Eventos de precipitación extrema aumentan la circulación de patógenos infecciosos: detección de rotavirus, norovirus, astrovirus, adenovirus entérico y micobacterias no tuberculosas en agua de las inundaciones en Asunción, Paraguay, año 2014

Las precipitaciones extremas representan uno de los eventos naturales climáticos más importantes y pueden originar inundaciones devastadoras. De junio a agosto del 2014 se registró una de las más graves inundaciones en la historia de la ciudad de Asunción. Ocasionó un incremento considerable del nivel del río Paraguay y el desplazamiento de 300.000 personas a campamentos provisionales. Debido a que el contacto directo con el agua de inundación, el consumo de agua contaminada y la congregación de los afectados en refugios provisorios son factores de riesgo para enfermedades infecciosas, el objetivo de este estudio fue la implementación de una metodología estandarizada para la concentración y detección de virus entéricos y micobacterias no tuberculosas, por PCR en tiempo real y PCR-asociada al análisis de restricción enzimática (PRA), en muestras de agua de inundaciones y el reporte de los patógenos detectados en las zonas afectadas de Asunción y en la Bahía del Río Paraguay. La metodología propuesta demostró poseer buena sensibilidad y se registró la presencia de rotavirus, norovirus (genogrupos I y II), astrovirus, adenovirus entéricos y micobacterias no tuberculosas en 50% (N=4/8) de las muestras de los barrios Sajonia, San Jerónimo y Ricardo Brugada, Chacarita. Además, reportamos datos secundarios de casos de enfermedades infecciosas, registrados en los servicios de salud de los barrios afectados durante el periodo de inundación.

Extreme rainfall represents one of the most important natural climatic events and can cause devastating floods. From June to August 2014, one of the most serious floods in the history of the city of Asunción was recorded. It caused a considerable increase in the level of the Paraguay River and the displacement of 300,000 people to temporary camps. Since direct contact with flood water, consumption of contaminated water and the congregation of those affected in temporary shelters are risk factors for infectious diseases, the objective of this study was the implementation of a standardized methodology for the concentration and detection of enteric viruses and non-tuberculous mycobacteria, by real-time PCR and PCR-associated enzyme restriction analysis (PRA), in samples of flood water and the report of the pathogens detected in the affected areas of Asunción and in the Bay of the Paraguay River. The proposed methodology proved to have good sensitivity and the presence of rotavirus, norovirus (genogroups I and II), astrovirus, enteric adenovirus and non-tuberculous mycobacteria was recorded in 50% (N=4/8) of the samples from the Sajonia, San Jeronimo and Ricardo Brugada, Chacarita neighborhoods. In addition, we report secondary data on cases of infectious diseases, registered in the health services of the affected neighborhoods during the flood period.

Occurrence of viral gastroenteritis in children below 5 years: A hospital-based study from Assam, India

Viral gastroenteritis is an important cause of mortality and morbidity in children under 5 years of age. Many a time, these cases go unnoticed causing immense scarcity of data on viral diarrhoea. The study aimed to determine the occurrence of viral gastroenteritis among children below 5 years and the aetiological viral agents. Stool samples were collected from patients suffering from acute gastroenteritis. Real-time polymerase chain reaction was done for detection of rotavirus, adenovirus, norovirus, astrovirus and sapovirus. Viruses were detected in 55% of children. Adenovirus was found to be the most common virus (33.7%), followed by rotavirus infection (28.7%).

Developments of an Emerging Infectious Agent: Norovirus

Norovirus, a member of calciviruses family is the leading cause of community-acquired and nosocomial acute gastroenteritis or inflammation of the stomach and intestine. This pathogenic virus is highly communicable and found in the stools and vomit of infected persons. The symptoms of infection include sudden vomiting, diarrhea, abdominal cramp, headache, low grade fever, nausea, chills, etc. This RNA virus spreads through contaminated foods or liquids, sharing norovirus loaded objects and contact with infection individual. There is neither a specific medicine nor vaccination available for norovirus infection. Some vaccines are under pre-clinical trials. However, the virus can be controlled by following good personal hygiene practices such as hand washing, eating properly washed fruits and vegetables, properly cooked foods, and cleaning of the area occupied by patient. Norovirus infection can be regulated through public awareness and dissemination of proper knowledge about this viral infection. The present review summarizes the biology of infections caused by norovirus and their control measures.

