This report is of a community-based case control study to assess whether the severity of acute diarrhea by rotavirus (RV) in young children is associated with a particular VP7 (G) or VP4 (P) RV serotype. Five hundred twenty children younger than 2 years of age with diarrhea lasting less than 3 days were age and gender matched with 520 children with no diarrhea. The G and P serotypes were determined with specific monoclonal antibodies, and the VP4 serotype specificity in a subgroup was confirmed by genotyping. Infection with a G3 serotype led to a higher risk of diarrhea than infection with a G1 serotype. Infection with a G3-nontypeable-P serotype was associated with more severe gastroenteritis than infection with a G3 (or G1) P1A[8] serotype. A child with diarrhea-associated dehydration was almost five times more likely to be infected with a G3-nontypeable-P serotype than a child without dehydration (P < 0.001). Moreover, the two predominant monotypes within serotype P1A[8] had significantly different clinical manifestations. In this study, the severity of RV-associated diarrhea was related to different P serotypes rather than to G serotypes. The relationship between serotype and clinical outcomes seems to be complex and to vary among different geographic areas.Group A rotaviruses (RVs) are the leading cause of acute diarrhea with severe dehydration, which endangers the lives of children under 2 years of age (14). An effective vaccine could prevent the death of 800,000 children per year (7,20).Antibody specificity to neutralize different RV strains has been used to classify them into serotypes, and both of the viral surface proteins, VP4 and VP7, induce neutralizing antibodies; hence, the RV serotype is dual and has been named G and P for VP7 and VP4, respectively (15,18,19). Based on VP7, 15 different RV serotypes have been classified in group A (19). Ten of these serotypes (G1 to G6, G8 to G10, and G12) infect humans, although five of them (G1 to G4 and, more recently, G9) seem to be responsible for most infections (19,24,29,35), while serotype G5 is emerging as epidemiologically important in Brazil (16,22). At least 21 different types of VP4, P [1] to P [21], have been defined by genomic analysis (hybridization and sequencing) (19). Ten of these P types have been found among human RV strains and correspond to specific serotypes or subtypes of VP4, as was determined by neutralization assays with monospecific hyperimmune sera directed against this protein (19). Two of these serotypes (subtypes A and B of serotype P1 and subtype A of serotype P2) are the most frequent among human RV strains (11,26). Recently, two research groups reported the isolation of the first specific monoclonal antibodies (MAbs) that recognize different reference strains of serotypes P1A, P1B, and P2A (5, 25). Coulson (4) introduced the term "monotype" to define the intraserotypic RV variants, which differ in their reactivities with a given MAb. Thus, a previous study identified five monotypes of serotype P1A [8] according to their reactiv...

131 children with nephritic syndrome of acute onset were studied by renal biopsy and were followed clinically from 2 to 13 years. 87 patients (66%) with proliferative endocapillary glomerulonephritis all recovered. 21 (16%) had focal extracapiUary and diffuse endocapillary glomerulonephritis. Eleven (52%) of these recovered. Six patients (5%) had diffuse extra and endocapillary glomerulonephritis, 13 (10%) had membranoproliferative glomerulonephritis and four had diffuse glomerular fibrosis. All 23 patients of the latter groups progressed to renal insufficiency. A correlation between morphology and prognosis was apparent in this study.

ResumenObjetivo. Comparar la gravedad de la diarrea por rotavirus (RV) y por no rotavirus. Material y métodos. Estudio transversal en 520 lactantes con diarrea aguda, efectuado entre octubre de 1994 y marzo de 1995 en siete centros del primer nivel de atención en cinco estados de México. El diagnóstico de RV se realizó con ensayo inmunoenzimá-tico o por electroforesis. El análisis se hizo a través de medidas de tendencia central. Los resultados se presentan como promedio y desviación estándar o mediana o variación. Resultados. Se aisló RV en 264 lactantes (50.7%) con predominio en varones de 6 meses a un año. Las manifestaciones clínicas fueron significativamente diferentes entre el grupo rotavirus positivo y el grupo rotavirus negativo en mediana de evacuaciones por 24 horas, frecuencia de vómi-tos, temperatura > 38° C, deshidratación y calificación de gravedad, respectivamente. Conclusiones. Estos resultados mostraron peor pronóstico por mayor gravedad de la diarrea por RV en lactantes, con relación a otra etiología. El texto completo en inglés de este artículo está disponible en: http://www.insp.mx/salud/index.html Between October 1994 and March 1995, a cross-sectional study was performed in 520 infants with acute diarrhea, at seven primary care level centers in five states of Mexico. Diagnosis of RV was done through immunoenzymatic assay or electrophoresis. Central tendency measures were used for data analysis. Results were presented as means and standard deviations, or median and variation. Results. RV was isolated from 264 children; most of them were males aged 6 months to 1 year. Differences in clinical manifestations were statistically significant between the rotavirus-positive group and the rotavirus-negative group, in the following variables: median number of stools/24 hours; frequency of vomiting; temperature > 38°C; dehydration; and clinical severity scoring. Conclusions. These results showed a poorer prognosis and a higher severity of rotavirus diarrhea, as compared to non-rotavirus diarrhea in infants. The English version of this paper is available at: http://www.insp.mx/salud/ index.html

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