Rotavirus as an important cause of diarrhoea in a hospital for children in Dammam, Saudi Arabia

A major cause of morbidity and mortality among children in developing countries is acute diarrhoea and rotavirus, a reovirus-like agent, is found to be a leading causative agent. We report here the incidence of rotavirus infection among infants and young children with gastro-enteritis treated at the Children's Hospital in Dammam, Kingdom of Saudi Arabia. One hundred and fifty children, aged between 1 and 60 months, suffering from diarrhoeal illness, were selected as the study cohort; another 150 hospitalized children of the same age group, but not suffering from diarrhoea, served as controls. Sixty-two per cent of the study children complained of watery diarrhoea and 39% of vomiting; all had mild to moderate dehydration. Seventy-two per cent had fever and 30% associated respiratory illness. Worst affected were those 7-12 months old, among whom rotavirus was detected by ELISA techniques in 39.6%, compared with 7.5% of the control children of comparable age group. We could not detect any rotavirus from control children aged over 36 months, whereas approximately 15% of the study children in this age group yielded rotavirus from the stool. The second most common pathogen isolated was Shigella ssp. It was isolated from 18.7% of children under study as against 3% of the controls.     

A prospective clinical study of rotavirus diarrhoea in young children

The clinical and laboratory features of 96 children aged 6 to 36 months with acute rotavirus diarrhoea were compared to findings on 63 children of the same age with acute non-rotavirus diarrhoea. Of the rotavirus-associated cases 80% occurred between January and June. In general, the diarrhoea was more severe in these patients than in the others, but no difference was seen in duration of symptoms. Clinical features characteristic of rotavirus-associated cases included: dehydration and acidosis upon admission, vomiting, fever, neutropenia and sugar in the stools (Clinitest greater than or equal to 0.5%). In contrast, no difference was seen in the occurrence of respiratory symptoms (53% in the rotavirus, 62% in the non-rotavirus group), or in the presence of mucus strands, occult blood or leucocytes in stools. A combination of the above criteria may be helpful in the presumptive diagnosis of rotavirus diarrhoea.     

A PROSPECTIVE CLINICAL STUDY OF ROTAVIRUS DIARRHOEA IN YOUNG CHILDREN

Abstract. Mäki, M. (Department of Paediatrics, Tampere Central Hospital, Tampere, Finland). A prospective clinical study of rotavirus diarrhoea in young children. Acta Paediatr Scand, 70:107, 1981.–The clinical and laboratory features of 96 children aged 6 to 36 months with acute rotavirus diarrhoea were compared to findings on 63 children of the same age with acute non-rotavirus diarrhoea. Of the rotavirus-associated cases 80% occurred between January and June. In general, the diarrhoea was more severe in these patients than in the others, but no difference was seen in duration of symptoms. Clinical features characteristic of rotavirus-associated cases included: dehydration and acidosis upon admission, vomiting, fever, neutropenia and sugar in the stools (Clinitesf® 0.5 %). In contrast, no difference was seen in the occurrence of respiratory symptoms (53 % in the rotavirus, 62% in the non-rotavirus group), or in the presence of mucus strands, occult blood or leucocytes in stools. A combination of the above criteria may be helpful in the presumptive diagnosis of rotavirus diarrhoea.     

Diarrhoea in Swedish infants. Aetiology and clinical appearance

Ninety-five children with gastroenteritis admitted at the Department of Paediatrics, Malm? General Hospital, Malm?, Sweden, starting November 1978 through October 1979 were studied. Patients were examined clinically and the course of their disease was followed. Stool specimens from all patients were analysed by routine bacteriology and rotavirus identification was done by immune-electroos-mophoresis. Fifty-eight per cent of patients had rotavirus. Campylobacter was found in 6%, enteropathogenic E. coli in 2%, Yersinia enterocolitica in 2% and Salmonella in 1% of patients. Stool specimens from 53 healthy children matched for sex and age served as controls for bacterial pathogens. All were negative. Forty per cent of patients presented with a clinical dehydration, but only 11%-half of them with bacterial enteropathogens-needed i.v. therapy and 4% required antibiotic treatment. Median time for hospitalization was three days. Vomiting, fever, watery diarrhoea and initial clinical dehydration were more commonly associated with rota virus infection. Macroscopic blood in stools was restricted to patients with bacterial aetiology.     