Etiologic characteristics of norovirus in outbreaks of acute gastroenteritis in Quanzhou from 2014 to 2017 / 中华实验和临床病毒学杂志

Objective@#To understand the etiology, genotype and molecular characteristics of acute viral gastroenteritis in Quanzhou from 2014 to 2017.@*Methods@#Specimens from 15 outbreaks of acute viral gastroenteritis in Quanzhou area from 2014 to 2017 were collected and real-time fluorescence quantitative PCR was used to detect norovirus GI and GII, sapovirus, astrovirus and rotavirus, and the result were statistically analyzed. Furthermore, specimens positive for norovirus was further subjected to the amplification and sequencing of polymerase and VP1 genes of norovirus, and sequences were analyzed using DNAstar and MEGA7.0 software.@*Results@#In this study, 96 specimens from 15 outbreaks of acute viral gastroenteritis were collected, and norovirus was detected in 30 specimens with a positive rate of 31.25%, among which 23 specimens were genotype GII and 7 specimens genotype GI. Meanwhile, 10 specimens were randomly selected for nucleic acid sequence analysis. The result showed that 9 of them were GII.P16/GII.2 and 1 was GI.6. The phylogenetic analysis showed that the new recombinant norovirus subtype GII.P16/GII.2 was highly homologous to the same subtype detected in outbreaks home and abroad recently.@*Conclusions@#The main pathogens caused the outbreak of acute viral gastroenteritis in Quanzhou from 2014 to 2017 were norovirus belonging to subtype GII.P16/GII.2 and subtype GI.6, and subtype GII.P16/GII.2 was the predominant strain which was found for the first time in Quanzhou.

Viral gastroenteritis outbreaks associated with new recombinant strain GⅡ.P16/GⅡ.2 of norovirus in Fujian, 2016 / 中国人兽共患病学报

We delineated the molecular characteristic of recombinant strain GⅡ.P16/GⅡ.2 of norovirus associated with acute viral gastroenteritis outbreaks in Fujian Province in winter of 2016.Norovirus were detected in specimens of patients collected from the gastroenteritis outbreaks by real time reverse transcription-PCR and reverse transcription-PCR (RT-PCR).The PCR products of the positive samples were purified,and partial RNA dependent RNA polymerase (RdRp) gene and partial capsid gene were sequenced.The sequences were analyzed using bioinformatics software and online database,and phylogenetic tree were also constructed.Norovirus were detected in all 18 stools.Analysis of 9 positive sequences indicated an emergence of norovirus GⅡ.P16/ GⅡ.2 and confirmed being the cause of gastroenteritis outbreaks.All the strains shared homology of 98％ with strains of Kawasaki 194 of Japan detected in 2016 and 97.7％-98.8％ with IPH2161-08VG06 of Belgium detected in 2008,RdRp and capsid separately.These outbreak strains showed some degree of differences from the predominant strain,2012 Sydney GⅡ.4 variant.This is the first time to have found norovirus GⅡ.P16/ GⅡ.2 causing viral gastroenteritis outbreaks in Fujian.More in-depth analysis of the Norovirus GⅡ.P16/ GⅡ.2 could be useful to optimize preventative strategies and develop new and more effective therapeutic measure.

Viral gastroenteritis outbreaks associated with new recombinant strain GⅡ.P16/GⅡ.2 of norovirus in Fujian, 2016 / 中国人兽共患病学报

We delineated the molecular characteristic of recombinant strain GⅡ.P16/GⅡ.2 of norovirus associated with acute viral gastroenteritis outbreaks in Fujian Province in winter of 2016.Norovirus were detected in specimens of patients collected from the gastroenteritis outbreaks by real time reverse transcription-PCR and reverse transcription-PCR (RT-PCR).The PCR products of the positive samples were purified,and partial RNA dependent RNA polymerase (RdRp) gene and partial capsid gene were sequenced.The sequences were analyzed using bioinformatics software and online database,and phylogenetic tree were also constructed.Norovirus were detected in all 18 stools.Analysis of 9 positive sequences indicated an emergence of norovirus GⅡ.P16/ GⅡ.2 and confirmed being the cause of gastroenteritis outbreaks.All the strains shared homology of 98％ with strains of Kawasaki 194 of Japan detected in 2016 and 97.7％-98.8％ with IPH2161-08VG06 of Belgium detected in 2008,RdRp and capsid separately.These outbreak strains showed some degree of differences from the predominant strain,2012 Sydney GⅡ.4 variant.This is the first time to have found norovirus GⅡ.P16/ GⅡ.2 causing viral gastroenteritis outbreaks in Fujian.More in-depth analysis of the Norovirus GⅡ.P16/ GⅡ.2 could be useful to optimize preventative strategies and develop new and more effective therapeutic measure.

Aetiology of childhood viral gastroenteritis in Lucknow, north India.

