Characterization of rotaviruses and subgroup F adenoviruses from acute summer gastroenteritis in South Africa

Prevalence, Pattern and Genetic Diversity of Rotaviruses among Children under 5 Years of Age with Acute Gastroenteritis in South Africa: A Systematic Review and Meta-Analysis

Rotavirus is the most significant cause of severe acute gastroenteritis among children under 5 years of age, worldwide. Sub-Saharan Africa particularly bears the brunt of the diarrheal deaths. A meta-analysis was conducted on 43 eligible studies published between 1982 and 2020 to estimate the pooled prevalence of rotavirus infection and changes in the main rotavirus strains circulating before and after vaccine introduction among under-five children in South Africa. The pooled national prevalence of rotavirus infection was estimated at 24% (95% CI: 21-27%) for the pre-vaccination period and decreased to 23% (95% CI: 21-25%) in the post-vaccination period. However, an increased number of cases was observed in the KwaZulu-Natal (21-28%) and Western Cape (18-24%) regions post-vaccination. The most dominant genotype combinations in the pre-vaccine era was G1P[8], followed by G2P[4], G3P[8], and G1P[6]. After vaccine introduction, a greater genotype diversity was observed, with G9P[8] emerging as the predominant genotype combination, followed by G2P[4], G12P[8], and G1P[8]. The introduction of the rotavirus vaccine was associated with a reduction in the burden of rotavirus-associated diarrhea in South Africa, although not without regional fluctuation. The observed changing patterns of genotype distribution highlights the need for ongoing surveillance to monitor the disease trend and to identify any potential effects associated with the dynamics of genotype changes on vaccine pressure/failure.

High prevalence of species D human adenoviruses in fecal specimens from Urban Kenyan children with diarrhea

Human adenoviruses (HAdVs) cause a wide range of clinical syndromes and are classified in seven species, A-G, comprising 52 serotypes. HAdV-A31, -F40, and -F41 have been associated with diarrhea in infants and young children. In developing countries gastroenteritis is a major cause of morbidity and mortality in children and, in comparison to rotaviruses, there are no data on the HAdVs associated with diarrhea in pediatric patients in Kenya. This study investigates the prevalence and genotypes of HAdVs in 278 stool specimens (211 diarrheal; 67 non-diarrheal) from children < or =14 years of age in urban and rural areas in Kenya. Stool specimens were screened for HAdVs using a nested polymerase chain reaction and the HAdVs genotyped by sequence analysis of a conserved hexon gene fragment. HAdVs were detected in 104/278 (37.4%) of the stool specimens: 35/43 (81.4%) of diarrheal and 10/61 (16.4%) of non-diarrheal stool specimens from children in an urban hospice; 25/94 (26.6%) of diarrheal specimens from urban children and 34/80 (42.5%) of diarrheal specimens from children in a rural area. Species D HAdVs were identified as the most prevalent HAdV species in diarrheal stool specimens from urban children comprising 18/37 (48.6%) of the strains identified. In contrast HAdV species F predominated in pediatric diarrheal specimens from the rural area, being identified in 7/16 (43.8%) of the characterized strains. This study provides valuable new data on the prevalence and distribution of HAdV genotypes in diarrheal stool specimens in Kenya and Africa, and highlights the necessity for further investigations.

Infection kinetics of human adenovirus serotype 41 in HEK 293 cells

The purpose of this work was to acquire an overview of the infectious cycle of HAdV-41 in permissive HEK 293 cells and compare it to that observed with the prototype of the genus, Human adenovirus C HAdV-2. HEK 293 cells were infected with each virus separately and were harvested every 12 h for seven days. Infection kinetics were analysed using confocal and electronic microscopy. The results show that, when properly cultivated, HAdV-41 was not fastidious. It had a longer multiplication cycle, which resulted in the release of complete viral particles and viral stocks reached high titres. After 60 h of infection, the export of viral proteins from the infected cell to the extracellular milieu was observed, with a pattern similar to that previously described for HAdV-2 penton-base trafficking after 30 h of infection. HAdV-41 had a non-lytic cycle and the infection spread from the first infected cell to its neighbours. The release process of the viral particles is unknown. The results observed for HAdV-41 infection in HEK 293 cells show how different this virus is from the prototype HAdV-2 and provides information for the development of this vector for use in gene therapy.

