Abstract
Non-bacterial acute gastroenteritis (AGE) associated with virus infection affects individuals living in developing countries, especially children. To investigate whether shedding of certain human enterovirus (EV) is more frequently detected in the stool of individuals with AGE of unknown etiology than individuals without AGE symptoms, we tested fecal samples collected from 2,692 individuals with diarrhea between January 2010 and December 2016. Samples were tested for rotavirus, norovirus, and EV by reverse-transcription polymerase chain reaction (RT-PCR) and adenovirus by PCR. EV-positive samples were subjected to sequencing and phylogenetic analysis to identify EV species and types. Findings were compared to EV found in 1,310 fecal samples from individuals without AGE who were diagnosed with hand, foot, and mouth disease (HFMD). While the majority of viruses identified in AGE consisted of human rotavirus (22.7%), norovirus (11.4%) and adenovirus (9.3%), we identified EV (6.2%) belonging mainly to species B, C, and rhinovirus. In contrast, >92% of EV found without AGE symptoms belonged to species A. Although AGE symptoms are not often attributed to EV infection, EV was associated with diarrhea of unknown etiology at least in 3.4% of AGE cases. While CV-A6 was most likely to be found in stools of HFMD patients, rhinovirus A and C were the two most common EV species associated with AGE. Elucidating group-specific EV infection in diseases with and without AGE will be useful in assisting identification, clinical management, and the surveillance of EV infection in the community.
Highlights
Acute gastroenteritis (AGE) caused by viral infection contributes significantly to childhood morbidity and is a leading cause of death in young children [1]
To determine whether certain EV species are more often associated with AGE of unknown etiology, we described a multi-year molecular surveillance of EV found in association with AGE compared to EV shed by individuals with HFMD
Many EVs are increasingly recognized as being associated with a proportion of persistent diarrhea and are often examined when stools are negative for commonly implicated enteric viruses [14, 19, 35, 39]
Summary
Acute gastroenteritis (AGE) caused by viral infection contributes significantly to childhood morbidity and is a leading cause of death in young children [1]. Despite steep declines in mortality associated with viral gastroenteritis in some countries, diarrhea in children resulting in hospitalization still contributes to significant socio-economic burden [2, 3]. Human enteroviruses associated with and without diarrhea. Agency (P-15-50004), Ratchadaphiseksomphot Endowment Fund of Chulalongkorn University (RES560530093), Chulalongkorn University Centenary Academic Development Project (CU56HR01), and The Center of Excellence in Clinical Virology at King Chulalongkorn Memorial Hospital (GCE 58-014-30-004).
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