J Korean Med Sci.  2008 Dec;23(6):937-940. 10.3346/jkms.2008.23.6.937.

Coinfection of Viral Agents in Korean Children with Acute Watery Diarrhea

• Koh H
• Baek SY
• Shin JI
• Chung KS
• Jee YM

• KMID: 1107513
• DOI: http://doi.org/10.3346/jkms.2008.23.6.937

Abstract

Currently, there are a few reports on viral coinfection that causes an acute watery diarrhea in Korean children. So, to evaluate the features of coinfectious viral agents in children with acute watery diarrhea, we enrolled 155 children with acute watery diarrhea from July 2005 to June 2006. Fecal samples were collected and evaluated for various viral infections such as rotavirus, norovirus, adenovirus and astrovirus. The mean (+/-standard deviation) age of the children was 2.71+/-2.37 yr. The detection rate of viral agents was most common in children between the ages of 1 and 3 yr. Rotavirus was detected in 63 children (41.3%), norovirus in 56 (36.2%), adenovirus in 11 (7.1%), and astrovirus in 1 (0.6%). Regarding rotavirus, there were 38 (60.3%) cases with monoinfection and 25 (39.7%) with coinfection. For norovirus, there were 33 (58.9%) cases with monoinfection and 23 (41.1%) with coinfection. Coinfection with rotavirus and norovirus was most common, and occurred in 20/155 cases (12.9%) including coinfection with adenovirus. So, rotavirus and norovirus were the most common coinfectious viral agents in our study population with acute watery diarrhea.

Keyword

Coinfection; Watery Diarrhea; Rotavirus; Norovirus; Children

MeSH Terms

Acute Disease
Adenovirus Infections, Human/epidemiology
Astroviridae Infections/epidemiology
Caliciviridae Infections/epidemiology
Child
Child, Preschool
Diarrhea/epidemiology/*virology
Feces/virology
Humans
Infant
Korea/epidemiology
Norovirus/isolation & purification
Rotavirus Infections/epidemiology
Virus Diseases/complications/*epidemiology/virology

Reference

1. Gallimore CI, Cubitt DW, Richards AF, Gray JJ. Diversity of enteric viruses detected in patients with gastroenteritis in a tertiary referral paediatric hospital. J Med Virol. 2004. 73:443–449.

2. Bon F, Fascia P, Dauvergne M, Tenenbaum D, Planson H, Petion AM, Pothier P, Kohli E. Prevalence of group A rotavirus, human calicivirus, astrovirus, and adenovirus type 40 and 41 infections among children with acute gastroenteritis in Dijon, France. J Clin Microbiol. 1999. 37:3055–3058.

3. Chikhi-Brachet R, Bon F, Toubiana L, Pothier P, Nicolas JC, Flahault A, Kohli E. Virus diversity in a winter epidemic of acute diarrhea in France. J Clin Microbiol. 2002. 40:4266–4272.

4. Guerrero ML, Noel JS, Mitchell DK, Calva JJ, Morrow AL, Martinez J, Rosales G, Velázguez FR, Monroe SS, Glass RI, Pickering LK, Ruiz-Palacios GM. A prospective study of astrovirus diarrhea of infancy in Mexico City. Pediatr Infect Dis J. 1998. 17:723–727.

5. Simpson R, Aliyu S, Iturriza-Gómara M, Desselberger U, Gray J. Infantile viral gastroenteritis: on the way to closing the diagnostic gap. J Med Virol. 2003. 70:258–262.

6. Sánchez-Fauguier A, Montero V, Moreno S, Solé M, Colomina J, Iturriza-Gomara M, Revilla A, Wilhelmi I, Gray J. Gegavi/VIGESS-Net Group. Human rotavirus G9 and G3 as major cause of diarrhea in hospitalized children, Spain. Emerg Infect Dis. 2006. 12:1536–1541.

7. Clark B, McKendrick M. A review of viral gastroenteritis. Curr Opin Infect Dis. 2004. 17:461–469.

8. Sugieda M, Nakajima K, Nakajima S. Outbreaks of Norwalk-like virus-associated gastroenteritis traced to shellfish: coexistence of two genotypes in one specimen. Epidemiol Infect. 1996. 116:339–346.

