Peculiarities of norovirus and rotavirus infections in hospitalised young children.

OBJECTIVES: To investigate the features of norovirus infection in hospitalised children under the age of 3 and to compare the results with those of rotavirus infection. PATIENTS AND METHODS: Case notes were randomly selected and retrospectively analysed for 70 norovirus- and 70 rotavirus-infected children. All of the children were treated in Vilnius University Children's Hospital in 2005. The norovirus antigen was assayed using enzyme-linked immunosorbent assay, the rotavirus using immunochromatography diagnostic assay. RESULTS: In young children, norovirus infection manifested as vomiting (94% of all cases), diarrhoea (81%), and fever (66%). It presented as gastroenteritis with fever (47%) or without fever (30%). However, 19% of cases were without diarrhoea. During rotavirus infection, fever was present in 97% of cases and 81% of them were >38 degrees C. However, in norovirus infection, the percentages were 66% and 48%, respectively (P < 0.0001). Intensive diarrhoea (> or =7 times/day) more frequently appeared in children with rotavirus infection than with norovirus (P < 0.0001). Repeated vomiting (> or =4 times/day) has been more common for children with norovirus infection. As opposed to norovirus infection, which has 2 main syndromes (gastroenteritis with fever and without fever), rotavirus infection is dominated by just 1 clinical syndrome-gastroenteritis with fever (P < 0.0001). CONCLUSIONS: Norovirus infection in young children can present as gastroenteritis with or without fever. Norovirus and rotavirus infections had statistically significant differences in the presence and the degree of fever, and the intensity of diarrhoea and vomiting, as well as frequency of different syndromes.

Synthesis of recombinant human parainfluenza virus 1 and 3 nucleocapsid proteins in yeast Saccharomyces cerevisiae.

Human parainfluenza virus types 1 and 3 (HPIV1 and HPIV3, respectively), members of the virus family Paramyxoviridae, are common causes of lower respiratory tract infections in infants, young children, the immunocompromised, the chronically ill, and the elderly. In order to synthesize recombinant HPIV1 and HPIV3 nucleocapsid proteins, the coding sequences were cloned into the yeast Saccharomyces cerevisiae expression vector pFGG3 under control of GAL7 promoter. A high level of recombinant virus nucleocapsid proteins expression (20-24 mg l(-1) of yeast culture) was obtained. Electron microscopy demonstrated the assembly of typical herring-bone structures of purified recombinant nucleocapsid proteins, characteristic for other paramyxoviruses. These structures contained host RNA, which was resistant to RNase treatment. The nucleocapsid proteins were stable in yeast and were easily purified by caesium chloride gradient ultracentrifugation. Therefore, this system proved to be simple, efficient and cost-effective, suitable for high-level production of parainfluenza virus nucleocapsids as nucleocapsid-like particles. When used as coating antigens in an indirect ELISA, the recombinant N proteins reacted with sera of patients infected with HPIV1 or 3. Serological assays to detect HPIV-specific antibodies could be designed on this basis.

Consequences of varicella in pregnancy: a report of four cases.

UNLABELLED: Four infants are reported with varicella-Zoster virus (VZV) infection, whose mothers had varicella during the second-third trimester of pregnancy. Two newborns had neonatal varicella. One of them, whose mother contracted varicella 5 days before delivery, had a severe and complicated form of the disease. The infants who had herpes zoster did not have specific VZV-IgG antibodies at the onset of the disease. CONCLUSION: These cases showed that varicella during the second-third trimester of pregnancy may have serious consequence for infants.

Aetiological diagnostics of acute bacterial meningitis in children.

Aetiology of bacterial meningitis (BM) can be confirmed by various microbiological methods. The aim of this study was to assess the role of microbiological methods used for confirmation of BM in children and determine the influence of the aetiological agent, patient age and antibacterial treatment on study results. Over a 5-y period (1998-2002) BM was diagnosed in 90 children at Vilnius University Centre for Paediatrics. Aetiology was confirmed by cerebrospinal fluid (CSF) and blood culture, microscopic CSF smear examination, CSF and blood latex agglutination test. CSF and blood cultures were positive in 53% and 39% of cases, respectively. Microscopic CSF smear examination was positive for 57% of the specimens. CSF latex agglutination was positive in 64% and blood in 47% of cases. Causative agent and received antibiotic therapy prior to investigation of obtained material affected some final microbiological results. However, no influence of patient age was found. Microbiological confirmation was achieved in 59% of cases using CSF and/or blood culture and in 78% of cases using all available methods in practice. The most common pathogens of bacterial meningitis were H. influenzae type b, N. meningitidis and S. pneumoniae.

