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Clinical characteristics of viral intestinal infection in preterm and term neonates

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Abstract

The clinical presentation of the viral enteric pathogens in newborn infants has not been adequately examined. The aim of this study was to evaluate the clinical characteristics of viral intestinal infections in newborn infants. Clinical data of all term and preterm infants admitted to our tertiary neonatal intensive care unit from 1998 to 2007 with clinical signs of gastroenteritis (GE) or necrotizing enterocolitis (NEC) were retrospectively reviewed and compared between infants with different viral enteric pathogens in stool specimens. In 34 infants with signs of GE or NEC, enteropathogenic viruses were found in stool specimens. Rotavirus was detected in 12 cases, of which two infants had NEC. Compared with infants with rotavirus or norovirus, infants with astrovirus more frequently suffered from NEC (p<0.05). In addition, an acute systemic inflammatory response was significantly more common in patients with astrovirus infection (astrovirus vs. rotavirus and astrovirus vs. norovirus, p < 0.01 and p < 0.05, respectively). Of eight children infected with norovirus, one infant had a systemic acute inflammatory response and NEC. This study demonstrates that in newborn infants, intestinal rotavirus, norovirus, and astrovirus infections may be associated with severe illness such as hemorrhagic enteritis resulting in bloody diarrhea or even NEC.

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References

  1. Clark B, McKendrick M (2004) A review of viral gastroenteritis. Curr Opin Infect Dis 17(5):461–469

    Article  PubMed  Google Scholar 

  2. Oh DY, Gaedicke G, Schreier E (2003) Viral agents of acute gastroenteritis in German children: prevalence and molecular diversity. J Med Virol 71(1):82–93

    Article  CAS  PubMed  Google Scholar 

  3. Walter JE, Mitchell DK (2003) Astrovirus infection in children. Curr Opin Infect Dis 16(3):247–253

    PubMed  Google Scholar 

  4. Patel MM, Widdowson MA, Glass RI, Akazawa K, Vinje J, Parashar UD (2008) Systematic literature review of role of noroviruses in sporadic gastroenteritis. Emerg Infect Dis 14(8):1224–1231

    Article  PubMed  Google Scholar 

  5. Simon A, Schildgen O, Maria Eis-Hubinger A, Hasan C, Bode U, Buderus S, Engelhart S, Fleischhack G (2006) Norovirus outbreak in a pediatric oncology unit. Scand J Gastroenterol 41(6):693–699

    Article  PubMed  Google Scholar 

  6. Thornton AC, Jennings-Conklin KS, McCormick MI (2004) Noroviruses: agents in outbreaks of acute gastroenteritis. Disaster Manag Response 2(1):4–9

    Article  PubMed  Google Scholar 

  7. Rotbart HA, Levin MJ, Yolken RH, Manchester DK, Jantzen J (1983) An outbreak of rotavirus-associated neonatal necrotizing enterocolitis. J Pediatr 103(3):454–459

    Article  CAS  PubMed  Google Scholar 

  8. Sharma R, Garrison RD, Tepas JJ 3rd, Mollitt DL, Pieper P, Hudak ML, Bradshaw JA, Stevens G, Premachandra BR (2004) Rotavirus-associated necrotizing enterocolitis: an insight into a potentially preventable disease? J Pediatr Surg 39(3):453–457

    Article  PubMed  Google Scholar 

  9. Herruzo R, Omenaca F, Garcia S, Diez J, Sanchez-Fauquier A (2009) Identification of risk factors associated with nosocomial infection by rotavirus P4G2, in a neonatal unit of a tertiary-care hospital. Clin Microbiol Infect 15(3):280–285

    Article  CAS  PubMed  Google Scholar 

  10. Bagci S, Eis-Hubinger AM, Franz AR, Bierbaum G, Heep A, Schildgen O, Bartmann P, Kupfer B, Mueller A (2008) Detection of astrovirus in premature infants with necrotizing enterocolitis. Pediatr Infect Dis J 27(4):347–350

    Article  PubMed  Google Scholar 

  11. Armbrust S, Kramer A, Olbertz D, Zimmermann K, Fusch C (2009) Norovirus infections in preterm infants: wide variety of clinical courses. BMC Res Notes 2:96

