Clinical manifestations of a cluster of rotavirus infection in young infants hospitalized in neonatal care units

Tai, I-Chen; Huang, Yhu-Chering; Lien, Reyin; Huang, Chi‐Che; Tsao, Kuo‐Chien; Lin, Tzou–Yien

doi:10.1016/j.jmii.2011.09.023

Cited by 16 publications

(8 citation statements)

References 19 publications

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“…Most cases (58%) of RVGE in neonates were hospital acquired. Tai Chen et al [ 8 ] recognized 72.4% of RVGE cases in neonates as hospital acquired, while Shim Jung Ok et al [ 6 ] reported a rate of 93% for nosocomial infection in preterm infants. Further statistical analysis comparing nosocomial with community samples was carried out, so that differences in the clinical picture of illness to be found.…”

Section: Discussionmentioning

confidence: 99%

“…It has been reported that maturational changes in intestine of premature neonates lead to increased incidence of NEC after RV infection [ 34 , 35 ]. This can be an explanation why preterm neonates present different symptoms in comparison with full term neonates or infants of older age; instead of fever and watery stool, preterm infants present blood/mucous in stool and NEC when RV infection occurs [ 8 , 32 , 33 ]. This study was carried out in a neonatal unit where neonates are referred by obstetric clinics and pediatricians in private practice and the percentage of premature or low birth weight was very low.…”

Section: Discussionmentioning

confidence: 99%

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Rotavirus Gastroenteritis in a Neonatal Unit of a Greek Tertiary Hospital: Clinical Characteristics and Genotypes

et al. 2015

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IntroductionRotavirus (RV) infection in neonatal age can be mild or even asymptomatic. Several studies have reported that RV is responsible for 31%-87% of pediatric nosocomial diarrhea and causes gastroenteritis outbreaks in pediatric and neonatal units.ObjectivesStudy clinical characteristics, genotypes and risk factors of RV infection in neonatal age.MethodsA prospective study was conducted from April 2009 till April 2013 in the neonatal special care unit of the largest tertiary pediatric hospital of Greece. Fecal samples and epidemiological data were collected from each neonate with gastrointestinal symptoms. RV antigen was detected with a rapid immunochromatography test. RV positive samples were further genotyped with RT PCR and sequencing using specific VP7 and VP4 primers.ResultsPositive for RV were 126/415 samples (30.4%). Mean age of onset was 18 days. Seventy four cases (58%) were hospital acquired. Seasonality of RV infection did not differ significantly throughout the year with the exception of 4 outbreaks. Genotypes found during the study period were G4P[8] (58.7%), G1P[8] (14.7%), G12P[8] (9.3%), G3P[8] (9.3%), G12P[6] (5.3%), G9P[8] (1.3%) and G2P[4] (1.3%). RV cases presented with: diarrhea (81%), vomiting (26.2%), fever (34.9%), dehydration (28.6%), feeding intolerance (39.7%), weight loss (54%), whilst 19% of cases were asymptomatic. Comparing community with hospital acquired cases differences in clinical manifestations were found.ConclusionsSignificant incidence of nosocomially transmitted RV infection in neonatal age including asymptomatic illness exists. Genotypes causing nosocomial outbreaks are not different from community strains. Circulating vaccines can be effective in prevention of nosocomial RV infection through herd immunity.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Rotavirus Gastroenteritis in a Neonatal Unit of a Greek Tertiary Hospital: Clinical Characteristics and Genotypes

et al. 2015

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“…The GI symptoms of rotavirus infection include diarrhea, bloody stools, abdominal distention, and intestinal necrosis. [39][40][41][42][43][44] Rotavirus enteritis may be associated with pneumatosis intestinalis, presumably due to the presence of clostridia. 45 Norovirus: Norovirus has been associated with at least two cases of hospital outbreak of NEC.…”

Section: Viral Agentsmentioning

confidence: 99%

The role of the intestinal microbiota in the pathogenesis of necrotizing enterocolitis

