Idiopathic gastric rupture in a 3-month-old girl

This case reports on idiopathic gastric rupture in a 3-mo-old girl who had frequent episodes of vomiting and abdominal distension the day before admission to the clinic. Metabolic acidosis was detected and rotavirus antigen was identified in the stools. Abdominal X-rays and CT scans revealed free air and fluid in the abdominal cavity, leading to a diagnosis of gastrointestinal perforation. During surgery, idiopathic gastric rupture was detected and treated. The postoperative course was uneventful. CONCLUSION: Idiopathic gastric rupture is extremely rare in childhood beyond the neonatal period. Early diagnosis and surgery are mandatory if children with this condition are to be saved.     

Rotavirus infection as cause of tacrolimus elevation in solid-organ-transplanted children

Rotavirus (RV) is the most common cause of diarrheal illness in children. We report three solid-organ-transplanted patients in whom RV infection caused increased trough levels of the immunosuppressive macrolide tacrolimus (TAC) by mechanisms that are still under investigation. The virus was detected for longer in the feces of these patients than in infants not receiving immunosuppressive therapy. In association with short-term monitoring of blood trough levels of TAC, the dosage should be reduced early if symptoms of an acute gastroenteritis are present.     

Pathogenic and pathological characteristic of new type gosling viral enteritis first observed in China

AIM: To study the purifying method and characteristics of new gosling viral enteritis virus (NGVEV),the etiological agent of new gosling viral enteritis (NGVE) which was first recognized in China, as well as the pathomorphological development in goslings infected artificially with NGVEV. METHODS: (1)NGVEV virions were purified by the procedure of treatment with chloroform and ammonium sulfate precipitation, dialysis to remove the sulfate radical and ammonium ion and separation by gel filtration chromatography, and SDS-PAGE. (2)Forty-2-day-old White Sichuan goslings were orally administered with NGVEV and 24 hr later 2 birds were randomly selected and killed at 24hr intervals until death occurred. Specimens(duodenum, ileum, liver, heart, kidney, spleen, lung, proventriculus, pancreas, esophagus, and the intestinal embolus) were taken until all birds in this group died and were sectioned and stained with hemotoxylin and eosin and studied by light microscope. RESULTS: NGVEV shared the typical characteristics of Adenovirus and which structural proteins consisted of 15 polypeptides. Necrosis and sloughing of the epithelial cells covering the villus tips of the duodenum were first observed in goslings 2 days postinfection artificially with NGVEV. With the progress of infection, this lesion rapidly occurred in the epithelium at the base of the villus and with infiltration of the inflammatory cells, the jejunum tended to be involved. With the intensification of mucosa necrosis and inflammatory exudation of the small intestine, fibrinonecrotic enteritis was further developed and embolus composed of either intestinal contents wrapped by pseudo-membrane or of the mixture of fibrous exudate and necrotic intestinal mucosa were observed in the middle-lower part of the small intestine. This structure occluded the intestinal tract and made the intestine dilated in appearance. The intestinal glandular cells underwent degeneration, necrosis and might be found sloughed into the lumen. Hemorrhage and hyperemia could be observed on the lung and kidney. Epithelial cells of the renal tubular underwent degeneration. In some cases, granular degeneration and fatty degeneration could be found in the liver and in some cases at a later stage of this disease the epithelial cells of trachea and proventriculus might be found sloughed. In some cases at an early stage of this disease, cardiac hyperemia and hemorrhage could be observed. Esophagus, pancreas and brain were found normal. Analyses and comparisons between the pathologic lesions of NGVE and Gosling Plague (GP) were available in this paper as well. CONCLUSION: (1)NGVEV is adenovirus. (2)Pathological characteristic could be as the data for NGVE diagnosis.     

婴幼儿轮状病毒性肠炎168例的肠外表现分析

目的分析婴幼儿轮状病毒性肠炎的肠外表现及可能机制，为进一步认识该疾病提供帮助。方法回顾性分析我院收治的168例确诊为轮状病毒性肠炎的病例资料。结果轮状病毒肠炎合并有肠外表现的发病率依次为心肌损害、呼吸系统、肾脏损害、肝脏损害等，住院过程给予对症治疗后均预后良好。结论轮状病毒感染不仅有胃肠道症状，还可以有其他系统的损害，虽说轮状病毒性肠炎是一种自限性疾病，但也有可能引起多系统损害，甚至衰竭，临床上不容忽视。     

畲药止泻汤治疗婴幼儿轮状病毒肠炎疗效观察

目的:观察畲药止泻汤治疗婴幼儿轮状病毒肠炎的疗效。方法:将78例确诊患儿分成治疗组和对照组,对照组予利巴韦林针10-15mg/(kg.d)静滴和对症治疗;治疗组在上述基础上加用畲族民间验方止泻汤。结果:治疗组止泻时间、脱水纠正时间和住院时间较对照组明显缩短,差异有统计学意义(P<0.01);而退热时间与对照组比较差异无统计学意义(P>0.05)。治疗组总有效率为92.5%,对照组为76.3%,但差异无统计学意义(P>0.05);治疗组与对照组治愈率分别为77.5%和57.9%,差异则有统计学意义(P<0.01)。结论:畲药止泻汤对婴幼儿轮状病毒肠炎有治疗作用,未发现毒副作用及不良反应,可供临床治疗选用。     

