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Transmissible gastroenteritis in endemically infected breeding herds of pigs in East Anglia, 1981-85.

Endemic infection was a common sequel to primary outbreaks of transmissible gastroenteritis in large breeding herds of pigs in East Anglia. The main clinical features of the disease were diarrhoea affecting sucking piglets aged about six days or more, diarrhoea among recently weaned pigs and brief episodes of overt clinical recrudescence in part of the herd. Post mortem and bacteriological findings were often more suggestive of colibacillosis than transmissible gastroenteritis. In some herds, endemic infection remained clinically mild or inapparent for long periods. Evidence of endemic transmissible gastroenteritis infection was found in 43 (50.6 per cent) of 85 herds of pigs studied prospectively between 1981 and 1983. There was a significant correlation with herd size; the disease recurred during the 12 months after primary outbreaks in 36 (65.5 per cent) of 55 herds with over 100 sows compared with seven (23.3 per cent) of 30 herds with less than 100 sows (P less than 0.001). In the larger herds it occurred more commonly where finishers were kept (P less than 0.05). Sow morbidity and management factors during the primary outbreak had no statistically significant effect on the incidence of recrudescence. Epidemiological aspects of the findings are discussed with emphasis on the difficulties associated with the diagnosis and control of endemic transmissible gastroenteritis infection.

Animals↗

Acute gastroenteritis-related encephalopathy.

We studied the incidence of convulsions in 1936 children with acute gastroenteritis. Sixty-eight children had convulsions (3.5%), which were categorized into three groups: (1) bacterial (n = 13; 19%), (2) Rotavirus (n = 30, 44%), and (3) no organism (n = 25; 37%). Only group 2 versus group 3 had a significant association with encephalopathy (P < .002). The relative risk was estimated to determine the risk of encephalopathy: Rotavirus versus no organism isolated (relative risk = 2.308), Rotavirus versus bacterial (relative risk = 1.846), and bacterial versus no organism (relative risk = 1.25). None developed epilepsy. Thus, acute gastroenteritis-related encephalopathy is a benign condition with single or recurrent seizures during an episode of acute gastroenteritis and an excellent prognosis. The underlying mechanism for provoking seizure is unknown. One should be reassured of a good outcome in the majority of children with recurrent episodes of afebrile/febrile seizures during an episode of acute gastroenteritis.

Acute Disease↗

Noroviruses associated with acute gastroenteritis in a children's day care facility in Rio de Janeiro, Brazil.

Noroviruses (Norwalk-like viruses) are an important cause of gastroenteritis worldwide. They are the most common cause of outbreaks of gastroenteritis in the adult population and occur in nursing homes for the elderly, geriatric wards, medical wards, and in hotel and restaurant settings. Food-borne outbreaks have also occurred following consumption of contaminated oysters. This study describes the application of a reverse transcription-polymerase chain reaction (RT-PCR) assay using random primers (PdN6) and specific Ni and E3 primers, directed at a small region of the RNA-dependent RNA polymerase-coding region of the norovirus genome, and DNA sequencing for the detection and preliminary characterisation of noroviruses in outbreaks of gastroenteritis in children in Brazil. The outbreak samples were collected from children <5 years of age at the Bertha Lutz children's day care facility at Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, that occurred between 1996 and 1998, where no pathogen had been identified. At the Bertha Lutz day care center facility, only Fiocruz's employee children are provided for, and they come from different social, economic and cultural backgrounds. Three distinct genogroup II strains were detected in three outbreaks in 1997/98 and were most closely related to genotypes GII-3 (Mexico virus) and GII-4 (Grimsby virus), both of which have been detected in paediatric and adult outbreaks of gastroenteritis worldwide.

Acute Disease↗

The differential leukocyte count in adults with acute gastroenteritis.