Background & objectives: Due to limited availability of data on viral aetiology of acute gastroenteritis in north India, the present study was planned to detect rotavirus, norovirus, sapovirus and astrovirus in stool samples of both in hospitalized and non-hospitalized children less than five years of age presenting with acute gastroenteritis. Methods: A total of 278 stool samples from equal number of children were tested for rotavirus antigen using ELISA and for norovirus, sapovirus and astroviruses by reverse transcription (RT)-PCR. Results: Of the 169 samples from hospitalized patients, rotavirus, norovirus, sapovirus and astrovirus were detected in 19.5, 2.3, 3.5 and 2.9 per cent samples, respectively. Of the 109 samples collected from the non-hospitalized patients, frequency of rotavirus and sapovirus detection was 9.1 and 1.8 per cent, respectively while norovirus and astrovirus were not detected. Interpretation & conclusions: Rotavirus was the most frequent cause of viral gastroenteritis in both hospitalized and non-hospitalized children. Maximum positivity of the viruses was seen in children less than two years of age.

Diarreia aguda / Acute diarrhea

Diarreia aguda infecciosa é processo autolimitado. Manejo adequado de um episódio de diarreia aguda, com hidratação, alimentação e uso racional de exames de laboratório e medicamentos, vem preocupando pediatras e órgãos responsáveis pela saúde mundial. São discutidas aqui estas preocupações. Aspectos fisiopatológicos apresentados visam diminuir, ao máximo, a investigação laboratorial e o uso de medicamentos, com tratamento orientado, principalmente para hidratação e alimentação. Orientações da Organização Mundial da Saúde, acompanhadas pelas do Ministério da Saúde, são comparadas com as últimas recomendações, em 2014, das Sociedades Europeias de Gastroenterologia Pediátrica, Hepatologia e Nutrição e de Doenças Infecciosas. Observa-se grande concordância entre elas, principalmente no tratamento baseado, quase exclusivamente, em hidratação e alimentação, enquanto se espera a autolimitação.

Citomegalovirus en enfermedad inflamatoria intestinal / Cytomegolavirus in inflammatory bowel disease

Cytomegalovirus (CMV) gastrointestinal infection in inflammatory bowel disease (IBD) is a diagnostic challenge with close relationship with clinical course and treatment response. This article summarizes biology, pathology, clinical manifestation and diagnosis of CMV disease and especially in IBD.

La infección gastrointestinal por citomegalovirus (CMV) en paciente con enfermedad inflamatoria intestinal (EII) constituye un desafío diagnóstico importante y se encuentra íntimamente relacionada con la evolución y respuesta a tratamiento de la EII. El presente artículo resume las características biológicas del CMV, sus características patogénicas, sus manifestaciones clínicas y sus métodos diagnósticos. Se expone con mayor detalle la implicancia de esta infección en pacientes portadores con EII y su enfrentamiento clínico.

Viral acute gastroenteritis: clinical and epidemiological features of co-infected patients

BACKGROUND: Acute gastroenteritis (AGE) is a common disorder that affects children worldwide. It is usually caused by viral agents, including rotavirus, enteric adenovirus, norovirus, and astrovirus groups. Currently, there are few reports about co-infection among these viruses, mainly in Brazil. METHODS: This is a retrospective study in which 84 rotavirus-positive samples from hospitalized patients at a teaching hospital in Southern Brazil, collected in the 2001-2010 period, were analyzed by polymerase chain reaction (PCR) and reverse transcription - polymerase chain reaction (RT-PCR), for the investigation of enteric adenovirus, astrovirus, and norovirus. RESULTS: In total, 12 of the 84 (14%) samples were positive to enteric adenovirus or norovirus. Clinical, laboratory, and demographic data showed statistically significant differences between mono and co-infected patients, including age and depletion rate. CONCLUSIONS: These findings highlight the need for implementation of other enteric virus detection assays in clinical diagnosis for a complete laboratory investigation of hospitalized pediatric patients with AGE, in order to understand the impact of these pathogens on disease severity, spread within hospital, and consequently, prevent the dissemination of nosocomial infections.

Rotavírus e as perspectivas para seu controle por terapia vacinal / Rotavirus and prospects for their control by vaccine therapy

A presente revisão tem por objetivo a descrição da infecção gastrointestinal por rotavírus no âmbito de sua epidemiologia e da importância do seu tratamento, na forma vacinal, que abrange bons resultados contra a maioria dos genótipos e sorotipos mais comuns no planeta. Neste caso, a vacina denominada de Vacina Oral de Rotavírus Humano (VORH), de origem humana, G1P[8] da cepa R1X4414, atualmentefoi a que demonstrou melhoreficácia. Como a vacinação específica é a medida mais eficaz na prevenção e controle, são necessários estudos da eficácia de novas candidatas a vacinas contra o rotavírus no Brasil e no mundo.

This review describes the gastrointestinal infection by rotavirus in the ambit of its epidemiology and the importance of its treatment by vaccines that embrace good results against most of the genotypes and more common sorotypes in the planet. In this case, the vaccine denominated Oral Vaccine of Human Rotavirus (OVHR), from human origin, G1P [8] of thestump R1X4414, now has demonstrated bettereffectiveness. Considering that thespecific vaccination is the most effective way to prevention and control, we need studies about the effectiveness of new vaccines against the rotavirus in Brazil and in the whole world.

