Acute gastroenteritis in children attending day-care centres with special reference to rotavirus infections. II. Clinical manifestations

In a prospective study of a cohort of 214 children (aged 6 months-7 years) attending day-care centres, a total of 197 episodes of acute gastroenteritis (GE) occurred in 109 children (i.e. 51% of the participants) during a 12-month observation period. Rotavirus, pathogenic bacteria and Giardia lamblia caused GE in 24%, 6% and 2% of the cases, respectively. The aetiology of the remaining 68% was not discovered. Generally, the symptoms of GE were light and only two episodes led to hospitalization. Thirty-two rotavirus infections were asymptomatic. Two rotavirus GE reinfections occurred. They showed less severe symptoms than the primary infections. The older children (greater than 1.5 years) with rotavirus GE had lighter symptoms than the younger ones (less than or equal to 1.5 years). Compared with children with non-rotavirus GE, those with rotavirus GE showed the following clinical features: (1) Age between 6 months and 2 years. (2) Occurrence of rotavirus GE almost exclusively during the rotavirus season, i.e. January to April (winter). (3) High frequency of vomiting, the onset of which often preceded that of diarrhoea. However, these signs did not form a safe basis for the clinical diagnosis of rotavirus GE. One or more upper respiratory manifestations (URM) were observed in 39% of the children with rotavirus GE and in 36% of those with non-rotavirus GE. The occurrence of URM was age-related being highest in children less than 2 years. Consequently, the existence of a rotavirus syndrome is questioned. It is argued that URM in children with rotavirus GE may be due to a co-infection of the upper respiratory tract by a different micro-organism.     

Acute gastroenteritis in children attending day-care centres with special reference to rotavirus infections. I. Aetiology and epidemiologic aspects

Acute gastroenteritis (GE) among 214 children (aged 6 months-7 years) attending day-care centres (DDCs) in the Copenhagen County was studied during a 12-month period. A total of 197 cases of GE was observed in 109 children (i.e. 51% of the participants). The aetiology was as follows: rotavirus (n = 48) (24%), pathogenic bacteria (n = 11) (6%), Giardia lamblia (n = 3) (2%), while the aetiology of 68% remains unknown. The pathogenic bacteria included Yersinia enterocolitica, thermophilic Campylobacter, Clostridium difficile (+/- toxin) and enteropathogenic E. coli. In 4% of the GE the infections were multiple and Cryptosporidium was seen in one of these cases. The rate of GE declined with age from 1.35 GE per child per year (age group 1.0- less than 2.0 years) to 0.36 (6.0- less than 8.0 years). Serum sampled at the start of the study period showed that the frequency of detectable rotavirus IgG increased with age from 48% in the 6 months- less than 1.0 year group to 96% in the 4.0- less than 7.0 year group. The highest rates of rotavirus GE occurred from January to April (i.e. the rotavirus season). Moreover, rotavirus GE was almost absent after the age of 4. Hence, the rates of rotavirus GE per rotavirus season per child were 0.80 (age group 6 months-less than 1.0 year), 0.32 (1.0-less than 2.0), 0.14 (2.0-less than 3.0), 0.16 (3.0-less than 4.0), 0.06 (4.0-less than 5.0) and 0.04 (5.0-less than 6.0). Only 2 out of the 48 rotavirus GE were reinfections.(ABSTRACT TRUNCATED AT 250 WORDS)     

Intestinal imaging of children with acute rotavirus gastroenteritis

OBJECTIVE: To examine the morphology and motility of the distal small bowel of infants with rotavirus gastroenteritis using non-invasive/non-ionizing imaging technology. METHODS: Prospective, non-randomized observational study of five infants with symptomatic rotavirus infection. Infants were imaged by real-time magnetic resonance imaging (MRI) and ultrasound within 5 days of onset of gastroenteritis symptoms. Imaging studies were repeated in the convalescent period 5 to 9 weeks later. RESULTS: Three of five infants had a significant increase in the ileal wall thickness visualized by ultrasound during acute rotavirus infection compared with convalescence. The number and size of mesenteric lymph nodes visualized by ultrasound appeared similar in the acute and convalescent phases, as did peristaltic activity assessed by MRI. CONCLUSION: Abdominal ultrasound can detect changes in ileal wall thickness in infants with rotavirus infection. These changes may reflect ileal inflammation elicited by viral infection. Such studies may prove useful in evaluating morphologic response to attenuated rotavirus vaccines.     