The total and differential leukocyte count of 4 groups of patients, admitted to the hospital because of acute gastroenteritis was evaluated. The 4 groups included: (a) 131 adult patients with positive stool culture for shigella; (b) 23 children (age less than 15 years) with positive stool culture for shigella; (c) 52 adult patients with positive stool culture for salmonella; (d) 43 adult patients with negative stool culture for bacterial pathogens. The total leukocyte count did not contribute to the differential diagnosis between shigella gastroenteritis and gastroenteritis of other etiology. However, the absolute band count was significantly higher in adults with shigella gastroenteritis. Moreover, a band to total neutrophil ratio further increased the diagnosis specificity. The differential leukocyte count can contribute to early diagnosis of shigellosis in adult patients.

Acute Disease↗

Estimating foodborne gastroenteritis, Australia.

We estimated for Australia the number of cases, hospitalizations, and deaths due to foodborne gastroenteritis in a typical year, circa 2000. The total amount of infectious gastroenteritis was measured by using a national telephone survey. The foodborne proportion was estimated from Australian data on each of 16 pathogens. To account for uncertainty, we used simulation techniques to calculate 95% credibility intervals (CrI). The estimate of incidence of gastroenteritis in Australia is 17.2 million (95% confidence interval 14.5-19.9 million) cases per year. We estimate that 32% (95% CrI 24%-40%) are foodborne, which equals 0.3 (95% CrI 0.2-0.4) episodes per person, or 5.4 million (95% CrI 4.0-6.9 million) cases annually in Australia. Norovirus, enteropathogenic Escherichia coli, Campylobacter spp., and Salmonella spp. cause the most illnesses. In addition, foodborne gastroenteritis causes approximately 15,000 (95% CrI 11,000-18,000) hospitalizations and 80 (95% CrI 40-120) deaths annually. This study highlights global public health concerns about foodborne diseases and the need for standardized methods, including assessment of uncertainty, for international comparison.

Australia↗

Eosinophilic gastroenteritis: clinical experience with 15 patients.

AIM: To evaluate the clinic features of eosinophilic gastroenteritis and to examine the diagnosis, treatment, long-term outcome of this disease. METHODS: Charts with a diagnosis of eosinophilic gastroenteritis from 1984 to 2002 at Mackay Memorial Hospital were reviewed retrospectively. There were 15 patients diagnosed with eosinophilic gastroenteritis. The diagnosis was established in 13 by histologic evaluation of endoscopic biopsy or operative specimen and in 2 by radiologic imaging and the presence of eosinophilic ascites. RESULTS: All the patients had gastrointestinal symptoms and 12 (80%) had hypereosinophilia (absolute eosinophil count 1,008 to 31,360/cm3). The most common symptoms were abdominal pain and diarrhea. Five of the 15 patients had a history of allergy. Seven patients had involvement of the mucosa, 2 of muscularis, and 6 of subserosa. One with a history of seafood allergy was successfully treated with an elimination diet. Another patient improved spontaneously after fasted for several days. The remaining 13 patients were treated with oral prednisolone, 10 to 40 mg/day initially, which was then tapered. The symptoms in all the patients subsided within two weeks. Eleven of the 15 patients were followed up for more than 12 months (12 to 104 months, mean 48.7), of whom 5 had relapses after discontinuing steroids (13 episodes). Two of these patients required long-term maintenance oral prednisolone (5 to 10 mg/day). CONCLUSION: Eosinophilic gastroenteritis is a rare condition of unclear etiology characterized by relapses and remissions. Short courses of corticosteroids are the mainstay of treatment, although some patients with relapsing disease require long-term low-dose steroids.

Adolescent↗

Cryptosporidiosis in hospital patients with gastroenteritis.

Among 884 hospital patients with gastroenteritis, 36 (4.1%) were excreting Cryptosporidium oocysts in their stools; only 5 of the 36 patients were also excreting other enteropathogens, while none of 320 hospital patients without gastroenteritis were excreting Cryptosporidium oocysts. Children were more commonly infected with Cryptosporidium (4.8%) than were adults (1.6%). The prevalence of infection was higher (7%) during the summer period of February-May 1981 than in the remainder of the observation period to the beginning of June 1982 (1.9%). The most common clinical manifestation of gastroenteritis in Cryptosporidium-infected patients was diarrhea, lasting from 3 to over 14 days, accompanied by vomiting, anorexia, and abdominal pain. The results show that a small proportion of patients with gastroenteritis are infected with Cryptosporidium, and the importance of the infection needs to be examined.

