Molecular Epidemiology of Norovirus Gastroenteritis Investigated Using Samples Collected from Children in Tunisia during a Four-Year Period: Detection of the Norovirus Variant GGII.4 Hunter as Early as January 2003

Sdiri-Loulizi, Khira; Ambert-Balay, Katia; Gharbi-Khélifi, Hakima; Sakly, Nabil; Hassine, M.; Chouchane, S.; Guédiche, M.N.; Pothier, Pierre; Aouni, Mahjoub

doi:10.1128/jcm.01852-08

Cited by 60 publications

(55 citation statements)

References 47 publications

(47 reference statements)

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“…A study from Tunisia reported that norovirus is equal to rotavirus infection in terms of necessity of hospitalization and severity of the clinical symptoms. 18 In this study, only rotavirus was significantly associated ( P < 0.02) with dehydrated children. However, our findings and those reported from Tunisia and Egypt indicate that rotavirus and norovirus are the leading causes of childhood diarrhea in the North Africa region.…”

Section: Discussionmentioning

confidence: 74%

Enteric Pathogens Associated with Childhood Diarrhea in Tripoli-Libya

Rahouma

Klena²,

Krema³

et al. 2011

The American Society of Tropical Medicine and Hygiene

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Abstract. Stool samples from children < 5 years of age with diarrhea ( N = 239) were examined for enteric pathogens using a combination of culture, enzyme-immunoassay, and polymerase chain reaction methods. Pathogens were detected in 122 (51%) stool samples; single pathogens were detected in 37.2% and co-pathogens in 13.8% of samples. Norovirus, rotavirus, and diarrheagenic Escherichia coli (DEC) were the most frequently detected pathogens (15.5%, 13.4%, and 11.2%, respectively); Salmonella , adenovirus, and Aeromonas were detected less frequently (7.9%, 7.1%, and 4.2%). The most commonly detected DEC was enteroaggregative E. coli (5.4%). Resistance to ≥ 3 antimicrobials was observed in 60% (18/30) of the bacterial pathogens. Salmonella resistance to ciprofloxacin (63.1%) has become a concern . Enteric viral pathogens were the most significant causative agents of childhood diarrhea in Tripoli. Bacterial pathogens were also important contributors to pediatric diarrhea. The emergence of ciprofloxacin-resistant Salmonella represents a serious health problem that must be addressed by Libyan health authorities * Address correspondence to Khalifa Sifaw Ghenghesh, Department of Microbiology and Immunology, Faculty of Medicine, Alfateh University, Tripoli, Libya. E-mail: ghenghesh@yahoo.com 887 DIARRHEA IN LIBYAN CHILDREN VA) were used to detect antigens of Cryptosporidium , Entamoeba histolytica , and Giardia lamblia in all specimens.Epi Info, version 3.5.1 software (Centers for Disease Control and Prevention, Atlanta, GA) was used to analyze the data. P values were calculated using the χ 2 test; P values < 0.05 were considered statistically significant. RESULTSEnteric pathogens were detected in 122 (51%) stool samples examined; single pathogens in 37.2%, and multiple pathogens in 13.9% ( Table 2 ). The most common pathogens detected were enteric viruses (82/239; 34.3%) followed by bacterial pathogens (64/239; 26.8%); parasitic pathogens (10/239; 4.2%) were the minority of detected pathogens.Overall, the most common individual pathogens detected were norovirus, rotavirus, and DEC. Among the DEC, pCVD432 (EAggEC) predominated at 5.4% (13/239) followed by eaeA (EPEC/EHEC) at 4.6% (11/239). No est and eltB genes (ETEC) were detected in this work. Salmonella species were detected in 7.9%; the majority of these were group C2. Cryptosporidium was the primary parasitic diarrheal pathogen detected (2.1%) ( Table 2 ).Total enteric pathogens were detected more frequently among diarrheic children ≤ 2 years of age (55.2%, 100/181; P < 0.03, odds ratio [OR] = 2.02) compared with children > 2 years of age (37.9%, 22/58). Although total enteric pathogens were detected at a higher rate in male (54%, 74/137) than in female (47.1%, 48/102) diarrheic children, the difference was not statistically significant ( P > 0.05).Of the 239 diarrheic children included in the study 202 (84.5%) had vomiting, 176 (73.6%) had fever, and 82 (34.3%) had dehydration. Vomiting, fever, and dehydration were significantly associated with children ≤ 2 years o...

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Section: Discussionmentioning

confidence: 74%

Enteric Pathogens Associated with Childhood Diarrhea in Tripoli-Libya

Rahouma

Klena²,

Krema³

et al. 2011

The American Society of Tropical Medicine and Hygiene

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“…1 It has recently been estimated that each year NoVs cause 64,000 episodes of diarrhea requiring hospitalization and 900,000 clinic visits among children in industrialized countries and up to 1.1 million hospitalizations and 200,000 deaths of children 5 years of age in developing countries. 2,3 NoVs cause outbreaks of acute gastroenteritis in a variety of settings, such as schools, restaurants, hospitals, cruise ships, nursing homes, and military settings. 4 Norovirus infections accounted for 18.2% of outbreaks and 65% of closures of hospital wards during 2008 and 2009 in the United States.…”

Section: Introductionmentioning

confidence: 99%

Norovirus Genogroup II Gastroenteritis in Hospitalized Children in South India

Menon

Sarkar

Moses

et al. 2013

The American Society of Tropical Medicine and Hygiene

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Abstract. The distribution of norovirus (NoV) genogroup II in children 5 years of age admitted to a south Indian hospital with diarrhea was investigated. Viral RNA extracted from 282 stool samples were screened for NoV GII and positive amplicons sequenced. Twenty-eight (9.9%) had NoV GII infection with a median age of 6 months, with more severe episodes of diarrhea among infected (median Vesikari score 13, interquartile range [IQR] 10-15) than children without infection (median score 10, IQR 8-13, P = 0.002). The study documents NoV GII infections as an important cause of gastroenteritis and the genetic diversity of circulating strains.

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“…GII.4 is the most common genotype circulating worldwide, having caused at least four global epidemics since 1995, each caused by a distinct GII.4 antigenic variant (18)(19)(20)(21). Genotype II.3 is a common cause of sporadic infection in children (22)(23)(24)(25). In infants and young children, GII.3 strains often predominate and were particularly prevalent in various countries throughout the late 1970s and 1980s (22), the early 1990s (26)(27)(28), and in the early and late 2000s (25,(29)(30)(31).…”

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confidence: 99%