Clinical presentation of pertussis in fully immunized children in Lithuania.

BACKGROUND: In Lithuania, the vaccination coverage against pertussis is high. Nevertheless, there is a significant increase in pertussis cases in fully immunized children. The aim of our study was to determine the frequency of classical symptoms of laboratory confirmed pertussis and describe its epidemiology in children fully vaccinated against pertussis. METHODS: From May to December 2001, 70 children aged 1 month to 15 years, suffering from prolonged cough were investigated in the Centre of Paediatrics, Vilnius University Children's Hospital. The collected information included personal data, vaccination history, clinical symptoms of the current illness, and treatment before hospitalization. At the admission to the hospital blood samples were taken from all studied children for Bordetella pertussis IgM and IgA. RESULTS: A total of 53 (75.7%) of the 70 recruited patients with prolonged cough showed laboratory evidence of pertussis. 32 of them were fully vaccinated with whole cell pertussis vaccine (DTP). The age of fully vaccinated patients varied from 4 to 15 years (average 10.9 +/- 3.1; median 11). The time period between the last vaccination dose (fourth) and the clinical manifestation of pertussis was 2.6-13 years (average 8.9 +/- 3.0; median 9). More than half of the children before the beginning of pertussis were in contact with persons suffering from long lasting cough illness in the family, school or day-care center. The mean duration from onset of pertussis symptoms until hospitalization was 61.4 +/- 68.3 days (range, 7 to 270 days; median 30). For 11 patients who had had two episodes (waves) of coughing, the median duration of cough was 90 days, and for 21 with one episode 30 days (p < 0.0002). Most of the children (84.4%) had paroxysmal cough, 31.3% had post-tussive vomiting, 28.1% typical whoop, and 3.1% apnea. Only 15.6% children had atypical symptoms of pertussis. CONCLUSION: Fully vaccinated children fell ill with pertussis at the median of 11 years old, 9 years following pertussis vaccination. More than half of the children could catch pertussis at home, at school or day-care center. Clinical picture of pertussis in previously immunized children is usually characterized by such classical symptoms as prolonged and paroxysmal cough, rarely by whopping and post-tussive vomiting, and very rarely by apnea.

Management of Lithuanian children's acute diarrhoea with Gastrolit solution and dioctahedral smectite.

OBJECTIVE: Acute gastroenteritis represents a major cause of morbidity and mortality worldwide among children, and rehydration treatment has been one of the cornerstones in the management strategy. The natural clay dioctahedral smectite (Smecta) increases intestinal barrier function and is effective against infectious diarrhoea in children. The purpose of this work was to compare the efficacy and tolerance of Lithuanian children's diarrhoea treatment with dioctahedral smectite combined with hypotonic oral rehydration solution (ORS)--Gastrolit--versus Gastrolit alone to establish the influence of Smecta on serum electrolyte balance in young children with diarrhoea and mild or moderate dehydration. METHODS: Smecta combined with ORS (study group) and ORS alone (control group) were evaluated in a multicentre, open, randomized trial in 54 children aged 6-48 months hospitalized for acute diarrhoea (mostly rotavirus aetiology) and signs of mild and moderate dehydration. The main outcomes examined were duration of diarrhoea, fever, number of vomiting episodes, and serum electrolyte balance before and after treatment. RESULTS: The mean duration of diarrhoea was significantly shorter in the study group (42.3 +/- 24.7 h) than in the control group (61.8 +/- 33.9 h). No side effects of Smecta were observed. The changes of sodium, potassium, chloride and calcium concentrations after treatment were minimal and in the normal range. CONCLUSIONS: Smecta significantly reduced the duration of diarrhoea, was safe and well tolerated, and had no impact on the adsorption of electrolytes. Smecta could be used together with ORS in children suffering from acute gastroenteritis (without uncontrollable vomiting) with mild and moderate dehydration.