Rotavirus,adenovirus, and non-viral enteropathogens in diarrhoea.

The aetiology of rotavirus and adenovirus in acute gastroenteritis was studied in a prospective series that comprised 283 children admitted consecutively with diarrhoea during a 1-year period. Rotavirus was associated in 49% of the cases by solid-phase radioimmunoassay and electron microscopical examination of stool specimens, or by serology. Adenovirus was detected by radioimmunoassay in the stool specimens of 29 (11%) patients, including 8 cases of possible dual infection with rotavirus. Rotavirus infections showed a typical age distribution and seasonal clustering between January and June, whereas the adenovirus-associated cases did not form a distinctive subgroup. Enteropathogenic bacteria were found in 10% of cases, and were nearly as common in association with rotavirus infection as not. Respiratory symptoms accompanied diarrhoea in 34% of the patients with rotavirus and in 25% of those with neither rotavirus nor adenovirus. Therefore we could not confirm the existence of a ''rotavirus syndrome'', nor could we confirm an association of respiratory symptoms with rotavirus infection. Use of antibiotics before the onset of diarrhoea was more common among those with non-viral diarrhoea (23%) than in the rotavirus group (13%). Rotavirus infections appeared to be common among cases of ''antibiotic-induced'' diarrhoea.     

DIARRHOEA IN SWEDISH INFANTS Aetiology and Clinical Appearance

ABSTRACT. Ninety-five children with gastroenteritis admitted at the Department of Paediatrics, Malmö General Hospital, Malmö, Sweden, starting November 1978 through October 1979 were studied. Patients were examined clinically and the course of their disease was followed. Stool specimens from all patients were analysed by routine bacteriology and rotavirus identification was done by immune-electroosmophoresis. Fifty-eight per cent of patients had rotavirus. Campylobacter was found in 6%, enteropathogenic E. coli in 2%, Yersinia enterocolitica in 2% and Salmonella in 1% of patients. Stool specimens from 53 healthy children matched for sex and age served as controls for bacterial pathogens. All were negative. Forty per cent of patients presented with a clinical dehydration, but only 11%–half of them with bacterial enteropathogens–needed i. v. therapy and 4% required antibiotic treatment. Median time for hospitalization was three days. Vomiting, fever, watery diarrhoea and initial clinical dehydration were more commonly associated with rota virus infection. Macroscopic blood in stools was restricted to patients with bacterial aetiology.     

Enteric adenovirus infection and childhood diarrhea: an epidemiologic study in three clinical settings

During a 2-year prospective study of gastroenteritis in children less than 2 years of age, the role of enteric adenovirus as a cause of infantile diarrhea was examined in three clinical settings in a case-control fashion. Using a monoclonal antibody-based enzyme-linked immunosorbent assay with specificity for adenovirus serotypes 40 and 41, enteric adenovirus was identified in 10 of 246 episodes of diarrhea in outpatients (4.1%), 13 of 211 children admitted to the hospital with diarrhea (6.2%), and 5 of 81 children in whom nosocomial diarrhea developed (6.2%), making this agent the third most commonly identified etiologic agent of diarrheal disease. Asymptomatic infections were uncommon (5 of 372 control subjects, or 1.3%) and were seen most frequently in the nosocomial setting. Cases occurred in every calendar month except March and April of each year. A syndrome of watery diarrhea of longer duration compared with other patients with diarrhea (mean 5.4 vs 3.8 days, P = .01), associated with vomiting and dehydration, was present in most cases. Compared with patients with rotavirus, patients were as likely to experience fever and dehydration and more likely to vomit. Household contact with gastroenteritis, often with a child 2 to 5 years of age, was a predisposing factor. It was concluded that enteric adenovirus is an important cause of infantile diarrhea in Baltimore children. Although far less common than rotavirus, this agent was associated with diarrheal illnesses that were at least as severe as those seen with rotavirus.     

Vibrio cholerae O139 in Calcutta.