Adolescent↗

Impaired acidification of urine in children aged two months to two years with acute gastroenteritis complicated by acidosis.

BACKGROUND: In some children with acute gastroenteritis and acidosis, the urine pH may be abnormally high thus simulating distal Renal Tubular Acidosis (dRTA). This inability to acidify urine properly in the presence of metabolic acidosis has been shown to be due to poor delivery of sodium to the distal nephron which prevents full excretion of a hydrogen ion load, instead of an intrinsic defect in the ability of the distal tubule to acidify urine. The aim of this study is to determine the prevalence of transient urinary acidification defect in children aged two months to two years with acute gastroenteritis, dehydration and acidosis, and the relationship between urine pH and urine sodium concentration. METHOD: A prospective study of children aged two months to two years admitted for the treatment of acute gastroenteritis and dehydration at the Children's Emergency Ward (CHEW) of the University of Port Harcourt Teaching Hospital, Rivers State. RESULTS: Of the 196 children (140 males and 56 females) studied with spontaneous acidosis which developed as a result of acute gastroenteritis, seventy-three of them had impaired acidification of urine, giving a prevalence of 37.2%. There was no significant difference in the age, duration of symptoms, degree of acidosis, degree of dehydration and serum potassium concentration between the children with impaired and those with proper urine acidification. Those with impaired acidification of urine however had a significantly lower serum sodium and urine sodium concentrations and a significantly higher urine potassium concentration and urine anion gap than those children with proper urine acidification. All urine samples with sodium concentration less than or equal to 25 mmol/L (52) had urine pH greater than 5.5. CONCLUSION: Mere presence of acidosis and high urine pH should not lead to a diagnosis of Distal Renal Tubular Acidosis (dRTA). The urine anion gap (UAG) should be calculated using the formula: urine [Na+] + [K+] [Cl], and if negative, it suggests a high ammonium excretion, which makes the diagnosis of dRTA unlikely.

Acidosis, Renal Tubular↗

Hospitalisations for rotavirus gastroenteritis among children under five years of age in New South Wales.

OBJECTIVE: To estimate the number of children under five years of age hospitalised for rotavirus gastroenteritis in New South Wales. DESIGN: Retrospective survey with comparison of patterns of hospital admissions for acute gastroenteritis in children under five with laboratory reports of rotavirus infection. SETTING: New South Wales, January 1991-December 1993. OUTCOME MEASURES: Laboratory reports of rotavirus infection to the Eastern Sydney Laboratory Surveillance Program (a voluntary laboratory reporting scheme) and hospital admissions of children under five with principal diagnosis classified under international classification of diseases, 9th revision, clinical modification (ICD-9-CM) codes 008.6, 008.8, 009.0-009.3 and 558.9 from NSW Inpatient Statistics Collection. RESULTS: Rotavirus infections were reported throughout each year (mean, 57 reports per month), with incidence peaks in August or September. Admissions for gastroenteritis showed the same seasonal pattern (correlation coefficient, 0.93). About 3700 children under five were admitted for rotavirus gastroenteritis annually in NSW at an estimated annual cost of 4.6 million dollars. Annual rates were highest for children aged 12-23 months (1800 per 100000 population in age group), intermediate for those aged 0-11 and 24-35 months (810 and 1000 per 100000 in age group, respectively) and lowest for those aged 36-47 and 48-59 months (450 and 190 per 100000 population, respectively, in age group). CONCLUSIONS: Rotavirus is a major cause of morbidity among young children in NSW. Routine infant vaccination against rotavirus could reduce this morbidity and the resulting health costs.

Age Distribution↗

Management of childhood gastroenteritis in the community.

