesion is not in the
intestine. Instead, it affects the skin, mucous membranes, myocardium,
respiratory system, and central nervous system, and a few serious patients even
die.
Viral
gastroenteritis, also known as viral diarrhea, is an acute intestinal
infectious disease caused by rotavirus, adenovirus, astrovirus, and
calicivirus. Urgent onset, nausea, vomiting, abdominal pain, diarrhea, drainage
or loose stools, fever and general discomfort, short duration, and low
mortality.
Enterovirus
infection is often a recessive infection that rarely causes diarrhea. Infants
and young children and adults with low immunity are susceptible.
The same
enterovirus can cause different clinical manifestations and can easily cause
polio, aseptic meningitis, and brain Inflammation, hand, foot and mouth
disease, myocarditis, respiratory infections, diabetes and other diseases.
Author's Bio
 |
| Dr. Shawna Reason |
Education: MBBS, MD
Occupation: Medical Doctor / Virologist
Specialization: Medical Science, Micro Biology / Virology, Natural Treatment
Experience: 15 Years as a Medical Practitioner
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