Vibrio cholerae O139 was recovered from 28 of 79 children with acute watery diarrhoea. Clinically, they presented with watery diarrhoea (100%), vomiting (79%), abdominal cramps (61%), anorexia (61%), dehydration (100%), and absence of fever. Both clinical and blood biochemical parameters of these cases were similar to the illness caused by the new strain in adults. Hypoglycaemia was seen in 40% of those screened.     

Persistent protein losing enteropathy in post measles diarrhoea.

Faecal alpha 1 antitrypsin was measured in two groups of children with diarrhoea aged 6 months to 6 years during the acute and recovery stages of the illness. Group 1 comprised 19 children with a history of measles in the two weeks preceding admission to hospital. In this group there were six cases of Shigella species, six enterotoxigenic Escherichia coli, and five rotavirus, and two did not yield an aetiologic agent. Group 2 comprised 15 children with diarrhoea only. In this group there were five cases of Shigella species, five enterotoxigenic Escherichia coli, and five rotavirus. Children with rotavirus diarrhoea belonging to both groups showed a transient high faecal clearance of alpha 1 antitrypsin during the acute stage. Post measles cases of diarrhoea showed significantly higher faecal clearance of alpha 1 antitrypsin than group 2 subjects in both the acute and recovery stages. The faecal clearance of alpha 1 antitrypsin in both groups was significantly higher during the acute stage compared with the recovery stage. Highest faecal clearances of alpha 1 antitrypsin were observed in children with post measles shigellosis in the acute stage and they also had persistently raised concentrations, thus suggesting prolonged protein losing enteropathy.     

Intestinal permeability assessed with polyethylene glycols in children with diarrhea due to rotavirus and common bacterial pathogens in a developing community

Intestinal permeability was assessed with different-sized polyethylene glycols (PEG 400 and PEG 1,000) in small children with acute diarrhea. All children with acute diarrhea absorbed and excreted less PEG of all molecular sizes into the urine when compared with healthy control children (p less than 0.001). Children with acute rotavirus infection excreted significantly less PEG of all sizes than children with Shigella, Salmonella, and enteropathogenic Escherichia coli (EPEC) infection (p less than 0.001-0.01), suggesting a more severe mucosal lesion caused by rotavirus. In patients with severe malnutrition there was also a significant decrease in absorption of PEGs observed. In addition, malnourished patients with rotavirus diarrhea showed a pronounced decrease of PEGs in comparison with well-nourished patients. The ratio between the recovery of a large PEG molecule, 1,074 Da, and a small molecule, 370 Da, was utilized to assess the absorption of large molecules in relation to that of smaller ones. On applying this ratio, it was noted that the intestine in children with Shigella and EPEC infection was relatively more permeable to larger molecules than in healthy controls, while in rotavirus and Salmonella infection it was less permeable to larger molecules. In this study significant differences in the permeability characteristics were observed, suggesting etiology-specific effects on the mucosal barrier.     

Four-country surveillance of intestinal intussusception and diarrhoea in children

Aim:   Establishment of baseline epidemiology of intussusception in developing countries has become a necessity with the possibility of reintroduction of rotavirus vaccine. The current study assessed the seasonal trend in cases admitted with intussusceptions and dehydrating acute watery diarrhoea in children aged 2 months to 10 years.
Methods:   In a prospective surveillance study, teaching and research hospital sites in India (Lucknow and Nagpur), Brazil (Fortazela), Egypt (Ismailia) and Kenya (Nairobi) established a surveillance where a network of hospitals with surgical facilities catered to a reference population of about 1–2 million for reporting of intussusception. One large hospital per site also recruited admitted cases of acute watery diarrhoea.
Results:   From April 2004 to March 2006, 173 and 2346 cases of intussusception and diarrhoea, respectively, were recruited. Cases of intussusception had no apparent seasonality. Most cases of intussusception (61.3%) (107/173) were in the ≤1 year age group, with males comprising 68.8% (119/173) of all cases. Hospital mortality of intussusception was 4.2% (4/96). Cases of diarrhoea peaked in March, with 56.6% (1328/2346) of admitted cases being males. Majority (83.1%) of cases of diarrhoea had received antibiotics, and the hospital mortality was 0.8% (18/2280).
Conclusion:   Intussusception in the four participating countries exhibited no seasonal trend. We found that it is feasible to establish a surveillance network for intussusception in developing countries. Future efforts must define population base before the introduction of rotavirus vaccine and continue for some years thereafter.     