OBJECTIVE: To examine general practitioners' (GPs') management of childhood gastroenteritis and their perceptions about barriers to optimal management in the community. DESIGN: Cross-sectional postal survey in which GPs' self-reported practices were assessed by a paediatric gastroenterologist for compliance with published guidelines. SETTING: Hunter region of NSW, mid 1994. PARTICIPANTS: All 422 urban and rural GPs practising in the Hunter region were sent questionnaires; 289 (243 urban and 46 rural) GPs responded. RESULTS: Nearly all GPs (97%) recommended clear fluids in the management of childhood gastroenteritis, with 195 (67%) recommending oral electrolyte solution. Management practices were assessed as: optimal, 170 GPs (59%); acceptable, 33 GPs (11%); inappropriate or potentially dangerous, 38 GPs (13%); and too vague to classify, 48 GPs (17%). Multiple logistic regression analysis showed that better management strategies were associated with being younger and practising in rural areas. GPs perceived the main barriers to effective management of gastroenteritis were: inadequate parenting skills, 131 GPs (45%); lack of parental understanding about the illness, 118 GPs (41%); other social problems, 67 GPs (23%); parental anxiety, 57 GPs (20%); and conflicting advice given by others, 42 GPs (15%). Only 33 GPs (11%) identified the taste and 16 (6%) the cost of oral electrolyte solution as major barriers. CONCLUSIONS: Most GPs reported management of gastroenteritis was acceptable, although not necessarily optimal. GPs need to ensure that parents fully understand the nature of their child's illness and their recommendations for management at home.

Child↗

Structure of the gastric mucosa in acute infectious bacterial gastroenteritis.

It is now well documented that a characteristic mucosal lesion of the proximal small intestine is present in acute nonbacterial gastroenteritis. To determine whether a gastric mucosal lesion also accompanies this illness, stool filtrate containing Norwalk agent was given orally to 15 volunteers after base line biopsies of gastric fundal and/or antral mucosa had been obtained. Gastric fundal and/or antral biopsies were then obtained serially between 24 and 168 hr after administration of the inoculum. Nine volunteers developed symptoms of gastroenteritis. gastric biopsies from those with normal base line fundal and/or antral biopsies remained normal during and after clinical illness. Those volunteers who had mild to moderate gastritis in their base line biopsies showed persistence but no progression of the lesion during illness. In 4 of the volunteers who became ill, intestinal biopsies were available and showed the typical gastroenteritis lesion. These results indicate that acute infectious nonbacterial gastroenteritis induced by Norwalk agent is not associated with histologically detectable gastric mucosal lesion.

Adult↗

[Magnitude of rainfall on viral contamination of the marine environment during gastroenteritis epidemics in human coastal population].

BACKGROUND: Sewage treatments are not efficient to eliminate enteric microorganisms. Viruses are able to persist and are discharged into the marine environment with treated effluents. Few data are now available on the magnitude and the contributive processes of marine viral contamination. This work evaluates the relationship between the magnitude of rainfall and the viral contamination of the marine environment during winter epidemics of gastroenteritis in human coastal populations. METHODS: A RT-PCR method was used to detect enterovirus, hepatitis A virus, Norwalk-like virus, astrovirus and rotavirus in shellfish, harvested monthly between August 1995 and July 1998. The frequency of virus detection in shellfish was expressed as an Index of Viral Contamination. Acute gastroenteritis in the population was estimated using the French Sentinel System for Monitoring of Communicable Diseases. Rainfall effects on the efficiency of sewage treatment were assessed using an estimated staying time of sewage effluents in the plant. RESULTS: The results indicate that the highest viral contamination occurs in winter. Maximal indexes of viral contamination were respectively 70% in January 1996, 100% in January 1997, but only 31% in January 1998. Viral contamination variations seemed to follow the pattern of the winter epidemic of acute gastroenteritis in the local population in 1996 and 1997. These observations should be linked to the winter rainfalls. Heavy rains on short periods of time could create an hydraulic overload in the sewage treatment plant, reducing the staying time of the sewage effluents and thus the efficiency of the disinfection process. CONCLUSION: The magnitude of the viral contamination of shellfish seems to result from the simultaneity between the winter epidemics of acute gastroenteritis in the coastal population and heavy rainfall. To prevent public health hazards associated with shellfish consumption, the monitoring of microbiological quality in shellfish harvesting areas should include accompagning survey of viral epidemic in the coastal population, and of sewage outputs in the coastal environment.

