The Wheel Turns
Clinical Vignette
A 74-year-old woman with osteoarthritis is admitted for elective right total knee replacement. The surgery is uncomplicated and she is transferred to the orthopedic recovery ward. On postoperative day four she develops sudden-onset profuse watery diarrhea with six to eight loose stools per day, nausea, vomiting, and a temperature of 38.2°C. She has no abdominal pain and no blood in the stool. She is not on antibiotics and has had no recent antibiotic exposure. She is otherwise healthy and takes no immunosuppressive medications.
Over the following 48 hours, three additional patients on the same ward develop identical symptoms. The infection control team is notified. Stool studies including Clostridioides difficile PCR return negative. An electron micrograph of the stool sample is shown below.
Electron micrograph of stool sample demonstrating viral particles with a characteristic wheel-like morphology. Image adapted from
Parashar et al., Lancet Infectious Diseases, 2004.
Question 1
What does the structure of this virus imply for infection control during this outbreak?
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Question 2
What is the most appropriate treatment for this patient?
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Question 3
Four patients on the ward are now affected. Which of the following best describes the most appropriate infection control response?
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References
Parashar UD, Hummelman EG, Bresee JS, Miller MA, Glass RI. Global illness and deaths caused by rotavirus disease in children. Emerging Infectious Diseases. 2003;9(5):565-572.
Lopman BA, Reacher MH, Vipond IB, Sarangi J, Brown DW. Clinical manifestation of norovirus gastroenteritis in health care settings. Clinical Infectious Diseases. 2004;39(3):318-324.
Desselberger U. Rotaviruses. Virus Research. 2014;190:75-96.