The diagnosis of norovirus infections in hospitalized children and adolescents with acute gastroenteritis: a study from Pilsen, Czech Republic.

BACKGROUND: Norovirus-associated sporadic gastroenteritis is an important cause of illness in Western Europe. However, at present, little information on the role of norovirus in sporadic gastroenteritis in Central Europe is available. Our study aimed at providing an assessment of their significance in hospitalized children and adolescents with acute gastroenteritis using ELISA test at the time of their introduction. METHODS: A prospective hospital based study of the etiology of acute gastroenteritis was undertaken in a total of 618 patients (mean age 39.8 months, range 0-228), who were hospitalized at the Charles University Hospital in Pilsen. All subjects were monitored in six fragmented periods during the years 2003 and 2004, 2006 and 2007. Clinical and laboratory data were processed, norovirus antigens in stools were detected using the EIA kits IDEIA Norovirus, DakoCytomation. RESULTS: A norovirus infection was confirmed in 62 cases, i.e., 10.0% of all patients with acute gastroenteritis. Vomiting was the most common symptom, recorded in 95.2 % of all the patients with norovirus infection. No severe extragastrointestinal complications were detected. The average interval between initial symptoms and the beginning of hospitalization was considerably shorter in patients with norovirus infection (1.3 days) compared with patients with rotavirus infections (2.4 days). The frequency of Salmonella spp., rotavirus, Campylobacter spp. and enteric adenovirus was 15.4%, 11.2%, 3.9%, 3.6%, respectively. CONCLUSIONS: Our findings confirm the clinical importance of noroviruses as a causative agent of acute gastroenteritis in children and teenagers in the region of a Central European country. Identification of norovirus infection should be included in the routine screenings of sporadic cases of acute gastroenteritis.

First experience with diagnosing astroviral infections in children hospitalized in Pilsen (Czechia).

Between the years 2000-2002 astroviral infection was confirmed in 0.8 % of 2606 children admitted for a diarrheal disease to the University Hospital in Pilsen (Czechia). Astrovirus infections most frequently occurred in the age group between 49-60 months, and 77.3 % of the infections occurred in winter. When the incidence was calculated for these most susceptible age groups, the positive rates were 2.4 % (between 49-60 months) and 1.2 % (between 7-12 months) respectively. On average the hospitalization lasted for 5 d, the diarrhea 3.7 d, vomiting 1.1 d, and 40.9 % of infected children had a raised temperature. In 7 out of 872 stool samples (0.8 %), astrovirus antigen has appeared in the course of the monitored period, i.e. nosocomial astrovirus infection was recorded. In view of the rarity of detecting astroviral infections it is probably not effective to include the diagnosis of these infections in the routine panel when examining the children admitted for gastrointestinal infections. The diagnosis of these infections should, however, be performed within the framework of epidemic incidence and in nosocomial infections.

[Diagnosis of rotavirus infections--comparison of various methods]. / Diagnostika rotavirových infekcí--porovnání ruzných metod.

In 179 samples of faeces from patients hospitalized with diarrhoeal diseases rotavirus infections were examined concurrently by three different sets--the latex agglutination test Diarlex Rota-Adeno (Orion Diagnostica) and two immunoenzyme tests (EIA)--EIA Rotavirus (Test-Line, CR) and IDEIA Rotavirus (Dako Ltd.) By the latex agglutination reaction the rotavirus infection was proved 31 times (17.3%), by the Test-Line test 87 times (48.6%), by the Dako test 96 times (53.6%). During the interval of 0-3 days after the onset of the disease the positivity assessed by different tests was 22.8%, 48.6% and 54.3%, on the 4th-7th day 12.8%, 51.1% and 57.4%, on the 8th and subsequent days 3.7%, 44.4% and 44.4%. Comparison of sets Orion Diagnostica and Dako revealed the sensitivity of the latex agglutination test only as 30.2% and specificity 97.6%. After the 9th day from the onset of the disease the infection was no longer confirmed by the latex agglutination test, while both EIA tests proved the rotavirus antigen up to the 16th day from the onset of the disease.

[Long-term follow-up of nosocomial rotavirus infections at the Infectious Diseases Clinic of the Medical School Hospital in Plzen (1987-1994)]. / Dlouhodobé sledování nozokomiálních rotavirových infekcí na Infekcní klinice Fakultní nemocnice v Plzni (1987-1994).

The authors evaluated in 1987-1994 the incidence of nosocomial rotavirus infections during hospitalization in 1718 junior children, 450 senior children and adults admitted with diarrhoeal diseases. Rotavirus infection was revealed in 6.2 and 1.3% of the patients resp. During hospitalization the rotaviruses were the most frequent causal agent of nosocomial infections. Hospital infection was contracted regardless of the initial diagnosis most frequently by patients aged 0-12 months. The majority of nosocomial rotavirus infections was associated with symptoms of diarrhoeal disease, on average symptomatic infections prolonged the hospitalization period by 4.2 days. The authors discuss the possibility to influence the incidence of these infections.

[Nosocomial rotavirus infections in children]. / Rotavirové nozokomiální infekce u detí.