Enteric adenoviruses

The 41 serotypes of human adenoviruses are classified into six subgenera (A-F) with different tropisms. Enteric infections are caused in children by serotypes Ad40 and Ad41 of subgenus F. Serotypes Ad40 and Ad41 transform embryonic cells but cannot induce tumours in newborn hamsters. They differ from all other (established) human adenoviruses by being unable to replicate in conventional cell cultures. Ad40 and Ad41 grow in 293 cells (human embryonic kidney cells immortalized by transfection with the E1A, E1B regions of Ad5). In spite of the difficulty of isolating Ad40 and Ad41 they can be directly identified in stools by enzyme-linked immunosorbent assay (ELISA) and solid-phase immuno-electron microscopy. The amount of viral DNA in stool preparations is sufficient for identification by DNA restriction or dot-blot analysis. Adenoviruses have been associated with 7-17% of cases of diarrhoea in children. Ad40 and Ad41 cause diarrhoea throughout the year. Clinical features are watery stools, vomiting and moderately elevated temperature; respiratory symptoms are infrequent. The diarrhoea is protracted (mean 8.6 and 12.2 days for Ad40 and Ad41 respectively). Children with rotavirus diarrhoea vomited more frequently and had a higher temperature and diarrhoea of shorter duration. The impact of enteric adenoviruses in the aetiology of diarrhoea world-wide is not known but is accessible to investigation.

Anticipating rotavirus vaccines: epidemiology and surveillance of rotavirus in South Africa

Rotavirus infection is associated with acute infantile gastroenteritis in infants and young children globally. In South Africa, rotavirus infection has been shown to be associated with approximately one-quarter of all diarrhoeal admissions to hospital. Rotavirus infection predominantly occurs in infants less than 12 months of age (75%) and has a peak of shedding during the cooler, drier months of the year. A secondary peak during the spring has been observed. Multiple infections with rotavirus and at least one other microbial agent are common. The circulating VP7 serotypes and VP4 genotypes have been determined in various regions of South Africa and show a geographic specific distribution. A decade previously, P[8]G1 or G4 strains predominated, and P[4]G2 strains occurred in an epidemic pattern in one region. More recently, rotavirus strains with P[6] genotype have become common and novel VP7/VP4 genotype combinations are occurring across the country. G9 strains have been reported from Cape Town to Vendaland. The circulating rotavirus types observed in this study add to the knowledge of the natural history of rotavirus infection and provide the groundwork to consider future vaccine strategies.

Human caliciviruses in acute gastroenteritis of young children in the community

Episodes of acute gastroenteritis in prospectively followed children between 2 months and 2 years of age were examined for rotaviruses, enteric adenoviruses, astroviruses, and human caliciviruses, including both Norwalk-like viruses (NLVs) and Sapporo-like viruses (SLVs), using PCR and reverse transcription (RT)-PCR assays. A virus was identified in 60% (502/832) of all episodes and in 85% of the moderately severe or severe episodes. Human caliciviruses were as common as rotaviruses, both being detected in 29% of the cases. NLVs accounted for a 20% etiologic share of all cases; the clinical picture was a moderately severe disease with vomiting as a predominant symptom. SLVs were detected in 9% of the cases, the clinical picture being a mild diarrheal disease. Astroviruses were found in 10% and enteric adenoviruses in 6% of the cases. Diagnosis with PCR and RT-PCR methods increases the detection of all gastroenteritis viruses, particularly human caliciviruses. As a group, human caliciviruses are common causative agents of gastroenteritis in children <2 years of age in Finland, and, of these, NLVs cause more severe disease than SLVs.

Relevance of commercial diagnostic tests to detection of enteric adenovirus infections in South Africa

The prevalence of enteric adenoviruses detected by an in-house enzyme-linked immunosorbent assay (the RIVM-ELISA) ranged from 13 to 38%, and subgroup F adenoviruses comprised 86%. All subgroup F adenoviruses reacted with both RIVM anti-adenovirus type 40 (Ad40) and anti-adenovirus type 41 (Ad41) monoclonal antibodies but were not detected by Adenoclone Type 40/41 enzyme immunoassay (EIA). The correlation between the Biotrin EIA and RIVM-ELISA results was low (26%). Immunospecific tests suggest that a significant proportion of enteric adenoviruses, possibly comprising previously unidentified or emerging types, are not detected by commercial diagnostic tests in South Africa.