Breastfeeding protects against acute gastroenteritis due to rotavirus in infants

To assess whether breastfeeding protects against acute gastroenteritis (AGE) due to rotavirus (RV) infection compared to RV-negative AGE (RV−) in children age 0–12 months. Data from a community-based study of children with AGE from 30 pediatric practices in Germany, Switzerland, and Austria were evaluated. A case–control design was conducted with RV-positive AGE (RV+) cases and RV− AGE as controls. Odds ratios and 95% confidence intervals were estimated using log-linear regression models adjusting for child’s age, family size, number of siblings, child care attendance, and nationality. A total of 1,256 stool samples were collected from infants with AGE; 315 (25%) were RV+ and 941 RV−. Being breastfed in the period of disease inception reduced the risk of AGE due to RV+ (OR, 0.53; 95% CI, 0.37–0.76). In infants 0–6 months of age, the protective effect was stronger (OR, 0.33; 95% CI, 0.19–0.55) than in 7–12-month-old children. Our study adds to the evidence of a protective concurrent effect of breastfeeding against rotavirus infection in infants, particularly in children 6 months and younger. Breastfeeding is important to diminish rotavirus-related gastroenteritis in infants before vaccination can be introduced.     

Vaccine-derived human-bovine double reassortant rotavirus in infants with acute gastroenteritis

We describe 3 cases of acute gastroenteritis in healthy infants after vaccination with RotaTeq, shedding a G1P[8] human-bovine double reassortant rotavirus in stools. Such a double reassortant virus appears stable in vitro and may explain diarrheal symptoms in a small percentage of RotaTeq recipients, and might also be transmitted to contacts in the environment.     

Ultrasonography findings and symptoms in acute rotavirus gastroenteritis

Background: The aim of the present study was to better understand how clinical events in acute rotavirus gastroenteritis are depicted on ultrasonography. Methods: The relationship between abdominal ultrasonography and clinical course and symptoms was evaluated in 92 patients with acute rotavirus gastroenteritis (51 boys, 41 girls) with an average age of 30.7 ± 24.6 months. Results: Significant correlations were observed between ultrasonography score and duration of illness after ultrasonography (P= 0.0232). It was also interesting that ultrasonography findings (score: 3.1 ± 1.0 vs 3.6 ± 1.2; P= 0.0118), clinical symptoms (3.1 ± 1.7 score vs 3.8 ± 1.8 score, P= 0.0293), and duration of illness after ultrasonography (4.4 ± 1.4 days vs 3.8 ± 1.1 days, P= 0.0301) were significantly different between patients examined on ultrasonography <1 day after illness onset (n= 50, but duration of illness after ultrasonography followed only in 42) and those examined ≥2 days after onset (n= 42, but duration of illness after ultrasonography followed only in 35). Conclusion: The ability of abdominal ultrasonography to indicate severity of disease makes abdominal ultrasonography an important guide to therapy.     

Detection of group C rotavirus in children with acute gastroenteritis in Blantyre, Malawi.

Among 606 children who were treated for acute gastroenteritis at the Queen Elizabeth Central Hospital in Blantyre, Malawi, Group C rotavirus (Gp C RV) was detected by enzyme-linked immunosorbent assay in fecal specimens from 16 (3.9%) of 408 inpatients and in 4 (2.0%) of 198 outpatients. Thirteen (65%) children excreting Gp C RV were coinfected with Group A rotavirus.     

Clinical features of acute gastroenteritis associated with rotavirus,enteric adenoviruses,and bacteria.