Norovirus Outbreak after a School Trip among Girls' High School Students

Norovirus is one of the common causative agents of viral gastroenteritis in developed countries. A large outbreak of gastroenteritis occurred among girls' high school students in Cheongju city, Chungbuk province, who had attended a school trip to Cheju island from 19 to 21 May 2003. One hundred and ninety six students were consistent with case definition and attack rate was 54.9%. The epidemic curve was characteristic of a point-source outbreak. The frequency of diarrhea was 1 to 6 times (76.8%) and the duration of diarrhea was within two days (85.1%) in most cases. The most common symptom with diarrhea was abdominal pain followed by headache, tenesmus, febrile sense, chill and vomiting. The following bacterial organisms, Salmonella spp, Shigella spp, Vibrio spp, Staphylococcus aureus, and E coli O157 were examined in 196 stool specimens, but no suspicious organism was detected. In virological examinations, Norovirus was dectected in 3 out of 25 stool specimens from the sick students. Among the 22 stool specimens of the food handlers during the school trip, both bacterial and virological examinations were all negative. Among the 13 environmental specimens, the groundwater of the hotel, where the students had stayed during their school trip, was contaminated with general bacteria and E. Coli. However, we could not detect Norovirus in the groundwater of the hotel. We concluded that Norovirus might be a possible cause of this outbreak, and the water supply of the hotel might be a probable source of this outbreak.

Epidemiologic Characteristics and DNA Sequencing of SRSV Causing Gastroenteritis Outbreak in Two Elementary School / 감염과화학요법

BACKGROUND: Small round structured virus (SRSV) is one of the common etiologic agents of viral gastroenteritis in childhood. However, SRSV has not easily been detected in many diarrheal outbreaks. Therefore, we experienced simultaneous outbreak of SRSV enteritis in two elementary schools, therefore, we analyzed the result of the surveillance. METHODS: We interviewed the pupil of two schools and questioned their demographic data, presence of gastrointestinal symptoms, contact with symptomatic persons within the last two weeks, and dietary history within the last one week in school. The specimens of the symptomatic pupil were collected for identification of bacteria (Shigella spp, Salmonella spp, E.coli O157 : H7) and viruses (Norwalk agent, SRSV, adenovirus, and astrovirus). RESULTS: The number of symptomatic patients was 193 (193/2843, 6.8%) and the distribution of symptom onset was unipolar. Frequent symptoms of the patients were abdominal pain (176/193, 91.2%), headache (111/193, 57.5%), vomiting (102/193, 52.8%), diarrhea (83/ 193, 43.0%), febrile sense (79/193, 40.9%), nausea (73/193, 37.8%), chilling (49/193, 25.4%), and tenesmus (8/193, 4.1%). We identified SRSV in 9 cases by PCR method, and analyzed the RNA polymerase gene by DNA sequencing; 2 genogroup (Genogroup I, II) and 3 genotype. CONCLUSION: We confirmed SRSV enteritis with different genotypes in two concurrent outbreaks. DNA sequencing and comparison of genotype among the isolated SRSV in near future are be necessary

Epidemiologic Characteristics and DNA Sequencing of SRSV Causing Gastroenteritis Outbreak in Two Elementary School / 감염과화학요법

BACKGROUND: Small round structured virus (SRSV) is one of the common etiologic agents of viral gastroenteritis in childhood. However, SRSV has not easily been detected in many diarrheal outbreaks. Therefore, we experienced simultaneous outbreak of SRSV enteritis in two elementary schools, therefore, we analyzed the result of the surveillance. METHODS: We interviewed the pupil of two schools and questioned their demographic data, presence of gastrointestinal symptoms, contact with symptomatic persons within the last two weeks, and dietary history within the last one week in school. The specimens of the symptomatic pupil were collected for identification of bacteria (Shigella spp, Salmonella spp, E.coli O157 : H7) and viruses (Norwalk agent, SRSV, adenovirus, and astrovirus). RESULTS: The number of symptomatic patients was 193 (193/2843, 6.8%) and the distribution of symptom onset was unipolar. Frequent symptoms of the patients were abdominal pain (176/193, 91.2%), headache (111/193, 57.5%), vomiting (102/193, 52.8%), diarrhea (83/ 193, 43.0%), febrile sense (79/193, 40.9%), nausea (73/193, 37.8%), chilling (49/193, 25.4%), and tenesmus (8/193, 4.1%). We identified SRSV in 9 cases by PCR method, and analyzed the RNA polymerase gene by DNA sequencing; 2 genogroup (Genogroup I, II) and 3 genotype. CONCLUSION: We confirmed SRSV enteritis with different genotypes in two concurrent outbreaks. DNA sequencing and comparison of genotype among the isolated SRSV in near future are be necessary