Grishin

Papillon

Bell

et al. 2013

Seminars in Pediatric Surgery

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Development of necrotizing enterocolitis (NEC) requires a susceptible host, typically a premature infant or an infant with congenital heart disease, enteral feedings and bacterial colonization. Although there is little doubt that microbes are critically involved in the pathogenesis of NEC, the identity of specific causative pathogens remains elusive. Unlike established normal adult gut microbiota, which is quite complex, uniform, and stable, early postnatal bacterial populations are simple, diverse, and fluid. These properties complicate studies aimed at elucidating characteristics of the gut microbiome that may play a role in the pathogenesis of NEC. A broad variety of bacterial, viral, and fungal species have been implicated in both clinical and experimental NEC. Frequently, however, the same species have also been found in physiologically matched healthy individuals. Clustered outbreaks of NEC, in which the same strain of a suspected pathogen is detected in several patients suggest, but do not prove, a causative relationship between the specific pathogen and the disease. Studies in Cronobacter sakazakii, the best characterized NEC pathogen, have demonstrated that virulence is not a property of a bacterial species as a whole, but rather a characteristic of certain strains, which may explain why the same species can be pathogenic or non-pathogenic. The fact that a given microbe may be innocuous in a full-term, yet pathogenic in a pre-term infant has led to the idea of opportunistic pathogens in NEC. Progress in understanding the infectious nature of NEC may require identifying specific pathogenic strains and unambiguously establishing their virulence in animal models.

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“…The immature enterocytes of preterm infants exhibit excessive signaling in the TLR4 pathway in response to the lipopolysaccharide (LPS) presented by Gram-negative bacteria, and this interaction has often been implicated in NEC onset [12,13,15]. Various other agents have also been associated with NEC onset, including bacterial, viral, and fungal pathogens [9-11,16-18]. Despite this, no specific microbial pattern has been consistently identified with NEC onset.…”

Section: Introductionmentioning

confidence: 99%

Early microbial and metabolomic signatures predict later onset of necrotizing enterocolitis in preterm infants

et al. 2013

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BackgroundNecrotizing enterocolitis (NEC) is a devastating intestinal disease that afflicts 10% of extremely preterm infants. The contribution of early intestinal colonization to NEC onset is not understood, and predictive biomarkers to guide prevention are lacking. We analyzed banked stool and urine samples collected prior to disease onset from infants <29 weeks gestational age, including 11 infants who developed NEC and 21 matched controls who survived free of NEC. Stool bacterial communities were profiled by 16S rRNA gene sequencing. Urinary metabolomic profiles were assessed by NMR.ResultsDuring postnatal days 4 to 9, samples from infants who later developed NEC tended towards lower alpha diversity (Chao1 index, P = 0.086) and lacked Propionibacterium (P = 0.009) compared to controls. Furthermore, NEC was preceded by distinct forms of dysbiosis. During days 4 to 9, samples from four NEC cases were dominated by members of the Firmicutes (median relative abundance >99% versus <17% in the remaining NEC and controls, P < 0.001). During postnatal days 10 to 16, samples from the remaining NEC cases were dominated by Proteobacteria, specifically Enterobacteriaceae (median relative abundance >99% versus 38% in the other NEC cases and 84% in controls, P = 0.01). NEC preceded by Firmicutes dysbiosis occurred earlier (onset, days 7 to 21) than NEC preceded by Proteobacteria dysbiosis (onset, days 19 to 39). All NEC cases lacked Propionibacterium and were preceded by either Firmicutes (≥98% relative abundance, days 4 to 9) or Proteobacteria (≥90% relative abundance, days 10 to 16) dysbiosis, while only 25% of controls had this phenotype (predictive value 88%, P = 0.001). Analysis of days 4 to 9 urine samples found no metabolites associated with all NEC cases, but alanine was positively associated with NEC cases that were preceded by Firmicutes dysbiosis (P < 0.001) and histidine was inversely associated with NEC cases preceded by Proteobacteria dysbiosis (P = 0.013). A high urinary alanine:histidine ratio was associated with microbial characteristics (P < 0.001) and provided good prediction of overall NEC (predictive value 78%, P = 0.007).ConclusionsEarly dysbiosis is strongly involved in the pathobiology of NEC. These striking findings require validation in larger studies but indicate that early microbial and metabolomic signatures may provide highly predictive biomarkers of NEC.

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Clinical manifestations of a cluster of rotavirus infection in young infants hospitalized in neonatal care units

Cited by 16 publications

References 19 publications

Rotavirus Gastroenteritis in a Neonatal Unit of a Greek Tertiary Hospital: Clinical Characteristics and Genotypes

Rotavirus Gastroenteritis in a Neonatal Unit of a Greek Tertiary Hospital: Clinical Characteristics and Genotypes

The role of the intestinal microbiota in the pathogenesis of necrotizing enterocolitis

Early microbial and metabolomic signatures predict later onset of necrotizing enterocolitis in preterm infants

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