9. Saito H, Saito S, Kamada K, Harata S, Sato H, Morita M, Miyajima Y. Application of RT-PCR designed from the sequence of the local SRSV strain to the screening in viral gastroenteritis outbreaks. Microbiol Immunol. 1998. 42:439–446.

10. Wang J, Jiang X, Madore HP, Gray J, Desselberger U, Ando T, Seto Y, Oishi I, Lew JF, Green KY. Sequence diversity of small round-structured viruses in the Norwalk virus group. J Virol. 1994. 68:5982–5990.

11. Lew JF, Petric M, Kapikian AZ, Jiang X, Estes MK, Green KY. Identification of Minireovirus as a Norwalk-like virus in pediatric patients with gastroenteritis. J Virol. 1994. 68:3391–3396.

12. Hamano M, Kuzuya M, Fujii R, Ogura H, Yamada M. Epidemiology of acute gastroenteritis outbreaks caused by Noroviruses in Okayama, Japan. J Med Virol. 2005. 77:282–289.

13. Kojima S, Kageyama T, Fukushi S, Hoshino FB, Shinohara M, Uchida K, Natori K, Takeda N, Katayama K. Genogroup-specific PCR primers for detection of Norwalk-like viruses. J Virol Methods. 2002. 100:107–114.

14. Rosenfeldt V, Vesikari T, Pang XL, Zeng SQ, Tvede M, Paerregaard A. Viral etiology and incidence of acute gastroenteritis in young children attending day-care centers. Pediatr Infect Dis J. 2005. 24:962–965.

15. Middleton PJ. Viruses that multiply in the gut and cause endemic and epidemic gastroenteritis. Clin Diagn Virol. 1996. 6:93–101.

16. Kapikian AZ. Overview of viral gastroenteritis. Arch Virol. 1996. 12:7–19.

17. Cubitt WD. Historical background and classification of caliciviruses and astroviruses. Arch Virol Suppl. 1996. 12:225–235.

18. Chung JY, Huh K, Kim SW, Shin BM, Han TH, Lee JI, Song MO. Molecular epidemiology of human astrovirus infection in hospitalized children with acute gastroenteritis. Korean J Pediatr Gastroenterol Nutr. 2006. 9:139–146.

19. Lee JI, Chung JY, Han TH, Song MO, Hwang ES. Detection of human bocavirus in children hospitalized because of acute gastroenteritis. J Infec Dis. 2007. 196:994–997.

20. Torres ME, Pírez MC, Schelotto F, Varela G, Parodi V, Allende F, Falconi E, Dell'Acqua L, Gaione P, Méndez MV, Ferrari AM, Montano A, Zanetta E, Acuña AM, Chiparelli H, Ingold E. Etiology of children's diarrhea in Montevideo, Uruguay: associated pathogens and unusual isolates. J Clin Microbiol. 2001. 39:2134–2139.

21. Yan H, Yagyu F, Okitsu S, Nishio O, Ushijima H. Detection of norovirus (GI, GII), Sapovirus and astrovirus in fecal samples using reverse transcription single round multiplex PCR. J Virol Methods. 2003. 114:37–44.

22. Román E, Wilhelmi I, Colomina J, Villar J, Cilleruelo ML, Nebreda V, Del Alamo M, Sánchez-Fauquier A. Acute viral gastroenteritis: proportion and clinical relevance of multiple infections in Spanish children. J Med Microbiol. 2003. 52:435–440.

23. Li L, Phan TG, Nguyen TA, Kim KS, Seo JK, Shimizu H, Suzuki E, Okitsu S, Ushijima H. Molecular epidemiology of adenovirus infection among pediatric population with diarrhea in Asia. Microbiol Immunol. 2005. 49:121–128.

24. Inouye S, Yamashita K, Yamadera S, Yoshikawa M, Kato N, Okabe N. Surveillance of viral gastroenteritis in Japan: Pediatric cases and outbreaks incidents. J Infect Dis. 2000. 181:Suppl 2. S270–S274.

25. Lee WS, Rajasekaran G, Pee S, Karunakaran R, Hassan HH, Puthucheary SD. Rotavirus and other enteropathogens in childhood acute diarrhoea: a study of two centres in Malaysia. J Paediatr Child Health. 2006. 42:509–514.