Abstract
Adenoviruses have been recognized as important causal pathogens of community-acquired diarrhea (CAD) among children, but their role in hospital-acquired diarrhea (HAD) is not well-understood. Hospitalized children with acute diarrhea and children who visited the outpatient department due to diarrhea were investigated from 2011 to 2012. Adenovirus was detected in stool specimens by PCR and further characterized by sequencing and phylogenetic analysis. SPSS software (version 19.0) was used for statistical analyses. A total of 2233 diarrheal children were enrolled in this study; this sample was comprised of 1371 hospitalized children, including 885 with CAD (IP-CAD) and 486 with HAD, and 862 outpatients with CAD (OP-CAD). Among these 2,233 patients, adenovirus was detected in 219 cases (9.8%). The positive rates for adenovirus were significantly different between the IP-CAD (9.3%), HAD (13.8%) and OP-CAD (8.1%) cases (X2 = 11.76, p = 0.003). The positive rate of adenovirus was lower in infants under six months of age compared to the positive rates in the other age groups. Of the 219 of adenovirus positive patients, 91 (41.6%) were identified as having serotype 41. Although enteric adenovirus (group F) was the most frequently detected adenovirus among children with either CAD or HAD, the role of non-enteric adenoviruses, especially the adenovirus 31 type (19.7%), cannot be ignored in diarrheal children.
Highlights
Acute diarrhea is one of the most common diseases in infants and young children worldwide
862 cases were classified as OP-community-acquired diarrhea (CAD) because these cases of acute diarrhea were identified in the outpatient department
Co-infection with rotavirus occurred in 1.1% (10/885), 1.9% (9/486) and 0.6% (5/862) of the cases of IP-CAD, hospital-acquired diarrhea (HAD) and outpatients with CAD (OP-CAD), respectively, and there was no significant difference between groups (x2 = 4.77, p = 0.092)
Summary
Acute diarrhea is one of the most common diseases in infants and young children worldwide. The importance of hospitalacquired infection (HAIs) (i.e., infections that become clinically evident after 48 hours of admission) has been highlighted in several recent publications [8,9,10,11]. These publications have improved our understanding of the viral pathogenicity and epidemiology of HAI. The data about Ad in children with hospital-acquired diarrhea (HAD) obtained by our research team in 2010 indicate that Ad is one of the important pathogens of HAD and that some types of Ad, in addition to the F group, can cause infantile and childhood diarrhea [12].
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