ROTASCORE Study: Epidemiological observational study of acute gastroenteritis with or without rotavirus in Greek children younger than 5 years old

We present the results of a prospective multi-center, community-based epidemiological observational study regarding the clinical burden of pediatric rotavirus gastroenteritis (PRG) in Greece. Pharmaceutical companies VIANEX and Sanofi Pasteur MSD provided the test kits for rotavirus antigen stool detection. An erratum to this article can be found at     

Severe cryptosporidiosis in a seven-year-old renal transplant recipient: case report and review of the literature

Cryptosporidium is an intracellular protozoa that can cause gastroenteritis in humans. In immunocompromised hosts, infection can be severe, leading to life-threatening persistent diarrhea. There is limited experience in treating this infection in solid organ transplants. Although newer drugs active against Cryptosporidium exist, they are only licensed in the USA for treatment of immunocompetent hosts. Here we describe a seven-year-old renal transplant recipient with severe cryptosporidiosis. He had a protracted course of diarrhea of up to 2 L/day. He was successfully managed with combination antimicrobial therapy including nitazoxanide, paromomycin, and azithromycin. In conjunction with this regimen, he had a reduction in immunosuppression and complete bowel rest. His stool pattern normalized in four weeks and he has had no recurrence after six months of follow up.     

Isotonic is better than hypotonic saline for intravenous rehydration of children with gastroenteritis: a prospective randomised study

Aims

To determine whether the risk of hyponatraemia in children with gastroenteritis receiving intravenous (IV) fluids is decreased by the use of 0.9% saline.

Methods

A prospective randomised study was carried out in a tertiary paediatric hospital. A total of 102 children with gastroenteritis were randomised to receive either 0.9% saline + 2.5% dextrose (NS) or 0.45% saline + 2.5% dextrose (N/2) at a rate determined by their treating physician according to hospital guidelines and clinical judgement. Plasma electrolytes, osmolality, and plasma glucose were measured before (T₀) and 4 hours after (T₄) starting IV fluids, and subsequently if clinically indicated. Electrolytes and osmolality were measured in urine samples. Results were analysed according to whether children were hyponatraemic (plasma sodium <135 mmol/l) or normonatraemic at T₀.

Results

At T₀, mean (SD) plasma sodium was 135 (3.3) mmol/l (range 124–142), with 37/102 (36%) hyponatraemic. At T₄, mean plasma sodium in children receiving N/2 remained unchanged in those initially hyponatraemic (n = 16), but fell 2.3 (2.2) mmol/l in the normonatraemic group. In contrast, among children receiving NS, mean plasma sodium was 2.4 (2.0) mmol/l higher in those hyponatraemic at baseline (n = 21) and unchanged in the initially normonatraemic children. In 16 children who were still receiving IV fluids at 24 hours, 3/8 receiving N/2 were hyponatraemic compared with 0/8 receiving NS. No child became hypernatraemic.

Conclusions

In gastroenteritis treated with intravenous fluids, normal saline is preferable to hypotonic saline because it protects against hyponatraemia without causing hypernatraemia.     

Burden of severe rotavirus disease in Australia

AIM: To analyse the epidemiology of coded rotavirus hospitalisations in Australia from 1993 to 2002, with a view to understanding the pre-vaccination burden of severe disease in Australia. This study also seeks to determine the burden of rotavirus-related mortality. METHODS: Hospitalisation data from the Australian Institute of Health and Welfare for the period 1993-2002 were analysed. Rotavirus-related mortality data from the National Mortality Database were also analysed for the period 1990-2002. RESULTS: There were an average of 4260 patients hospitalised for rotavirus each year. The majority of rotavirus hospitalisations occurred in those under the age of 5 years, with the highest rate being in those aged 6-12 months (618.4 per 100,000). The Northern Territory was the most distinct region, with exceptionally high rates of admission (148.9 per 100,000 total population), younger age of admission and longer lengths of stay. Mapping of rotavirus hospitalisation in Australia showed well-defined areas of high hospitalisation rates. Thirteen rotavirus-related deaths occurred during 1990-2002. CONCLUSION: Rotavirus infection causes considerable morbidity and mortality in Australia. A vaccination programme would need to be completed by 6 months of age to have maximal impact.     

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.     

