Rotavirus Antigenemia in Patients with Acute Gastroenteritis

Abstract

Although rotavirus infections are generally considered to be confined to the intestine, recent reports suggest that extraintestinal disease occurs. We studied whether rotavirus infection was associated with antigenemia during a major outbreak of gastroenteritis in the Kingston metropolitan area, during July-August 2003. Rotavirus antigen was identified in 30 of 70 acute-phase serum samples (including from 2 deceased individuals) but in only 1 of 53 control samples. Serum antigen levels were inversely associated with time since symptom onset and were directly associated with antigen levels in stool (P = .02). Serum antigen levels were significantly elevated during primary infections (acute-phase serum immunoglobulin G [IgG] titers, <25), compared with those in subsequent infections (acute-phase serum IgG titers, > or = 25) (P = .02). Antigenemia was common in this outbreak and might provide a mechanism to help explain rare but well-documented reports of findings of extraintestinal rotavirus. In situations in which stool samples are not readily available (i.e., patients with severe dehydration or those recently recovered or deceased), serum testing by enzyme immunoassay offers a new and practical diagnostic tool.

Rotavirus antigen, cytokine, and neutralising antibody profiles in sera of children with and without HIV infection in Blantyre, Malawi

“…17 Our detection of rotavirus antigen, in the convalescent phase of both populations, 3 to 4 weeks after hospitalisation, is unlike other reports, where levels peaked 1 to 3 days after the onset of acute rotavirus gastroenteritis and were undetectable beyond a week. 15,18 Parallel results were also observed in paired plasma specimens from this collection (data not shown), validating our results obtained from sera. Our finding of the prolonged rotavirus antigenaemia in HIV-infected children mimics the prolonged rotavirus antigen shedding in stool of children from the original study.…”

Rotavirus Viremia and Extraintestinal Viral Infection in the Neonatal Rat Model

“…Since evidence is increasing that rotavirus escapes the gastrointestinal tract and that infectious virus is present in the blood (1,4,7,16,27,55), perfusion was performed in an attempt to remove, to the extent possible, potentially rotaviruscontaminated blood from the circulatory systems and organs of infected rat pups prior to examining tissues for virus. We found that rotavirus was able to disseminate to and replicate in a variety of organs, including the liver, lungs, spleen, kidneys, thymus, heart, pancreas, and bladder.…”

“…However, an increasing number of reports indicate that rotavirus escapes the gastrointestinal tract. Rotavirus antigen and RNA were detected in serum samples from approximately 65% of children with rotavirus diarrhea, indicating that antigenemia and possibly viremia occur during rotavirus infection (4,7,16). In other reports, rotavirus antigen and/or RNA was detected in the central nervous systems, spleens, hearts, kidneys, testes, and bladders of children who died during rotavirus infections (23, 29-32, 35, 42); in liver biopsies from infants with cholestatic disease (47); and in respiratory secretions, lung cells, or the microvasculature of hearts from children and adults with respiratory infections or cardiorespiratory failure (11,41,48,56) and rotavirus gastroenteritis.…”

Extraintestinal Spread and Replication of a Homologous EC Rotavirus Strain and a Heterologous Rhesus Rotavirus in BALB/c Mice

“…Recent findings (2,6,11,18,20,22,32) make it clear that rotaviral antigenemia is common in humans and animals and can occur during both homologous and heterologous rotavirus infections. What remains to be seen is whether this spread is associated with extraintestinal replication and how the level of systemic viremia compares quantitatively to the levels seen during intestinal replication.…”