BACKGROUND: Worldwide rotaviruses cause in young children one third of diarrhoeal diseases which call for hospital admission. Rotaviruses are also considered the most frequent etiological agent of nosocomial diarrhoeal infections. The objective of the present work was an analysis of the etiology of diarrhoea and nosocomial infection, in particular of rotavirus etiology in children under three years of age. METHODS AND RESULTS: In 1990-1994 a total of 2002 children under three years were admitted to hospital, incl. 1480 (73.9%) on account of diarrhoeal diseases. A rotavirus etiology was proved in 25.4%, adenovirus etiology in 3.3%. As to bacterial infections, salmonellosis was most frequent (24.4%), less frequent campylobacteriosis (8.4%), shigellosis (1.7%), colibacillary infection (1.3%) or yersiniosis (0.2%). In 36.4% cases of gastroenteritis the etiology was not elucidated. Nosocomial infection with rotaviruses was proved in 59 of 1480 patients with diarrhoea (4.0%) and in 4.5% of the total number of 2002 sick children resp. Nesocomial infection developed most frequently between the 4th and 6th day of hospitalization; the clinical picture is not very different, as a rule isoosmolal dehydration which in cca 50% called for parenteral rehydration. About three quarters of the patients have temporarily elevated aminotransferases. As far as the seasonal character of the disease is concerned, the highest incidence was recorded in the following months of the year: I, II, III, IV, X and XI. This two-phase rotaviral incidence of enteritis does, however, not correspond with the incidence of nosocomial infections. Symptomatic treatment is successful. The prognosis is favourable. Nosocomial rotavirus infection protracted hospitalization on average by five days. CONCLUSIONS: Nosocomial rotavirus gastroenteritis is a serious problem in particular in departments with young children. So far we are unable to influence their occurrence. They are not seasonal, they do not have a different clinical picture or course. Luckily they have a favourable prognosis. However, they prolong the period of hospitalization.

[Long-term follow-up of the etiology of diarrhea with emphasis on the role of rotaviruses in hospitalized patients at the Infectious Disease Clinic of the Medical School Hospital in Plzen]. / Dlouhodobé sledování etiologie prujmu u hospitalizovaných nemocných na Infekcní klinice Fakultní nemocnice v Plzni se zamerením na uplatnení rotaviru.

During 1986-1994 the etiological structure of diarrhoea in hospitalized patients at the Infectious Diseases Clinic, University Hospital Plzen was analyzed. In children under four years most frequently (in 26%) rotaviruses were involved, in older patients their ratio was lower and the decisive pathogenetic organism were salmonellae. In rotavirus infections the shortest hospitalization period was recorded. These infections were encountered all round the year with a maximum prevalence in the winter months.

[Clinical and epidemiologic findings in studies of Campylobacter infections]. / Klinické a epidemiologické poznatky ze sledování kampylobakterióz.

During the period between May 1987 and April 1989 from 929 patients hospitalized at the Clinic for Infectious Diseases with acute diarrhoeal disease Campylobacter infection was detected in 10.6%; a bacterial aetiology was confirmed in 29%. The maximum incidence of campylobaterioses was in the summer months, among those affected children aged 1-14 years predominated. Analysis of the course of the disease in children under three years revealed typical high fever and blood in the faeces--in half the patients. Carriership of Campylobaters was short, as a rule 2-3 weeks. In cases reported to the hygiene service in the region contact with animals was reported by half the patients. In particular chickens and smoked meat products were considered a suspect vehicle.

[Clinical and epidemiologic findings from a study of rotavirus infections in hospitalized children]. / Kliniké a epidemiologické poznatky ze sledování rotavirových infekcí u hospitalizovaných detí.

The authors examined in 1986-1988 the aetiology of acute diarrhoea in 323 children hospitalized at the Infectious Diseases Clinic in Plzen. An infectious aetiology was proved in 47.7% of the children, the most frequently detected aetiological agent were rotaviruses which caused 28% of the recorded diseases. Their prevalence culminated in December--May; as to age, children between 7 and 24 months predominated. In 41.1% of the subjects with rotavirus infection respiratory symptoms were present all round the year, in 65.5% children transiently pathological transaminase values were recorded. Of 145 children where by laboratory methods nosocomial intestinal infections were monitored, this infection was contracted by 14 children (9.6%). The most frequent causal agent of these diseases were rotaviruses.

[Cytohormonal picture of the vaginal epithelium in girls with premature pubic hair (author's transl)]. / Obraz cytohormonalny nablonka pochwy u dziewczynek z przedwczesnym owlosieniem plciowym

The study has aimed at assessing the cytohormonal picture of the vaginal epithelium of girls in whom the appearance of "pubarche" before the period of physiological sexual maturation was first perceivable symptom of disease or of the influence of the influence of exogenous hormones. The observation involved 16 girls hospitalized at the Pediatric Clinical Department or the Oncological Clinical Department or were remaining under the care of the Endocrinological Dispensary of the National Research Institute for Mother and Child, in whom "pubarche" appeared at the age of 1-7 1/2 years. Vaginal smears were the material for the present study. The estimation of the cytohormonal pictures of the vaginal epithelium together with the clinical symptoms and the laboratory analyses enabled the author to draw the following conclusions: 1. There may be diverse causes of the appearance of premature pubic hair. 2. In girls, in whom "pubarche" was the first symptom of precocious sexual maturation induced by the central nervous system, in most cases pituitary gonadotropins were found in the urine and the cytohormonal picture of the vaginal epithelium showed an oestrogenic reaction. 3. In the case of premature pubic hair of unexplained etiology the cytohormonal picture of the vaginal epithelium was always atrophic. The cytohormonal smears taken from the vaginal epithelium of girls with with premature pubic hair may be a valuable test for establishing the diagnosis.