Rotavirus diarrhoea: an expanding clinical spectrum

To explore the clinical spectrum of rotavirus diarrhoea in Bangladeshi children, we reviewed surveillance data from randomly selected diarrhoeal cases who were intensively studied at the International Centre for Diarrhoeal Diseases Research--Bangladesh. Twenty-seven (29%) of children aged less than or equal to 4 years excreted rotavirus; rotavirus was the only pathogen isolated from 13 cases. Seven of these 13 cases displayed the typical features of rotavirus diarrhoea: occurrence in infancy, prominent vomiting, watery diarrhoea, and acid stools rarely exhibiting blood or leucocytes. In contrast, six of the 13 cases presented with non-watery diarrhoea. These cases were distinguished by older ages, infrequent vomiting, less acidic stools, faecal blood and leucocytes, and frequent left shifts on peripheral blood examination. We conclude that the clinical spectrum of rotavirus infections may include an invasive diarrhoeal syndrome that differs in several respects from the more widely appreciated watery diarrhoeal syndrome.