Symptomatic and asymptomatic infections of rotavirus, norovirus, and adenovirus among hospitalized children in Xi'an, China

Rotavirus (RV), norovirus (NoV), and adenovirus (AdV) have been reported as the common viral pathogens of acute gastroenteritis in children. To determine the prevalence of RV, NoV, and AdV infections among hospitalized children with and without symptoms of acute gastroenteritis, fecal specimens, and data on clinical symptoms were collected from 201 children with diarrhea and 53 children without diarrhea admitted to the Xi'an Children's Hospital in Xi'an, China between March 2009 and May 2010. RV, NoV, and AdV were identified in 68.7% (138/201), 20.4% (41/201), and 5.0% (10/201), respectively, of children with diarrhea. These three viruses were also detected in 13.2% (7/53), 35.9% (19/53), and 9.4% (6/53), respectively, of children without diarrhea. Diarrheal children infected with RV alone showed the average severity score of 6.5, statistically significant higher than the average score of 5.3 in children with unidentifiable viruses. GII.3 and GII.4 were the only two NoV genotypes identified, and the GII.4 sequences were genetically close to GII.4 2006b cluster. These findings highlight the importance of NoV as a causative agent of pediatric diarrhea after RV based on the clinical and epidemiological characteristics of NoV infection, and particularly convey information of asymptomatic infections of enteric viruses in young children.     

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.     

Epidemiology of rotavirus infection in Thailand

Rotavirus is a major cause of acute severe diarrhea in children worldwide and an important cause of death among young children in developing countries. Group A rotaviruses are antigenically complex and multiple serotypes infect humans. Reassortant rotavirus vaccines are now available which offer protection against severe illness caused by rotavirus serotypes G1-4. Before vaccines are introduced into target populations, it is necessary to establish the baseline data of the epidemiology of rotavirus infection in those countries. The purpose of the present study is to provide information related to the epidemiology of rotavirus infection in Thailand. All rotavirus studies performed in Thailand were found through Medline and Thai Index Medicus searches. A total of 26 of the most relevant studies published in international and national journals are reviewed. Most studies reported that the prevalence of rotavirus infection in Thailand was 27-34%, although a few studies have reported a prevalence above this range. The peak seasonal distribution of rotavirus infection among children hospitalized with diarrhea in Thailand was seen in the dry cool seasons: October to February. The prevalence of rotavirus infection was most frequently found in children aged 6-11 months up to 2 years. G1 was the most prevalent serotype in Thailand, followed by G2, G4 and G3, respectively. At least three G serotypes, mostly G1, G2 and G4, are seen to coexist in Thailand each epidemic year and in some studies all four G-serotypes were reported in the same epidemics. In a 1996-1997 study, G9 was the third prevailing serotype after G1 and G2, respectively. These results indicate that rotavirus epidemics occur in Thailand every year and children are the most affected population. In Thailand, although G1-G4 have been reported, G1 is the most prevalent serotype in each epidemic and G9 is becoming increasingly common.     

赖氨葡锌颗粒联合消旋卡多曲治疗小儿轮状病毒性肠炎的临床研究

目的探讨赖氨葡锌颗粒联合消旋卡多曲治疗小儿轮状病毒性肠炎的临床疗效。方法选取2014年3月—2016年3月在宝鸡市妇幼保健院进行治疗的轮状病毒性肠炎患儿108例,依据治疗方案的差别分为对照组(54例)和治疗组(54例)。对照组口服消旋卡多曲颗粒,30 g/次,3次/d。治疗组在对照组的基础上口服赖氨葡锌颗粒,5 g/次,2次/d。两组患儿均治疗7 d。评价两组患者临床疗效,同时比较治疗前后两组患儿临床症状消失时间和心肌酶指标变化。结果治疗后,对照组总有效率为85.19%,显著低于治疗组的97.53%;两组比较差异具有统计学意义(P0.05)。治疗后,治疗组患儿发热、腹泻、呕吐消失时间均显著短于对照组患儿,两组比较差异具有统计学意义(P0.05)。治疗后,两组血清磷酸肌酸激酶(CK)、磷酸肌酸激酶同功酶(CK-MB)和乳酸脱氢酶(LDH)水平均显著降低,同组比较差异具有统计学意义(P0.05);且治疗组患儿心肌酶指标比对照组降低更显著,两组比较差异具有统计学意义(P0.05)。结论赖氨葡锌颗粒联合消旋卡多曲治疗小儿轮状病毒性肠炎可有效改善患儿临床症状,缓解心肌损害,具有一定的临床推广应用价值。