Seroepidemiological study of genogroup I and II calicivirus infections in South and southern Africa

Diarrhoea is associated with the daily death of between 180 and 200 children under the age of 5 years in South Africa. Until recently, many cases and outbreaks of diarrhoea were not associated with a known aetiologic agent. Previous studies using baculovirus-expressed Norwalk virus (NV) and Mexico virus (MxV) capsid antigens have shown that human calicivirus infection is common in South Africa. In this study, our surveillance was extended to different populations, as well as to four other southern African countries: Namibia, Angola, Zimbabwe, and Mozambique. More than 1,700 specimens, some involved in previous cohort studies of infectious diseases, were enrolled in the surveillance. The overall seroprevalence of antibody against NV was >90% for all cohorts except for Mozambican refugees that had 83. 8% sero-positivity. The MxV antibody prevalence was higher than NV, with >95% positivity for all cohorts, except for one in Namibia that had 81% exposure. This study is one of only a few reporting on the concurrent incidence of NV and MxV infections in a cohort study, and has determined that small round structured viruses are prevalent in the local populations of South and Southern Africa. These agents may account for a number of previously unknown or unidentified causes of diarrhoeal illness, in both adults and children, in southern Africa.

Managed care and public health departments: who is responsible for the health of the population?

This review examines changes over the past decade in the delivery of health care in the United States, specifically the move toward managed care and capitation. Over 77 million Americans are now enrolled in health maintenance organizations, and the health care delivery system is reorganizing into large group practices and integrated health systems. Examined here are the implications of this shift on the interaction between managed care and public health agencies. How will a population-based system of health care be achieved in light of managed care organizations' responsibility only for their enrolled population, in contrast to the responsibility of the public health service for the entire population? Where does the responsibility of MCOs end and that of public health begin? Should certain public health functions be absorbed by managed care organizations? What are the prospects for partnership between these two systems?

PCR-based detection and typing of human adenoviruses in clinical samples

Since human adenoviruses (Ad) are associated with a variety of diseases, there is need for a fast and sensitive diagnostic procedure. The polymerase chain reaction (PCR) has been previously applied for the detection and typing of adenoviruses directly in clinical samples. So far, only Ad8, Ad31, Ad40 and Ad41 could be typed by PCR. To extend the technique of type-specific PCR to other adenovirus serotypes, type-specific primers for Ad1, Ad2, Ad4, Ad5, Ad19 and Ad37 were evaluated. In the present study, 50 stool and 68 eye swab specimens were first tested for the presence of adenoviruses using genus-specific primers. Adenoviruses could be detected in 42 stool and 47 eye swab samples. While the adenovirus-positive stool samples were subsequently typed with primers for Ad2, Ad5, Ad31, Ad40 and Ad41, the positive eye swab specimens were typed with primers for Ad4, Ad8, Ad19 and Ad37.

The molecular epidemiological study on enteric adenovirus in stool specimens collected from Wuhan area by using digoxigenin labeled DNA probes

A summer-autumn (1994) molecular epidemiological study of enteric adenoviruses (EAds) in stool specimens collected in Wuhan area was conducted by using Digoxigenin-labelled DNA probes specific to EAd40 and EAd41 respectively. 44 of 602 specimens were positive, among which 23 cases were identified as EAd40, 14 were EAd41 infection and 7 were dual infection. The ratio of males to females for the positive specimens was 1. 44. The infection rate of EAd40 and EAd41 each displayed no marked difference in seasons (summer and autumn) and similar age distribution was found between them. All of the two types of EAds infections predominated in patients with diarrhea under 3 years old. The results indicated that the Digoxigenin probe could detect DNA quantities as low as 1 pg with satisfactory specificity and the technique can be used for both clinical and experimental purposes.

