Molecular epidemiology and clinical characteristics of norovirus gastroenteritis with seizures in children in Taiwan, 2006–2015

Abstract

This study examined the characteristics of norovirus (NoV) gastroenteritis associated with convulsions in children and its molecular epidemiology. From July 2006 through December 2015, NoV infection was confirmed by the genome detection using reverse transcriptase polymerase chain reaction. Viral genotyping with strain validation was achieved using sequence analyses with Basic Local Alignment Search Tool genome identification. The patients’ clinical features were assessed retrospectively, focusing on convulsive disorders. The diagnosis of encephalitis followed the International Encephalitis Consortium. Seizures occurred in 52 (20.9%) of 249 NoV infections. GII.4 Den_Haag_2006b (n = 22, 42.3%) and GII.4 Sydney 2012 (n = 10, 19.2%) were major variants correlated with convulsions. Patient with convulsions tend to have GII.4 genotype infection (P < .001), short vomiting (≤2 days) (P < .001), and no fever (P = .002). Compared to GII.4 Den_Haag_2006b, the GII.4 Sydney 2012-associated convulsions had similar manifestations except without significant winter preponderance (P = .049). The NoV infection with convulsions had less febrile course, specific genotype (GII.4) infections, and with shorter symptom of vomiting. Continuous surveillance is important for uncommon disease associated with emerging NoV strain infections. The prevention of NoV diseases requires the development of vaccines targeting highly virulent variants.

Prevalence of GII.4 Sydney Norovirus Strains and Associated Factors of Acute Gastroenteritis in Children: 2019/2020 Season in Guangzhou, China

“…In addition, we recorded that 38 patients had seizures, accounting for 22.6% of the 168 norovirus-infected children in this study. The result was consistent with previous studies (Chen et al, 2009 , 2019 ; Ma et al, 2019 ), which also showed that norovirus infection has a significantly higher incidence of seizures than rotavirus infection. Seizures, in this study, were similar to benign convulsions associated with mild gastroenteritis reported previously by Chen et al ( 2018 ).…”

“…Seizures, in this study, were similar to benign convulsions associated with mild gastroenteritis reported previously by Chen et al ( 2018 ). The mechanism of norovirus-induced seizures in children is still unclear, and may be associated with the children’s immature immune system (Chen et al, 2019 ). Recently, some studies found that norovirus infection can cause encephalitis/encephalopathy (Chen et al, 2019 ; Sánchez-Fauquier et al, 2015 ).…”

Prevalence of GII.4 Sydney Norovirus Strains and Associated Factors of Acute Gastroenteritis in Children: Winter 2019-2020 in Guangzhou

“…In addition, we recorded that 38 (22.6%) patients had seizures, which was the main reason why some patients were admitted. Previous studies have also shown that the probability of seizures in norovirus infections is signi cantly higher than that in rotavirus infections [37][38][39]. Seizures, in this study, were similar to benign convulsions associated with mild gastroenteritis reported previously by Boman et al [40].…”

“…Seizures, in this study, were similar to benign convulsions associated with mild gastroenteritis reported previously by Boman et al [40]. The mechanism of norovirus-induced seizures in children is still unclear, and may be associated with the children's immature immune system [37]. Recently, some studies found that norovirus infection can cause encephalitis/encephalopathy [37,41].…”

“…The mechanism of norovirus-induced seizures in children is still unclear, and may be associated with the children's immature immune system [37]. Recently, some studies found that norovirus infection can cause encephalitis/encephalopathy [37,41]. However, no case of encephalitis/encephalopathy was found in our study.…”