Disease Outbreaks↗

[The relationship of serum mitochondrial creatine kinase and rotavirus gastroenteritis in pediatric patients].

The objective of this study was to investigate the relationship between serum mitochondrial creatine kinase(mCK) and rotavirus gastroenteritis in pediatric patients. Stool and serum specimens were simultaneously collected from 45 patients(25 males and 20 females) with suspected rotavirus gastroenteritis from January to December 1998. Stool specimens were tested by rotavirus latex agglutination assay. Fourteen patients(10 males, 4 females) were proved as positive, and peak season was in winter and early spring(7 positive cases in March). Six of the 14 were younger than one and 7 were between one and two. Total serum CK activity was measured by The Japan Society of Clinical Chemistry (JSCC) recommended method, and mCK activity was calculated from mCK fraction % obtained by CK isoenzyme electrophoresis. Patients' mCK activities were as follows, rotavirus antigen positive patients(n = 14): 60.0 +/- 20.6 U/l and rotavirus antigen negative patients(n = 31): 7.2 +/- 5.5 U/l. Significant difference was observed between rotavirus antigen positive group and rotavirus antigen negative group(p < 0.01), and control children group(n = 105): 7.1 +/- 2.9 U/l, (p < 0.01). The clinical implications and mechanisms of increased serum mCK activity are unclear. It is known that histological study of the small intestine from rotavirus gastroenteritis patients reveal shortened villi and mononuclear cell infiltration of the lamia propria; electron microscopy shows mitochondrial swelling and sparse irregular microvilli. Elevated serum mCK level of rotavirus gastroenteritis patient may therefore reflect diffused intestinal epithelial cell damage.

Child, Preschool↗

[Characteristic of Norwalk gastroenteritis and its prevention].

The application of recently developed molecular technique revealed the important role of the Norwalk virus(NV). The major role of the NV as agents of food and water-related outbreaks of gastroenteritis has now been recognized in the world. Moreover, a part of NV is also documented as important agents of gastroenteritis in childhood and infancy. A high rate of food-related viral gastroenteritis outbreaks was observed following ingestion of shellfish in Japan. Specific methods are not available for the prevention or control of NV gastroenteritis. Hand washing will be the most effective to decrease transmission within a family and a hospital. To control food-borne diseases a different strategy is necessary with virus and bacteria.

Animals↗

[A gastroenteritis epidemic caused by a Norwalk-like virus after 2 weddings in a restaurant; a plea for integral microbiological investigation].

OBJECTIVE: To elucidate the cause of an epidemic of gastroenteritis amongst the guests and waiting staff of two weddings celebrated on the same day in the same restaurant. DESIGN: Retrospective and descriptive. METHOD: Following an outbreak of gastroenteritis amongst 215 wedding guests and restaurant staff in 1999, the Public Health Institute Midden-Limburg, the Netherlands, inventoried the demographic and clinical variables and consumed foods by means of a structured written interview. Faecal samples and remaining food products were bacteriologically examined, and later on faeces were virologically examined for the presence of the Norwalk-like virus (NLV). The attack rates and the incidence rates of NLV-positive faecal specimens amongst consumers and non-consumers of specific food products were calculated, as well as the corresponding relative risks with 95% confidence intervals. RESULTS: The overall attack rate was 66%. An NLV with the same genotype was found statistically significantly more frequently in faecal specimens of ill persons compared with non-ill individuals. Of the 61 different dishes served, two showed a statistically significant relation with being ill. These food products were eaten by 26% of the ill persons. No statistically significant association was found between NLV-positive faeces and consumption of a specific dish. The index case began having symptoms of gastroenteritis at the morning of the wedding party, before food was served. The guests of the two wedding parties used the same entrance and toilets. CONCLUSION: The epidemic was caused by a single NLV strain. No association could be found between the consumption of certain food products and being ill. The NLV epidemic was probably caused through direct or indirect contact between wedding guests and restaurant personnel. In the case of such reports of gastroenteritis epidemics, it is strongly recommended to test faecal, food product and environment samples for both bacteria and viruses, with an emphasis on NLV, to ensure early diagnosis.

Caliciviridae Infections↗

[Calicivirus and acute gastroenteritis].