Acute diarrhoea and rotavirus infections in young children in Kuwait

The role of rotavirus infections in acute diarrhoea in young children was studied over a period of one year. Rotavirus was detected by electron microscopy and enzyme immunoassay methods in 40.2% of faecal specimens from 343 children with acute diarrhoea and in 4.7% of 86 controls. The infections were most common in children aged 2-12 months (42.3%). Twelve per cent of the rotavirus infected children were also infected with bacterial enteropathogens (Salmonellae, Shigellae and enteropathogenic Escherichia coli). The incidence of rotavirus infections was not related to sex, socio-economic or nutritional status of children. Rotavirus-associated diarrhoea differed in several clinical parameters from bacterial associated and nonspecific diarrhoea. Rotavirus was detected throughout the year but was most frequent during months with little rainfall and low humidity (March-May). Our results suggest that in Kuwait, rotavirus infection is a major cause of childhood diarrhoea.     

Folic acid in the treatment of acute watery diarrhoea in children: a double-blind, randomized, controlled trial

One-hundred and six male children aged 6-23 months with a history of acute watery diarrhoea of less than 72 h duration were randomized to receive either folic acid in a dose of 5 mg at 8-h intervals or placebo for 5 d. There were 54 children in the folic acid group and 52 in the placebo group. The admission characteristics were comparable between the two groups. No significant differences were observed in the intake of oral rehydration solution or stool output between the groups. The mean ± SD of total stool output (g kg⁻¹) was 532 ± 476 vs 479 ± 354 and the duration (h) of diarrhoea was 108 ± 68 vs 103 ± 53 in the folic acid vs placebo group, respectively. The findings, therefore, should have a positive influence on preventing the inappropriate use of folic acid in acute diarrhoea.     

Carbohydrate intolerance after acute gastroenteritis—a disappearing problem in Polish children

The prevalence of carbohydrate intolerance in Polish children during an acute episode of gastroenteritis was determined. One hundred and seven consecutive children, less than 3 years old, with acute diarrhoea were enrolled into the study. Carbohydrate intolerance (diagnostic criteria: >0.5% reducing substances and stool pH less than 5.5) was diagnosed in 14/107 (13.08%) children: lactose intolerance was present in 12 (11.2%) patients; glucose polymer intolerance in 1 (0.93%) and monosaccharide intolerance in 1 (0.93%). The most important predisposing factor was rotavirus. In all cases the carbohydrate intolerance was transient, resolving within 5 days. Carbohydrate intolerance is also an infrequent problem in Polish children. Restriction of lactose-containing foods (use of lactose-free or low lactose formulas) for the majority of children with gastroenteritis does not seem to be justified.     

Mucoid presentation of acute enterocolitis in children: a hospital-based case-control study

A hospital-based case-control study was carried out to clarify the characteristics of mucoid presentation of acute enterocolitis in children. One hundred sixty-eight cases of acute mucoid enterocolitis (study population) were compared with 200 cases of watery diarrhoea and 118 cases of blood dysentery (control groups) on the basis of clinical characteristics and findings on stool examination. Study and control groups were comparable with respect to age, body weight and nutritional status. There was no significant difference in clinical characteristics (duration of diarrhoea, stool frequency, presence of vomiting, fever and dehydration) between patients suffering from mucoid enterocolitis and blood dysentery. However, watery diarrhoea patients had significantly high frequencies of vomiting (p = 0.00001) and dehydration (p     

Epidemiological and Clinical Features of Rotavirus Associated Acute Infantile Diarrhoea in Cairo, Egypt

