Abstract
ObjectiveTo evaluate the pathogenicity of a broad range of 11 possible gastroenteritis viruses, by means of statistical relationships with cases vs. controls, or Ct-values, in order to establish the most appropriate diagnostic panel for our general practitioner (GP) patients in the Netherlands (2010–2012).MethodsArchived stool samples from 1340 cases and 1100 controls were retested using internally controlled multiplex real-time PCRs for putative pathogenic gastroenteritis viruses: adenovirus, astrovirus, bocavirus, enterovirus, norovirus GI and GII, human parechovirus, rotavirus, salivirus, sapovirus, and torovirus.ResultsThe prevalence of any virus in symptomatic cases and asymptomatic controls was 16.6% (223/1340) and 10.2% (112/1100), respectively. Prevalence of astrovirus (adjusted odds ratio (aOR) 10.37; 95% confidence interval (CI) 1.34–80.06) and norovirus GII (aOR 3.10; CI 1.62–5.92) was significantly higher in cases versus controls. Rotavirus was encountered only in cases. We did not find torovirus and there was no statistically significant relationship with cases for salivirus (aOR 1,67; (CI) 0.43–6.54)), adenovirus non-group F (aOR 1.20; CI 0.75–1.91), bocavirus (aOR 0.85; CI 0.05–13.64), enterovirus (aOR 0.83; CI 0.50–1.37), human parechovirus (aOR 1.61; CI 0.54–4.77) and sapovirus (aOR 1.15; CI 0.67–1.98). Though adenovirus group F (aOR 6.37; CI 0.80–50.92) and norovirus GI (aOR 2.22, CI: 0.79–6.23) are known enteropathogenic viruses and were more prevalent in cases than in controls, this did not reach significance in this study. The Ct value did not discriminate between carriage and disease in PCR-positive subjects.ConclusionsIn our population, diagnostic gastroenteritis tests should screen for adenovirus group F, astrovirus, noroviruses GI and GII, and rotavirus. Case-control studies as ours are lacking and should also be carried out in populations from other epidemiological backgrounds.
Highlights
Acute diarrhea is a frequent cause of morbidity in the general population
Diagnostic gastroenteritis tests should screen for adenovirus group F, astrovirus, noroviruses GI and GII, and rotavirus
Because the pathogen cannot be deduced from symptoms alone, laboratory diagnostics are essential
Summary
Acute diarrhea is a frequent cause of morbidity in the general population. In The Netherlands approximately 4.5 million people a year experience an episode of gastroenteritis [1]. In 2019, 294,100 Dutch patients out of a population of 17.2 million visited their family physician (GP) because of complaints of diarrhea or gastrointestinal (GI) complaints. Often self-limiting, testing is rarely indicated, but should be considered in more serious cases, immunocompromised patients, or epidemical situations [1]. Since there were no data of recently identified putative gastroenteritis pathogens in the general population of a high-income-country (HIC) such as The Netherlands, we conducted a case-control study involving bacterial, protozoal and viral pathogens. Following our analyses on the bacterial and protozoal agents we report on the viruses [3,4]
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