Comparison of primer sets for detection of fecal and ocular adenovirus infection using the polymerase chain reaction

Adenoviruses of subgenus F (types 40 and 41) cause infantile gastroenteritis and adenoviruses principally of types 1-7 are found in feces during respiratory or generalized infections. Adenoviruses (mostly types 3, 4, 8, 19, or 37) are also linked with follicular or epidemic conjunctivitis. The diagnostic efficiency of the polymerase chain reaction (PCR) for adenoviruses was assessed using genus-reactive primers H1 and H2 or JCH1 and JCH2 or subgenus F-specific primers F1a and F2a. With diarrheal stool specimens containing subgenus F adenoviruses, F1a/F2a PCR achieved at least as high a positivity rate (75/76 [99%]) as electron microscopy (72/76 [95%]) and was more sensitive than polyclonal antibody-based immune electron microscopy (IEM) for subgenus identification (75/76 [99%] vs. 66/76 [87%], P = 0.008). Twenty-three subgenus F strains untypeable by monoclonal antibody-based IEM were typed as 40 (n = 4) or 41 (n = 19) by Hha I digestion of the PCR product. The genus-reactive primer pairs provided DNA amplification assays of generally equal efficiency on conjunctival swab specimens though possible nucleic acid degradation in DNA extracts during storage could have meant that JCH1/JCH2 PCR was truly the more sensitive. The use of either genus-reactive primer set on fecal specimens cannot be recommended because, although the positivity rates with subgenus F PCR positive specimens were high (70/75 [93%] for H1 and H2, 14/15 [93%] for JCH1 and JCH2), the detection rates were disappointing with similar specimens yielding nonsubgenus F adenoviruses.

Sequence characterization of the adenovirus 31 fibre and comparison with serotypes of subgenera A to F

The amino acid sequence of the adenovirus type 31 (subgenus A) fibre polypeptide was deduced from the nucleotide sequence of the fibre gene. The analysed peptide sequence showed an organization consistent with the structural domains described for other adenoviruses: an amino-terminal tail region, an intervening shaft region and a carboxy-terminal knob. The AV31 fibre shaft displayed 20 repeats of the 15-amino-acid segments in the shaft domain, which agreed with the reported length of the fibre. The predicted AV31 fibre polypeptide sequence was compared to fibre polypeptides of serotypes representing subgenera A to F. As expected, AV31 and AV12, both belonging to subgenus A, showed the highest overall homology (75.4%). When comparing the AV31 fibre to the fibre polypeptides of subgenera B to F, AV31 and AV41 (subgenus F) shared the highest overall homology (35.3%), followed by AV40 (34.8%). The lowest overall homology (20.3%) was found for the AV31 and Av3 fibres (subgenus B). From the data presented, it could be suggested that AV31 is more closely related to the enteric viruses of subgenus F than to the other adenoviruses analysed. Comparing the fibre polypeptides of 14 adenovirus serotypes, 10 conserved amino acid sequences were detected, 5 of which were in the knob region. Since the fibre knob interacts with the host cell during infection, these conserved amino acids might be important for virus attachment. The gastroenteritis-causing adenoviruses AV40 and AV41 shared 3 additional conserved amino acid residues with AV31 and AV12 in the knob region.

Adenovirus genome types isolated from stools of children with gastroenteritis in São Paulo, Brazil

In a prospective one-year study of acute gastroenteritis in hospitalized children less than 2 years of age, in São Paulo (Brazil), adenoviruses were detected by specific enzyme immunoassay (El-ARA) in 7 of 67 (10%) ill children and in 9 of 79 (11.4%) controls. They were the sole recognizable agent of diarrhea in 6 ill children. In another child these viruses were detected in a dual infection with astrovirus. Enteric adenoviruses (Ad40/41) were the most common serotypes detected in children with diarrhea (3/7) and Ad7 the serotype most detected in the controls (5/9), associated with lower respiratory tract infection. Thirteen adenovirus strains, isolated in HEp2 or HEK-293 cells, were characterized by seroneutralization and restriction enzyme analysis. The established adenoviruses were typed as AV-7-D5 (five associated to lower respiratory tract infection and one to diarrhea), AV-1-D10 (one diarrhea case), AV-31-D2 (two controls with respiratory infection), and two isolates as AV-12-D7, a new genome type. One subgenus D isolate, serotype 28, with restriction patterns different from those of the prototype, remained untyped. Only one enteric adenovirus could be typed. The restriction patterns of this isolated were similar to those of the prototype AV-41-D1. The genome type of the other three enteric adenoviruses could not be determined.

