A remarkable percentage of acute gastroenteritis cases remain etiologically undiagnosed. The aim of the study was to determine the prevalence of common and emerging enteric viruses, such as novel human astroviruses, among undiagnosed samples from children with acute gastroenteritis. Epidemiological studies for novel human astroviruses are still scarce. Stool samples collected over two consecutive winter seasons (2016–2017) from children with gastroenteritis in Spain, which were negative for bacteria, rotavirus, and adenovirus by routine diagnostics were screened by real-time RT-PCR assays for the presence of classical and novel astrovirus, rotavirus, norovirus GI and GII, sapovirus, and adenovirus. Overall, 220/384 stool samples (57.3%) were positive for at least one virus. Co-infections were identified in 21% of cases. Among a total of 315 viruses identified, adenovirus was the most prevalent (n = 103), followed by rotavirus (n = 51), sapovirus (n = 50), classical astrovirus (n = 43), novel astroviruses (n = 42), and norovirus (n = 26). Novel astroviruses were present in 13.3% of virus-positive cases. Most novel astroviruses were found in children <2-year-old (30/39 children, 77%, p = 0.01) and were found in co-infection (66%). Only classical astroviruses demonstrated significant differences in the Cq values during mono-infections compared to co-infections. In conclusion, common enteric viruses may be frequently found in children with undiagnosed gastroenteritis, indicating the need to implement more sensitive diagnostic methods. Novel astroviruses circulate in the community and could be the cause of gastroenteritis among young children.

We report 2 cases of recurrent Campylobacter coli enteritis caused by macrolide-and fluoroquinolone-resistant strains in 2 patients with hypogammaglobulinemia, successfully treated with a prolonged course of fosfomycin-tromethamine with no side effects. Fosfomycin-tromethamine may be a feasible alternative therapy for recurrent enteritis caused by Campylobacter species resistant to first-line drugs. Campylobacter jejuni and Campylobacter coli, among other Campylobacter species, are frequent causes of foodborne enteric infection. Macrolides are the drug of choice for treatment, reducing the duration of the illness and bacterial shedding, and fluoroquinolones are the most commonly used alternative therapy (1). Since the 1990s, a significant increase in the prevalence of fluoroquinolone resistance in Campylobacter spp. has been reported in Asian and European countries (1, 2). Increased macrolide resistance has also been described, particularly in developing countries (3). It has also been noted that C. coli isolates are more frequently resistant to antibiotics than C. jejuni isolates (3, 4). Most cases of Campylobacter species enteritis are mild and selflimited; nevertheless, some episodes follow a relapsing course with repeated treatment failures, particularly in patients with predisposing conditions like impaired humoral immunity (5).Fosfomycin-tromethamine (FT) is an antimicrobial agent active against various Gram-positive and Gram-negative bacteria. It is generally safe and well tolerated and is currently approved for the treatment of uncomplicated urinary infection. A previous study demonstrated that most fluoroquinolone-resistant C. jejuni strains are susceptible to fosfomycin (6). However, reports on its use in acute Campylobacter species enteritis are scarce, outdated, and limited (7,8).We report 2 cases of relapsing C. coli enteritis successfully treated with oral FT. Case 1. A 64-year-old woman was admitted for persistent diarrhea. She had been diagnosed with common variable immunodeficiency many years before and had a history of recurrent respiratory tract infections, bronchiectasis, and chronic diarrhea with numerous exacerbations and repeated isolation of C. jejuni in stool cultures. The patient's gastroenterologist had undertaken an extensive study of her chronic diarrhea, and other possible causes had been excluded. Her usual medications included intravenous gamma globulin every 3 weeks, bronchodilators, and nebulized colistin. She had received several courses of azithromycin treatment for respiratory and gastrointestinal infections over the last 5 years.Over the previous 7 days her diarrhea had markedly worsened (up to 10 stool passages a day), and she experienced abdominal pain and hypovolemic shock. She was admitted to the intensive care unit. Blood cultures were sterile; stool cultures were positive for C. coli, which was resistant to erythromycin (MIC of Ͼ256 mg/liter), ciprofloxacin (MIC of Ͼ32 mg/liter), and tetracycline, as tested by Etest (bioMérieux, Marcy l'Etoile, France), and susceptible...

Novel human astroviruses (HAstV) were discovered 10 years ago and have been associated with fatal cases of central nervous system infections. Their role in gastroenteritis is controversial, as they have been identified in symptomatic and asymptomatic subjects. The aim of the study was to investigate novel HAstV in a gastroenteritis case-control study including a pediatric population in Spain over a one-year period. We included stool samples from patients with gastroenteritis and negative results for viruses screened by routine diagnostics, and stool samples of control subjects who sought for a routine medical consultation. All samples were screened by real-time Rt-pcR assays for novel HAstV. An additional screening for rotavirus, norovirus GI, GII, sapovirus, classic HAstV and adenovirus was also performed for the control group. Overall, 23/363 stool samples from case patients (6.3%) and 8/199 stool samples from control patients (4%) were positive for ≥1 novel HAstV. MLB1 was predominant (64.5% of positives). Seasonality was observed for the case group (p = 0.015), but not the control group (p = 0.95). No difference was observed in the prevalence of novel HAstV between the case and control groups (OR 1.78, 95% CI 0.68-5.45; p = 0.30). Nevertheless, MLB genome copy numbers/ml of fecal suspension was significantly higher in the control group than in the case group (p = 0.008). In our study, we identified a lack of association between novel HAstV and gastroenteritis in the studied population, which could indicate a potential role of reservoir for children, especially given the higher viral load observed in the asymptomatic group for some of them.

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During a waterborne outbreak of norovirus in Spain, we estimated 50% illness doses for a group of exposed (secretor) persons to be 556 (95% CI 319–957) genome copies/day for norovirus GI and 2,934 (95% CI 1,683–5,044) genome copies/day for norovirus GII. Use of a propidium monoazide viability assay reduced these values.

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Norovirus infections are a leading cause of acute gastroenteritis outbreaks worldwide, with genotypes GII.2 and GII.4 being the most prevalent. The aim of this study was to compare the characteristics of GII.2 and GII.4 norovirus outbreaks reported in Catalonia in closed or semi-closed institutions in 2017 and 2018. The epidemiological and clinical characteristics of GII.2 and GII.4 outbreaks were compared using the chi-square test or Fisher's exact test for categorical variables and the Mann–Whitney U test for continuous variables. Odds ratios and their 95% confidence intervals were estimated. 61 outbreaks were reported: GII.4 was the causative agent in 12 outbreaks (30%) and GII.2 in 9 outbreaks (22.5%). GII.2 outbreaks were detected more frequently in schools or summer camps (66.7%) and GII.4 outbreaks in nursing homes (91.7%) (p = 0.01). Ninety-three people were affected in GII.2 outbreaks and 94 in GII.4 outbreaks. The median age was 15 years (range: 1–95 years) in GII.2 outbreaks and 86 years (range: 0–100 years) in GII.4 outbreaks (p < 0.001). Nausea, abdominal pain, and headache were observed more frequently in persons affected by GII.2 outbreaks (p < 0.05). Symptomatic cases presented a higher viral load suggestive of greater transmission capacity, although asymptomatic patients presented relevant loads indicative of transmission capacity.