Acute gastroenteritis and enteric viruses in hospitalised children in southern Brazil: aetiology, seasonality and clinical outcomes

Abstract

Viral acute gastroenteritis (AG) is a significant cause of hospitalisation in children younger than five years. Group A rotavirus (RVA) is responsible for 30% of these cases. Following the introduction of RVA immunisation in Brazil in 2006, a decreased circulation of this virus has been observed. However, AG remains an important cause of hospitalisation of paediatric patients and only limited data are available regarding the role of other enteric viruses in these cases. We conducted a prospective study of paediatric patients hospitalised for AG. Stool samples were collected to investigate human adenovirus (HAdV), RVA, norovirus (NoV) and astrovirus (AstV). NoV typing was performed by nucleotide sequencing and phylogenetic analysis. From the 225 samples tested, 60 (26%) were positive for at least one viral agent. HAdV, NoV, RVA and AstV were detected in 16%, 8%, 6% and 0% of the samples, respectively. Mixed infections were found in nine patients: HAdV/RVA (5), HAdV/NoV (3) and HAdV/NoV/RVA (1). The frequency of fever and lymphocytosis was significantly higher in virus-infected patients. Phylogenetic analysis of NoV indicated that all of these viruses belonged to genotype GII.4. The significant frequency of these pathogens in patients with AG highlights the need to routinely implement laboratory investigations.

Detection of enteric‐ and non‐enteric adenoviruses in gastroenteritis patients, Bangladesh, 2012‐2015

“…Similar evidence of mixed infections was evident in other HAdV epidemiological studies conducted in other parts of the globe. [42][43][44] Many epidemiology studies demonstrated that many HAdVs types can be found in stool due to prolonged shedding in the feces after a previous infection, 28,38,45 the Department for International Development, UK (UK Aid). We gratefully acknowledge these donors for their support and commitment to icddr,b's research efforts.…”

“…3,[6][7][8] Among seven subgenera, subgenus HAdV-F representing type 40 and 41 is associated with acute gastroenteritis; the incidence ratio is higher in low-or middle-income countries (2-31%) compared to the highincome countries (1-8%). [9][10][11][12] Other subgenera such as HAdV-A (types 12, 18, and 31), 13 HAdV-C (types 1, 2, and 5), and HAdV-D (types 28,29,30,32,37,[43][44][45][46]), [14][15][16] and HAdV-G (type 52) 17 have also been identified sporadically in patients with gastroenteritis, however, their role in causing diarrhea remains unclear.…”

High prevalence of enteric viruses associated with acute gastroenteritis in pediatric patients in a low‐income area in Vitória, Southeastern Brazil

“…Although this study was conducted during a 1‐year period, the results are consistent with Brazilian data confirming the incidence of RVA mainly in the winter and spring (June to August and September to November) and NoV in the summer (December to February). However, there is considerable controversy regarding the seasonality of NoV in Brazil, mainly because it is a country of continental dimensions and, consequently, of diverse climates …”

“…Reference strains are identified by genotype|GenBank accession number followed by genogroup or subgroup February) 32. However, there is considerable controversy regarding the seasonality of NoV in Brazil, mainly because it is a country of continental dimensions and, consequently, of diverse climates 33. Factors such as low income, poor access to education, poor hygiene, and low nutritional and immune status might be responsible for the high prevalence of AGE in the child population.…”

Assessment of the prevalence of enteric viruses in the final effluents of two peri-urban wastewater treatment plants

“…This study confirms these reports as Adv40 was not detected. Detection of these Adv serotypes in sewage final effluents is health threatening [53,54].…”