BACKGROUND: Outbreaks of calicivirus gastroenteritis are common during the winter season, especially among elderly residents in institutions. The outbreaks are often difficult to control in institutions and may occasionally result in closure of wards. Reliable diagnostic methods are therefore important. We have studied the prevalence of calicivirus in samples sent to our laboratory for calicivirus detection during the winter season 2001 to 2002. MATERIAL AND METHODS: The presence of calicivirus was studied by nested RT-PCR. A total of 117 faecal samples obtained from patients with suspected calicivirus gastroenteritis were examined. RESULTS: Sixteen outbreaks of acute gastroenteritis were observed during the study period. While calicivirus was confirmed in nine of the outbreaks, the virus was detected in only 25 of the 117 faecal samples analyzed (21%). An increased detection rate was observed when faecal samples were collected during the first two days after onset of symptoms. INTERPRETATION: Appropriate surveillance systems are required in order to control calicivirus gastroenteritis in institutions. Microbiological laboratories should be aware of the importance of collecting specimens during the acute phase (i.e., within 48-72 hours after onset) of illness.

Acute Disease↗

Clinical relevance of herpes simplex virus in the throat of elderly with Salmonella enteritidis gastroenteritis.

It is not known whether the presence of Herpes simplex virus in the throat of elderly patients with severe gastroenteritis and pulmonary implications is of clinical relevance. We cultured throat swabs and faeces of elderly patients with (n = 11) and without (n = 12) severe Salmonella gastroenteritis for viruses and bacteria to study the aetiology of respiratory complications. Complement fixation titers for anti-Herpes simplex antibodies in paired sera were also ascertained. Throat swabs of 6 out of 11 elderly patients with severe Salmonella enteritidis gastroenteritis were positive for Herpes simplex virus type 1. However, a four-fold increase of anti-Herpes simplex antibody titers in paired sera could not be demonstrated. None of the 12 throat swabs of elderly patients without gastro enteritis grew Herpes simplex virus. No other pathogens causing pulmonary complications could be demonstrated in throat swabs of the elderly patients. Herpes simplex virus present in the throat of the elderly patients was very probably not the agent responsible for the pulmonary complications and consequently treatment with acyclovir was not indicated. Weakness caused by severe gastroenteritis and the relative T-lymphocyte immunodeficiency state in the elderly probably enhanced the shedding of Herpes simplex virus in the throat of the elderly patients, without clinical relevance.

Aged↗

Rotavirus gastroenteritis associated with afebrile convulsion in children: clinical analysis of 40 cases.

BACKGROUND: The purpose of this study was to evaluate the clinical manifestations and outcomes of hospitalized children with afebrile seizures following rotavirus gastroenteritis. METHODS: We conducted a retrospective study enrolling patients under 18 years old who were admitted to our hospital during a 10-year period with the diagnosis of rotavirus gastroenteritis. We identified and further analyzed patients who presented with afebrile seizures, without previous seizure disorders, electrolyte imbalances or hypoglycemia. The statistical methods used were the Chi-square test, the Kruskal-Wallis test and the Mann-Whitney test. RESULTS: Of 1937 patients, 40 patients (24 female and 16 male patients) met the inclusion criteria. The incidence of afebrile seizures following rotavirus gastroenteritis was 2.06%. The age of the patients ranged from 6 months old to 6 years old (mean, 1.9 years). The highest incidence of afebrile seizures was 4.67% in children 1 to 2 years of age (p < 0.001). Twenty-seven patients (67.5%) had two or more seizures, which usually were in clusters within a 24-hour period. No status epilepticus was observed. More than half of the patients (52.5%) suffered from seizures on the third day of diarrhea. Only five of 35 patients showed abnormal electroencephalogram (EEG) findings, which reverted to normal in four of the patients during the follow-up period. Most patients did not require long-term anticonvulsant treatment. During the follow-up period, all patients displayed normal psychomotor development without the recurrence of seizures, except in one patient who had a febrile convulsion. CONCLUSION: We found that the course of afebrile seizures following rotavirus gastroenteritis was benign with satisfactory outcomes.

Adolescent↗