    Article  PubMed  Google Scholar 

  12. Caplan MS, Jilling T (2001) New concepts in necrotizing enterocolitis. Curr Opin Pediatr 13(2):111–115

    Article  CAS  PubMed  Google Scholar 

  13. Bell MJ, Ternberg JL, Feigin RD, Keating JP, Marshall R, Barton L, Brotherton T (1978) Neonatal necrotizing enterocolitis. Therapeutic decisions based upon clinical staging. Ann Surg 187(1):1–7

    Article  CAS  PubMed  Google Scholar 

  14. Faustini A, Forastiere F, Giorgi Rossi P, Perucci CA (2004) An epidemic of gastroenteritis and mild necrotizing enterocolitis in two neonatal units of a University Hospital in Rome, Italy. Epidemiol Infect 132(3):455–465

    Article  CAS  PubMed  Google Scholar 

  15. Weitkamp J-H, Aschner JL (2005) Diagnostic use of C-reactive protein (CRP) in assessment of neonatal sepsis. NeoReviews 6(11):e508–e515

    Article  Google Scholar 

  16. Krueger M, Nauck MS, Sang S, Hentschel R, Wieland H, Berner R (2001) Cord blood levels of interleukin-6 and interleukin-8 for the immediate diagnosis of early-onset infection in premature infants. Biol Neonate 80(2):118–123

    Article  CAS  PubMed  Google Scholar 

  17. Ando T, Monroe SS, Noel JS, Glass RI (1997) A one-tube method of reverse transcription-PCR to efficiently amplify a 3-kilobase region from the RNA polymerase gene to the poly(A) tail of small round-structured viruses (Norwalk-like viruses). J Clin Microbiol 35(3):570–577

    CAS  PubMed  Google Scholar 

  18. Hohne M, Schreier E (2004) Detection and characterization of norovirus outbreaks in Germany: application of a one-tube RT-PCR using a fluorogenic real-time detection system. J Med Virol 72(2):312–319

    Article  CAS  PubMed  Google Scholar 

  19. Schreier E, Doring F, Kunkel U (2000) Molecular epidemiology of outbreaks of gastroenteritis associated with small round structured viruses in Germany in 1997/98. Arch Virol 145(3):443–453

    Article  CAS  PubMed  Google Scholar 

  20. Lodha A, de Silva N, Petric M, Moore AM (2005) Human torovirus: a new virus associated with neonatal necrotizing enterocolitis. Acta Paediatr 94(8):1085–1088

    Article  PubMed  Google Scholar 

  21. Turcios-Ruiz RM, Axelrod P, St John K, Bullitt E, Donahue J, Robinson N, Friss HE (2008) Outbreak of necrotizing enterocolitis caused by norovirus in a neonatal intensive care unit. J Pediatr 153(3):339–344

    Article  PubMed  Google Scholar 

  22. Lundgren O, Svensson L (2001) Pathogenesis of rotavirus diarrhea. Microbes Infect 3(13):1145–1156

    Article  CAS  PubMed  Google Scholar 

  23. Mumphrey SM, Changotra H, Moore TN, Heimann-Nichols ER, Wobus CE, Reilly MJ, Moghadamfalahi M, Shukla D, Karst SM (2007) Murine norovirus 1 infection is associated with histopathological changes in immunocompetent hosts, but clinical disease is prevented by STAT1-dependent interferon responses. J Virol 81(7):3251–3263

    Article  CAS  PubMed  Google Scholar 

  24. Sirinavin S, Techasaensiri C, Okascharoen C, Nuntnarumit P, Tonsuttakul S, Pongsuwan Y (2006) Neonatal astrovirus gastroenteritis during an inborn nursery outbreak. J Hosp Infect 64(2):196–197

    Article  CAS  PubMed  Google Scholar 

  25. Lundgren O, Peregrin AT, Persson K, Kordasti S, Uhnoo I, Svensson L (2000) Role of the enteric nervous system in the fluid and electrolyte secretion of rotavirus diarrhea. Science 287(5452):491–495

