The CNS symptoms of rotavirus infections under the age of two

Since isolation of the Rotavirus (RV), there is rapidly growing concern about the possible involvement of RV in Central Nervous System (CNS) disorders, especially in Japan. We looked for symptomatic CNS involvement in a large series of RV infections and it's possible risk factors in a European setting.

Two-year retrospective survey based at the University Children's Hospital of Freiburg, Germany, a secondary and tertiary care centre with a urban and rural catchment area of 400,000 people. First, the case records of all 366 inpatients aged under two years excreting RV were searched for signs and symptoms of CNS involvement. Second, records of all 32 patients hospitalised with meningitis/encephalitis during the study period were checked for evidence of RV infection.

In 15 of 366 children signs of CNS involvement (seizures, meningeal and encephalitic signs) were found. They were older (p = 0.023), had higher temperatures (p = 0.001) and CRP values (p = 0.019). Five of the fifteen had underlying neurological diseases, two had an additional salmonella infection and one suffered from hypernatraemic toxicosis. In the remaining seven children, higher temperature (p = 0.037) and older age (p = 0.05) remained significant risk factors. CNS-signs occurred in 2% of RV-excreting children, a rate equal to the prevalence of febrile seizures among all inpatients during the study period (2.2%). Of all 32 patients hospitalised with a diagnosis of meningitis or encephalitis only four had their stools tested for RV, all with a negative result.

CNS symptoms in children aged less than two years with rotavirus diarrhoea have the same clinical epidemiology as febrile seizures and thus, in general, don't need additional diagnostic procedures.