Acute viral gastroenteritis: proportion and clinical relevance of multiple infections in Spanish children

Abstract

Dual infections associated with acute infectious diarrhoea and its microbiological, epidemiological and clinical findings have been evaluated in patients selected from a comprehensive survey of children under 4 years old, admitted to hospital emergency rooms from October 1996 to November 1997. A total of 820 children (433 males and 387 females) were enrolled. Stools were tested for rotavirus, adenovirus, astrovirus and bacterial enteropathogens. Patients were grouped according to age, and the seasonality of mixed infections was evaluated. Clinical trends and severity of gastrointestinal disease by Ruuska's score were also analysed. Mixed infections were identified in 39 cases (5 %), of which 23 were males and 16 were females. The majority of cases were in the 7-18-month age group (26 cases) and occurred in autumn (67 %). Virus-virus co-infections were more frequent (26/39) than virus-bacteria co-infections (13/39). More than two infectious agents were detected in only four cases. The most common viral co-infections were rotavirus-astrovirus (13/26) and rotavirus-adenovirus (10/26). The present report is the first prospective analysis of clinical-epidemiological trends of dual infections in young Spanish children with acute viral gastroenteritis. Our results emphasize the clinical importance of mixed infections as a cause of severe diarrhoea in children.

Astrovirus infection in children living in the Central West region of Brazil

“…Co-infection of astrovirus with other viruses has also been observed in studies carried out by Román et al (2003) and Phan et al (2004) in Spain and Pakistan, respectively. In this study, although the association of astrovirus with AG has been demonstrated, a larger proportion (30.4%) of samples was also positive for other viruses making it difficult to determine the primary viral pathogen.…”

Acute Gastroenteritis Agents Among 0–5 Years-Old Turkish Children

“…This study found that the highest proportion of dual infections was identified in February, March and April months and seasonal occurrence of some mono-infections such as Rotavirus is more frequent in winter and spring. At the same study that performed in Spain, most of the cases with mixed infection occurred in autumn (26 cases in autumn, 5 in winter, 6 in spring, 2 in summer), and no seasonal differences were detected between the different co-infections 19 . As seen in the present study, Rotavirus is the most common isolated viral agent (40.74%) for acute childhood diarrhea.…”

“…Most of the studies have mentioned that mixed infections were less frequent than mono-infections. A study that performed in Spain showed that the most frequent mixed infections were Rotavirus-Astrovirus (13 cases) and RotavirusAdenovirus (10 cases in 820 stool samples) infections 19 . This study found that the highest proportion of dual infections was identified in February, March and April months and seasonal occurrence of some mono-infections such as Rotavirus is more frequent in winter and spring.…”

Adenovirus, Norovirus and Rotavirus in Etiology of Children with Acute Gastroenteritis Applying to Istanbul American Hospital

“…(17) 'nın yaptıkları çalış-mada farklı viruslerin birlikteliği % 0.6-9.6 arasında bildirilmiş olup en sıklıkla rotavirus ve adenovirus birlikteliği gözlenmiştir. İspanya'da yapılan bir çalışmada ise rotavirus-astrovirus koenfeksiyonu daha çok bildirilmiş (% 1.6), rotavirus-adenovirus koenfeksiyonu ise vakaların % 1.2'sinde saptanmıştır (19) . Rotavirus enfeksiyonun mevsimsel dağılımı coğrafi farklılıklar göstermekle birlikte genellikle kış aylarında artış göster-mektedir (1,8,13,26) .…”

“…Çalışmamızda adenovirus vakaları en fazla kış mevsiminde görülmüştür. Norovirus vakalarının dağılımı ile ilgili olarak yaz veya kış aylarında artış bildirilmiştir (5,19,21) . Ancak Bozkurt ve ark.…”