Etiology of Acute Gastroenteritis in Three Sentinel General Practices, Austria 2007

Clostridium difficile in children: colonisation and disease

Clostridium difficile is the commonest cause of hospital acquired diarrhoea in adults and is associated with significant mortality and morbidity. The clinical significance of C. difficile in children, however, is less certain. In this article we discuss colonisation and infection and describe C. difficile in childhood in terms of risk factors, epidemiology and management.

G2 as an emerging rotavirus strain in pediatric gastroenteritis in southern Italy

BACKGROUND

Human rotaviruses (HRVs) represent a major cause of acute gastroenteritis in children worldwide. It is estimated that they are responsible for a large number of diarrhea-associated hospitalizations in childhood each year. In Italy, limited data are available on the patterns of distribution of HRV G and P types. We report here the results of 2 years of rotavirus strain surveillance among children with severe gastroenteritis diagnosed in the town of Portici, Campania, southern Italy.

METHODS

A total of 421 stool specimens from children between 6 months and 5 years of age and presenting acute diarrhea were collected and tested by routine diagnostic tests for HRV, adenovirus, astrovirus, norovirus, and common bacterial pathogens.

RESULTS

The laboratory results showed that 110 of the 225 (26.1%) virus-positive samples contained HRVs. The different G and P rotavirus genotypes were analyzed by polymerase chain reaction (PCR). Among the VP7 genotypes identified, G1 and G2 were predominant, with percentages of 48.2 and 30.9%, respectively. G4, G9, and G10 were detected in a minority of cases. Among the VP4 genotypes, P[8] occurred the most frequently (56.4%), followed by P[4] (31.8%), and only a few P[10] and P[11] at percentages of 1.8 and 0.9%, respectively.

CONCLUSION

Our epidemiological data of HRV strains will contribute to assessing the magnitude of the problem of HRV in the south of Italy.

Recent diarrhea is associated with elevated salivary IgG responses to Cryptosporidium in residents of an eastern Massachusetts community

BACKGROUND

Serological data suggest that Cryptosporidium infections are common but underreported. The invasiveness of blood sampling limits the application of serology in epidemiological surveillance. We pilot-tested a non-invasive salivary anti-Cryptosporidium antibody assay in a community survey involving children and adults.

MATERIALS AND METHODS

Families with children were recruited in a Massachusetts community in July; symptoms data were collected at 3 monthly follow-up mail surveys. One saliva sample per person (n = 349) was collected via mail, with the last survey in October. Samples were analyzed for IgG and IgA responses to a recombinant C. hominis gp15 sporozoite protein using a time-resolved fluorometric immunoassay. Log-transformed assay results were regressed on age using penalized B-splines to account for the strong age-dependence of antibody reactions. Positive responses were defined as fluorescence values above the upper 99% prediction limit.

RESULTS

Forty-seven (13.5%) individuals had diarrhea without concurrent respiratory symptoms during the 3-month-long follow-up; eight of them had these symptoms during the month prior to saliva sampling. Two individuals had positive IgG responses: an adult who had diarrhea during the prior month and a child who had episodes of diarrhea during each survey month (Fisher's exact test for an association between diarrhea and IgG response: p = 0.0005 for symptoms during the prior month and p = 0.02 for symptoms during the entire follow-up period). The child also had a positive IgA response, along with two asymptomatic individuals (an association between diarrhea and IgA was not significant).

CONCLUSION

These results suggest that the salivary IgG specific to Cryptosporidium antigens warrants further evaluation as a potential indicator of recent infections.

Foodborne outbreaks, Austria 2007

In 2007 Austria reported a total of 438 foodborne outbreaks affecting 1715 people, including 286 hospitalized patients and one death. Salmonella spp. and Campylobacter spp. accounted for 95% of all reported outbreaks. Forty-eight (11%) of the 438 Austrian outbreaks were acquired abroad. Of the 390 domestically acquired foodborne outbreaks, bacterial infection caused 376, viruses (norovirus and 1-time hepatitis A virus) caused 11, and intoxications (Staphylococcus aureus enterotoxins, alkaloid toxins) caused two. In one outbreak the causative agent was unknown. Salmonella spp. caused 264 (70%) of the bacterial outbreaks, Campylobacter spp. caused 104 (28%), enterohemorrhagic Escherichia coli (EHEC O145:H-, O157:H-, O157:H7, O182: H49, O91:H7, ONT:H4) caused six, Shigella flexneri and Shigella sonnei each caused two. The hospitalization rates were 22% for domestically acquired infections with Salmonella spp. and 14% for Campylobacter spp. Among outbreaks where the source was known, eggs were implicated in 49%, meat products (especially poultry) in 44% and fish in 2%. The ratio of household outbreaks to general outbreaks was 82.3% to 17.7%. In 54 of the 62 general domestic outbreaks the following locations of exposure were documented: commercial food suppliers (e.g. restaurants, cafeterias) 24 times, family celebrations, nursery schools, take-aways and barbecues 22 times, nursing homes and hospitals eight times. It is likely that the relatively high number of household outbreaks reflects an insufficient level of epidemiological investigation of outbreaks in Austria. More resources may be needed for identification of individual clusters that belong to larger foodborne outbreaks exceeding district or provincial borders.