Rotavirus was looked for in stool specimens from 200 randomly chosen infants and children aged 1-24 months presenting with acute diarrhoea of not more than 5 days duration at the Bab El-Sha'reya University Hospital during a 12-month period (January-December 1986). Forty per cent of cases were positive for rotavirus by the ELISA technique. Considering the seasonal pattern, during the hot months May to August, the monthly percentage of rotavirus positive cases ranged from 24 to 32 per cent while during the rest of the year, the range was from 37 to 60 per cent. There was no statistically significant difference between the rotavirus positive and negative cases as regards mean age in months (9.5 +/- 5.1 and 9.2 +/- 5.5, respectively), type of feeding or nutritional status. However, rotavirus positive cases were significantly more likely to present earlier, to have watery stools, to vomit or even to have vomiting before the onset of diarrhoea and to have respiratory symptoms. On the other hand, the means of dehydration score, rectal temperature and serum Na+ were not significantly different between the two groups.     

A trial in the Karelian Republic of oral rehydration and Lactobacillus GG for treatment of acute diarrhoea

In a controlled trial in Petrozavodsk, Karelia, the effects of oral rehydration and Lactobacillus strain GG (LGG) on recovery from acute diarrhoea (27% rotavirus, 21% bacterial aetiology) were studied in 123 children aged between 1 and 36 months of age. On admission to hospital, the patients were first randomized to receive either isotonic oral rehydration solution (ORS) with osmolality 311mosmol/l and sodium 90mmol/l (WHO-ORS), or a hypotonic ORS with osmolality 224mosmol/l and sodium 60mmol/l (Light-ORS), and thereafter randomized to receive either 5 × 10⁹ colony forming units of LGG or a matching placebo. The two ORS performed equally for acute rehydration, and oral rehydration with either ORS was associated with a shorter duration of diarrhoea than intravenous rehydration ( p = 0.036). Patients receiving LGG had a significantly shorter duration of watery diarrhoea [mean (SD) 2.7 (2.2) days] than those receiving the placebo [3.7 (2.8) days, p = 0.03]. LGG significantly shortened the duration of rotavirus diarrhoea but not diarrhoea with confirmed bacterial aetiology.     

Intestinal Permeability in Small Children during and after Rotavirus Diarrhoea Assessed with Different-Size Polyethyleneglycols (PEG 400 and PEG 1000)

ABSTRACT. The permeability properties of the small intestinal mucosa was investigated in nine previously healthy children with acute diarrhoea due to rotavirus. The investigation was performed after intake of a mixture in water of polyethyleneglycol molecules (PEG 400 and 1000) ranging from 282 to 1250 dalton in molecular weight. The 6-h urinary recovery of the PEGs was determined with high performance liquid chromatography and used to assess the permeability characteristics of the intestine. The patients served as their own controls and were investigated in the same manner after recovery 3-5 weeks later. A significantly lower urinary recovery of PEG was noted for all molecular sizes (326-1206 dalton) during acute diarrhoea in comparison with the results obtained after recovery ( p <0.001-0.1). There was also a relatively lesser change in the urinary recovery of larger PEG molecules during infection, as reflected by a higher recovery ratio between 1074 and 370 dalton PEGs. The results indicate profound changes in the permeability characteristics of the intestine during acute rotavirus diarrhoea.     

Intestinal permeability in small children during and after rotavirus diarrhoea assessed with different-size polyethyleneglycols (PEG 400 and PEG 1000)

The permeability properties of the small intestinal mucosa was investigated in nine previously healthy children with acute diarrhoea due to rotavirus. The investigation was performed after intake of a mixture in water of polyethyleneglycol molecules (PEG 400 and 1000) ranging from 282 to 1250 dalton in molecular weight. The 6-h urinary recovery of the PEGs was determined with high performance liquid chromatography and used to assess the permeability characteristics of the intestine. The patients served as their own controls and were investigated in the same manner after recovery 3-5 weeks later. A significantly lower urinary recovery of PEG was noted for all molecular sizes (326-1206 dalton) during acute diarrhoea in comparison with the results obtained after recovery (p less than 0.001-0.1). There was also a relatively lesser change in the urinary recovery of larger PEG molecules during infection, as reflected by a higher recovery ratio between 1074 and 370 dalton PEGs. The results indicate profound changes in the permeability characteristics of the intestine during acute rotavirus diarrhoea.