Rotavirus diarrhea in children and adults in a southern city of Brazil in 2003: distribution of G/P types and finding of a rare G12 strain

Between May and August in 2003, a total of 251 fecal samples were collected from children and adults with diarrhea (5 inpatients and 246 outpatients) at a private hospital in the city of Ponta Grossa, the state of Paraná, Brazil. Group A rotavirus was detected in 71 of 251 (28.3%) specimens: 55 (77.5%) from children under 5 years of age and 16 (22.5%) from individuals aged 6-72 years. All 71 strains exhibited a "long" RNA pattern when analyzed by PAGE. Sixty-one positive samples that yielded enough RNA were submitted to PCR genotyping. The most frequent G/P genotype combination detected was G1P[8] (86.9%; 53/61) followed by G9P[8] (3.3%; 2/61) and G12P[9] (1.6%; 1/61). Rotaviruses with G2, G3, G4, P[4], or P[6] specificity were not detected. For three strains (4.9%) bearing G1 genotype, the VP4 specificity could no be determined, and two specimens (3.3%) remained G/P non-typeable. One rotavirus strain (HC91) bearing G12P[9] genotype with a "long" electropherotype was isolated from an 11-month-old boy with diarrhea for the first time in Brazil. The cell-culture grown HC91 strain was shown to belong to serotype G12 by neutralization.     

Rotavirus surveillance in the city of Rio de Janeiro-Brazil during 2000-2004: detection of unusual strains with G8P[4] or G10P[9] specificities

Rotavirus diarrhea is a potentially life-threatening disease that affects millions of children annually around the world. Because protection against rotavirus disease is thought to be type specific, continuous rotavirus surveillance before and after implementation of a vaccine is still of essential importance. Rotavirus surveillance has been conducted in the city of Rio de Janeiro, Brazil since 1982. In the present study, we report rotavirus surveillance data in Rio de Janeiro city from 2000 to 2004. One hundred twenty nine of 1,568 (8.2%) stool samples, collected from children with acute diarrhea between January 2000 and July 2004 were rotavirus-positive. One hundred twenty eight of the 129 (99.2%) rotavirus-positive samples were genotyped for G and/or P specificity. G1 was the predominant strain (49.6%, 64/129) followed by G9 (30.2%, 39/129), and G4 (17.8%, 23/129); G2 and G3 viruses were not detected. One sample (0.8%) was non-typeable. P genotypes were determined for 124 of the 129 (96%) samples, and P[8] was the predominant genotype (90.6%, 117/129). Genotypes P[4] and P[9] were detected in two (1.6%) samples each; one (0.8%) sample presented P[6] genotype; and five (3.8%) samples were non-typeable. Two samples (1.6%) presented mixed P genotypes (P[6] + P[8]). Two unusual strains were isolated: a G8P[4] strain isolated from a non-hospitalized child with diarrhea and a G10P[9] strain isolated from a hospitalized child with diarrhea.     

Fecal microbiota transplantation and prednisone for severe eosinophilic gastroenteritis

Eosinophilic gastroenteritis is a rare disease of unknown etiology.It is characterized by patchy or diffuse eosinophilic infiltration of the bowel wall to a variable depth and various gastrointestinal manifestations.We describe a case of severe eosinophilic gastroenteritis presenting as frequent bowel obstruction and diarrhea in a 35-year-old man.The patient was misdiagnosed and underwent surgery because of intestinal obstruction when he was first admitted to a local hospital.Then he was misdiagnosed as having Crohn’s disease in another university teaching hospital.Finally,the patient asked for further treatment from our hospital because of the on-going clinical trial for treating refractory Crohn’s disease by fecal microbiota transplantation.Physical examination revealed a slight distended abdomen with diffuse tenderness.Laboratory investigation showed the total number of normal leukocytes with neutrophilia as 90.5%,as well as eosinopenia,monocytopenia and lymphocytopenia.Barium radiography and sigmoidoscopy confirmed inflammatory stenosis of the sigmoid colon.We diagnosed the patient as having eosinophilic gastroenteritis by multi-examinations.The patient was treated by fecal microbiota transplantation combined with oral prednisone,and was free from gastrointestinal symptoms at the time when we reported his disease.This case highlights the importance of awareness of manifestations of a rare disease like eosinophilic gastroenteritis.