Adenovirus type 40 and 41 growth in vitro: host range diversity reflected by differences in patterns of DNA replication

Subgroup F adenoviruses adapt poorly to cell culture, but the reasons for their fastidious nature are as yet ill defined. In an attempt to gain an overview of the differences in replication between adenovirus type 2 (Ad2) and representative strains of Ad40 and Ad41, cell lines which show different degrees of permissiveness to Ad40 and Ad41 were infected and examined with respect to three key functions in the Ad2 life cycle: host protein shutoff, DNA synthesis, and late antigen synthesis. The complexity of growth patterns exhibited by the subgroup F adenoviruses suggests that defectiveness is a multifactorial phenomenon not easily explainable by a single aberrant function. Furthermore, results suggest that there may be replicative defects in subgroup F adenoviruses which are not shared by both serotypes or by all strains.

Type- and group-specific polymerase chain reaction for adenovirus detection

We report on a 1,551-base-pair-long DNA sequence, encoding the variable region and parts of the flanking conserved regions of the human adenovirus type 8 (AV8) hexon, and a sequence comprising 1,404 base pairs, encoding the corresponding regions of the human adenovirus type 31 (AV31). Comparison of the hexon sequences showed that the major sequence changes were located in loops I1 and I2 of the hexon polypeptides which form the surface of the virion. We established a type-specific polymerase chain reaction (PCR), using a combination of a group-specific (general) primer, located in a conserved region of the hexon gene, and type-specific primers located in the region that encodes for loop I2 of the AV8 (subgroup D), AV31 (subgroup A) and AV40 and 41 (both subgroup F) hexon polypeptides. We performed PCR directly from several different clinical specimens or from isolates (AV31). Type-specificity was confirmed by restriction analysis. We also carried out several PCR directly from faecal specimens, using a group-specific primer pair and compared the sensitivity of PCR with that of electron microscopy and enzyme immuno assay.

Subgroup F adenovirus growth in foetal intestinal organ cultures

An in vitro foetal intestinal organ culture system was employed to determine the permissiveness of human intestinal cells for subgroup F adenovirus infection. Ad40 and Ad41 growth, monitored through group-specific hexon antigen production, was poor in comparison to that of Ad2 in these cultures, further demonstrating their fastidious nature in most human cells. The low growth capability of these viruses in culture, in relation to their association with gastrointestinal disease is discussed.

The E1B transcription map of the enteric adenovirus type 41

Enteric adenovirus type 41 (Ad41) is defective for growth in conventional established cell lines. Ad41 is dependent on the Ad5 early regions E1A/E1B since it cannot grow in HEK cells but only in 293 HEK cells transformed by Ad5 E1 region. However, Hep-2 cells have also been shown to support the growth of Ad41 to some extent. The nucleotide sequence of the E1B region of the Ad41 strain D389 has been determined. When compared to the corresponding region of the Ad41 prototype strain (Tak) the degree of homology in the DNA sequences was close to 100%. The mRNAs from the E1B region of the Ad41 strain D389 have been studied by Northern blot, primer extension, and polymerase chain reaction-cDNA analysis. E1B transcripts corresponding to Ad2 14 S, 22 S, and 9 S mRNAs were identified but no 13 S mRNA equivalent was detected, a pattern similar to that seen in the Ad40 and Ad12 transcription maps. However, the Ad41 E1B 14S mRNA equivalent has one additional small exon of 23 nucleotides, created by a donor and an acceptor splice site located at positions not seen in other E1B transcripts of human adenoviruses analyzed so far. The coding potential for E1B 19K, 55K, and 15K proteins and for pIX is retained in the Ad41 transcripts. In contrast to other adenoviruses, except for the closely related Ad40, the ORF of pIX starts in the intron of the 22 S mRNA.

The molecular epidemiology of rotavirus-associated gastro-enteritis in the Transkei, southern Africa

Rotaviruses were detected in 32.8% (71/216) of stool specimens collected from young children with gastro-enteritis attending the Rehydration Unit at Umtata General Hospital between April 1988 and March 1989. A seasonal distribution was observed with an increase in numbers shedding the virus during the colder months of the year. Based on variations in the migration pattern of the RNA genome segments when passed through polyacrylamide gels, 14 different electrophoretypes were identified: 69% were long patterns and 27% were short patterns. A single dominant long electrophoretype persisted throughout the 12-month study period, whereas 13 other minor types co-circulated at varying intervals. Mixed infections were observed in three cases, including one infant who was infected with both a long (Wa-like) virus and a short (DS-1-like) virus.