    Article  CAS  PubMed  Google Scholar 

  26. Mitchell DK (2002) Astrovirus gastroenteritis. Pediatr Infect Dis J 21(11):1067–1069

    Article  PubMed  Google Scholar 

  27. Graham DY, Jiang X, Tanaka T, Opekun AR, Madore HP, Estes MK (1994) Norwalk virus infection of volunteers: new insights based on improved assays. J Infect Dis 170(1):34–43

    CAS  PubMed  Google Scholar 

  28. Dolin R, Blacklow NR, DuPont H, Buscho RF, Wyatt RG, Kasel JA, Hornick R, Chanock RM (1972) Biological properties of Norwalk agent of acute infectious nonbacterial gastroenteritis. Proc Soc Exp Biol Med 140(2):578–583

    CAS  PubMed  Google Scholar 

  29. Guo M, Hayes J, Cho KO, Parwani AV, Lucas LM, Saif LJ (2001) Comparative pathogenesis of tissue culture-adapted and wild-type Cowden porcine enteric calicivirus (PEC) in gnotobiotic pigs and induction of diarrhea by intravenous inoculation of wild-type PEC. J Virol 75(19):9239–9251

    Article  CAS  PubMed  Google Scholar 

  30. Schreiber DS, Blacklow NR, Trier JS (1973) The mucosal lesion of the proximal small intestine in acute infectious nonbacterial gastroenteritis. N Engl J Med 288(25):1318–1323

    Article  CAS  PubMed  Google Scholar 

  31. Wobus CE, Thackray LB, HWt V (2006) Murine norovirus: a model system to study norovirus biology and pathogenesis. J Virol 80(11):5104–5112

    Article  CAS  PubMed  Google Scholar 

  32. Morotti RA, Kaufman SS, Fishbein TM, Chatterjee NK, Fuschino ME, Morse DL, Magid MS (2004) Calicivirus infection in pediatric small intestine transplant recipients: pathological considerations. Hum Pathol 35(10):1236–1240

    Article  PubMed  Google Scholar 

  33. Cheetham S, Souza M, Meulia T, Grimes S, Han MG, Saif LJ (2006) Pathogenesis of a genogroup II human norovirus in gnotobiotic pigs. J Virol 80(21):10372–10381

    Article  CAS  PubMed  Google Scholar 

  34. Kliegman RM, Walker WA, Yolken RH (1993) Necrotizing enterocolitis: research agenda for a disease of unknown etiology and pathogenesis. Pediatr Res 34(6):701–708

    Article  CAS  PubMed  Google Scholar 

  35. Lin PW, Stoll BJ (2006) Necrotising enterocolitis. Lancet 368(9543):1271–1283

    Article  PubMed  Google Scholar 

  36. Markel TA, Crisostomo PR, Wairiuko GM, Pitcher J, Tsai BM, Meldrum DR (2006) Cytokines in necrotizing enterocolitis. Shock 25(4):329–337

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Neonatology, Children’s Hospital, University of Bonn, Adenauerallee 119, 53113, Bonn, Germany

    S. Bagci, P. Bartmann, A. R. Franz & A. Mueller

  2. Institute of Virology, University of Bonn, Bonn, Germany

    A. M. Eis-Hübinger

  3. Institute for Medical Microbiology, Immunology, and Parasitology, University of Bonn, Bonn, Germany

    A. F. Yassin

  4. Department of Pediatric Hematology and Oncology, Children’s Hospital, University of Bonn, Bonn, Germany

    A. Simon

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  1. S. Bagci
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  2. A. M. Eis-Hübinger
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  3. A. F. Yassin
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  4. A. Simon
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  5. P. Bartmann
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  6. A. R. Franz
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Correspondence to S. Bagci.

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Bagci, S., Eis-Hübinger, A.M., Yassin, A.F. et al. Clinical characteristics of viral intestinal infection in preterm and term neonates. Eur J Clin Microbiol Infect Dis 29, 1079–1084 (2010). https://doi.org/10.1007/s10096-010-0965-4

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  • DOI: https://doi.org/10.1007/s10096-010-0965-4

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