In a prospective one year study, comprising children with acute gastroenteritis admitted to hospital or treated as outpatients, the clinical and laboratory features of rotavirus diarrhoea (168 cases) were compared with those of enteric adenovirus (32 cases), bacterial (42), mixed (16), and non-specific (135) infections. The rotavirus disease was remarkably consistent, with a sudden onset of vomiting, a high frequency of fever and dehydration, and a mean duration of diarrhoea of 5.9 days. Outpatients excreting rotavirus had a similar but milder illness, mainly on account of less pronounced vomiting. The predominant symptom of enteric adenoviruses was long lasting diarrhoea (mean 10.8 days). Abdominal pain, bloody stools, prolonged diarrhoea (mean 14.1 days), leucocytosis, and a raised erythrocyte sedimentation rate strongly suggested a bacterial aetiology. Mixed infections caused longer lasting diarrhoea (mean 8.0 days) than rotavirus alone, but the severity of the illness was not increased. The clinical features of infection with unidentified pathogens most resembled those of bacterial infections. Respiratory symptoms were not significantly associated with any particular pathogen. Hypernatraemia and complications were uncommon. This study showed that the clinical features of gastroenteritis with rotavirus, enteric adenoviruses, and bacteria each exhibited patterns that could guide the experienced clinician to a presumptive diagnosis.     

Nosocomial rotavirus infections in a general pediatric ward: epidemiology, molecular typing and risk factors]

OBJECTIVES: Nosocomial rotavirus infections induce difficult problems for pediatric wards during winter epidemics. This prospective study was carried out to measure their incidence in a general pediatric ward by using epidemiological tools, clinical and molecular methods, and to examine the main factors increasing the risk of cross contamination. MATERIAL AND METHODS: The study was carried out on children, younger than three years old, hospitalized between 15 November 1996 and 1 March 1997. We examined the feces of all children for rotavirus on admission and during their hospital stay if they had developed diarrhea. The strains were typed by RNA electrophoresis. A cohort study was done to identify the factors of exposure to risk. RESULTS: Three hundred twenty-six of the 415 hospitalized infants were studied. One hundred and five were hospitalized for gastroenteritis, including 39 (37.1%) with rotavirus infection. Among 221 infants admitted without diarrhea, 11 (5.0%) had an asymptomatic community infection and nine (4.3%) developed nosocomial gastroenteritis. The only significant predisposing factor (P = 0.003) for nosocomial infection was the distance between the hospital rooms and the nurses station. Despite the low level of typing (51%), the molecular study suggested a wide diversity of nosocomial and community strains. CONCLUSION: The relatively low incidence of nosocomial infections found may be due to routine assignment to individual rooms, the isolation of infants admitted with acute diarrhea, and the policy of routine detection of asymptomatic carriers with the use of similar isolation measures for these children.     

Child rotavirus infection in association with acute gastroenteritis in two Chinese sentinel hospitals

Rotavirus gastroenteritis is an important pediatric disease in China. In a survey of rotavirus infection at two sentinel hospitals in China (Beijing Friendship Hospital and Changchun Children's Hospital), 296 cases were detected. A total of 283 (95.6%) cases of rotavirus infection occurred in children under 5 years of age. Serotype G1 (62%) was most prevalent followed by G2 (28.5%), G3 (5%) and G4 (2%). Mixed infections (n = 8, 3%) were rate, and 16 isolates (5.5%) remained non-typeable. A consistent epidemic occurred during the winter. Rotavirus was responsible for about 61.8% of diarrhea-related hospitalizations in children under 5 years of age, with a mean hospital stay of 5.6 days (1.0-21 days). The estimated rate of rotavirus-attributed hospitalizations was 16/1000 children under 5 years of age per year. Rotavirus-related death is rare in Changchun and Beijing. The present findings suggest that a rotavirus vaccine for the prevention of severe disease and a reduction of treatment costs would be of significant benefit to China.     

Hospitalization for acute community-acquired rotavirus gastroenteritis: a 4-year survey]

OBJECTIVE: To evaluate the number of hospitalizations due to community-acquired rotavirus acute gastroenteritis in a general pediatric unit during a four-year survey. RESULTS: From January 1997 to December 2000, 725 patients were admitted for acute gastro-enteritis to the general paediatric unit of a Parisian children hospital (nosocomial diarrhoea excluded) and 706 (97.5%) of these patients had had a stool microbiologic examination. Diarrhoea was caused by rotavirus in 359 patients (50.89%) and Salmonella sp in 61 (8.6%). Children and infants hospitalized for rotavirus acute gastroenteritis were younger (26% had three months or less, and 50.03% had six months or less) than in other European studies. CONCLUSION: This study is the first in France reporting a systematic survey of hospitalized gastroenteritis during four years. More than half of hospitalized community-acquired gastroenteritis were due to rotavirus in this Parisian area. The young age of patients should be investigated in other French areas, searching for risk factors and rotavirus strains.