Epidemiology of enteric adenoviruses 40 and 41 in acute gastroenteritis in infants and young children in the Tokyo area

82/2,223 stool specimens, collected 1982-1988, from children with enteritis (3.7%) were found to contain adenoviruses; 17 adenovirus-positive samples were provided from other institutes. 89 adenoviruses were isolated in Graham 293 cells from these 99 specimens and were typed by DNA restriction enzyme analysis with Sma I. 37 strains were typed as adenovirus 40 (AD40), and 37 strains as adenovirus 41 (Ad41). Although most strains had the same DNA profiles, a few strains had 3 kinds of different electropherotypes generated by Sma I. Five strains were identified as adenovirus 31. The remaining 10 strains were adenovirus 1 (2 strains), adenovirus 2 (3 strains), adenovirus 3 (1 strain), adenovirus 5 (1 strain), and a non-classified adenovirus (3 strains). Ad40 and Ad41 infections were found throughout the year, but peaked between September and November. 80% of the children with adenovirus infections were less than or equal to 2 years of age. The highest incidence of diarrhea caused by Ad40 or Ad41 was in 6-11 months old children. 1982-1984, the rate of Ad40 infection was 91.7%, while the rate of Ad41 infection was only 8.3%. The prevalence of Ad40 infection gradually diminished from 1985. During 1987 and 1988 the reverse ratios, 20.6% and 79.4%, respectively, of Ad40 and Ad41 infections were observed. Thereafter, Ad41 infection became predominant.

Polymerase chain reaction for detection of adenoviruses in stool samples

The usefulness of the polymerase chain reaction (PCR) method for diagnosing adenovirus infections was investigated. Several primers, including primers specific for the hexon-coding region and for enteric adenovirus types 40 and 41, were evaluated. The PCR method was validated against cell culturing in routine diagnostic work and against restriction enzyme analysis of viral DNA. Sixty diagnostic specimens were selected for evaluation by the PCR method. Twenty of the 60 specimens were found positive on the basis of cytopathic effects and latex agglutination (Adenolex [Orion Diagnostica, Helsinki, Finland]), and 16 were identified and typed as adenoviruses by polyacrylamide gel electrophoresis. PCR was performed on all 60 specimens in parallel directly on diluted stool samples and on viral DNA extracted from cells inoculated with the same stool samples. When the general hexon primers were used 51 of the 60 specimens from infected cell cultures were found positive by PCR, whereas only 13 specimens were found positive when PCR was performed directly on stool samples. With the use of selective primers for enteric adenoviruses 16 of the 60 cell cultures were found to exhibit amplification products by PCR, whereas 4 were detected in stool samples. None of the 60 specimens were found positive by PCR when an adenovirus type 40-specific primer pair was used. PCR was found to be a fast, sensitive, and reliable method for the detection of adenoviruses in diarrheal disease, provided the amplifications were performed directly on diluted stool samples.

Infection by enteric adenoviruses, rotaviruses, and other agents in a rural African environment

From February 1985 to January 1986, 432 stool samples, 310 from rural African children with diarrhea and 122 from controls, were analysed for the presence of enteric viruses known to be associated with diarrhea. Group A rotavirus ELISA indicated 12.9% positivity among patients and 2.5% positivity among controls. Only 23 of the 43 rotavirus ELISA-positive stools were also positive by electron microscopy. Nine children, three of whom were controls, were found to be shedding coronavirus-like particles, detected by electron microscopy. Stools from all but one of the nine children had been taken within 1 month of each other. Dot-blot hybridization tests for the presence of Ad40 or Ad41 DNA revealed 44 positive stools, 41 of which were from patients (13.2% positivity). Only three of the Ad40-or Ad41-positive stools by DNA hybridization were positive by electron microscopy, and only these three strains could be grown in semipermissive Chang conjunctival cells and their identity checked by restriction enzyme analysis. Further attempts to rescue the other strains using a helper virus failed, but nine of the stools proved positive by ELISA using a subgroup F-specific monoclonal antibody. On the basis of the DNA hybridization results alone, subgroup F adenoviruses were encountered as frequently as rotavirus in the study and were significantly associated with diarrhea, although the viability and intactness of virus particles by the time of laboratory analysis appeared to be very low.

Human viral gastroenteritis

During the last 15 years, several different groups of fastidious viruses that are responsible for a large proportion of acute viral gastroenteritis cases have been discovered by the electron microscopic examination of stool specimens. This disease is one of the most prevalent and serious clinical syndromes seen around the world, especially in children. Rotaviruses, in the family Reoviridae, and fastidious fecal adenoviruses account for much of the viral gastroenteritis in infants and young children, whereas the small caliciviruses and unclassified astroviruses, and possibly enteric coronaviruses, are responsible for significantly fewer cases overall. In addition to electron microscopy, enzyme immunoassays and other rapid antigen detection systems have been developed to detect rotaviruses and fastidious fecal adenoviruses in the stool specimens of both nonhospitalized patients and those hospitalized for dehydration and electrolyte imbalance. Experimental rotavirus vaccines have also been developed, due to the prevalence and seriousness of rotavirus infection. The small, unclassified Norwalk virus and morphologically similar viruses are responsible for large and small outbreaks of acute gastroenteritis in older children, adolescents, and adults. Hospitalization of older patients infected with these viruses is usually not required, and their laboratory diagnoses have been limited primarily to research laboratories.

Enteropathogens isolated from children with gastro-enteritis at Ga-Rankuwa Hospital, South Africa

A prospective 3-year study for enteric pathogens associated with diarrhoea in children was undertaken at Ga-Rankuwa Hospital, South Africa. Rotavirus was the most commonly isolated pathogen (24%), showing a marked seasonal distribution, with an autumn peak in activity. Enterotoxigenic and enteropathogenic Escherichia coli were frequently identified, and Salmonella, Shigella and Campylobacter were also isolated. Cryptosporidium and Giardia lamblia were the most frequently seen parasites. Rotavirus, E. coli, Salmonella and Campylobacter occurred predominantly in children less than 1 year old, whilst Shigella and the parasites were prevalent at all ages.

One-year prospective cross-sectional study to assess the importance of group F adenovirus infections in children under 2 years admitted to hospital

A 1-year prospective cross-sectional study of 363 children under 2 years of age admitted to hospital was undertaken to assess the importance of group F adenovirus infections. Faeces obtained within 48 hours of admission from 97 patients with and 266 patients without diarrhoea were screened by electron microscopy. Viruses were identified by morphological criteria, and all adenoviruses seen were retested by immune electron microscopy to identify group F serotypes. Group F adenoviruses (4 infections) were second in frequency to rotaviruses (16 infections), and both viruses were significantly associated with diarrhoea (P = 0.005 and 0.00001 respectively, chi-squared test). All four group F infections occurred in children with diarrhoeal disease aged between 1 and 6 months and were numerically as important as rotavirus (three infections) in this group. Rotavirus infections occurred significantly more frequently in the 7-24-month age group with diarrhoea (11 v.0 infections, P = 0.001, chi-squared test). Nosocomial infection occurred with group F adenovirus as well as rotavirus. The finding that group F adenoviruses occur as frequently as rotaviruses in diarrhoeal disease that results in hospital admission in children between 1 and 6 months of age could have important implications for preventative strategies.

Comparison of enteric adenovirus infection in various human cell lines

Growth of the fastidious enteric adenoviruses 40 and 41 was compared in different human cell lines. Purified virions were used to infect the following cell lines: A549; KB; Chang's conjunctiva; 293; HeLa. Both types of enteric adenovirus were infectious for each cell line, with the exception of adenovirus 40 in HeLa cells. Relatively low infectious titers were obtained from each cell type following infection with adenovirus 40 (TCID50 average = 10(-1.5)), whereas adenovirus 41 replicated to significantly higher titer (TCID50 average = 10(-3.0)). For both viruses, the highest infectious titers were obtained with A549 and KB cells. A time course experiment performed to quantitate the amount of hexon present in A549 and KB cells infected with each virus indicated that while the kinetics of accumulation were similar for both viruses, the concentration of type 41 hexon was significantly greater than that for type 40 in either cell line. The concentration of type 41 hexon was similar in each cell type; for type 40, a greater concentration of hexon was obtained in the A549 cell line than in the KB cells. The results indicate the distinct replication characteristics exhibited by adenovirus 40 are not due to a restriction in a specific host cell, and, because purified virions were used, not attributable to interference that might occur with co-infection from multiple viruses present in the same clinical specimen. We conclude the differences observed in the replication of these viruses are independent of host cell type and are associated, uniquely, with each virus.