[Viral gastroenteritis in children].
PURPOSE OF THE TRIAL: To establish the involvement of viruses in the aetiology of diarrhoeal disorders in children, the incidence of individual viruses in various age groups and in different seasons, the impact of the aetiological agent on the clinical picture, the severity of the disorder, therapy and duration of hospital stay. The significance of intestinal viruses as nosocomial pathogens,a comparison of the sensitivity of latex agglutination and electron microscopy in the diagnosis of rotaviruses and adenoviruses.


METHODS
496 children, aged 3 weeks to 15 years, admitted in 2002 to the 1st Dpt of Infectious Diseases of the Bulovka Teaching Hospital with a diarrhoeal disorder, were examined to establish the aetiology of their complaint. All the children had the usual faecies culture and a culture of Campylobacter jejuni; direct electron microscopy was used for the demonstration of viruses. Additionally, latex agglutination was used in the investigation of rotaviruses and adenoviruses. In indicated cases the stools were also investigated for the presence of Clostridium difficile and of parasites.


RESULTS
Viruses were the most frequent cause of diarrhoeal diseases in children. Some type of virus was found in 413 children (83.26 % of the patients). Pure bacterial aetiology was seen in 35 children (7.05 %), pure viral aetiology in 381 children (66.73 %). A mixed infection, due to a combination of a bacterium and a virus, was found in 82 subjects (16.53 %), in 45 children (9.07 %) the aetiology of the disease could not be established. Rotaviruses, the most frequent infectious agent, were found in 300 children (6.48 %), caliciviruses in 68 (13.7 %), adenoviruses in 63 (12.7 %), coronaviruses in 39 (7.86 %), astroviruses only in 2 children (0.40 %). Children aged 1 to 5 years were the age group most affected by all the viral agents. The incidence of all the viruses, with the exception of coronaviruses, was highest in the cold seasons, the highest incidence of rotaviruses was in April. The most severe course of the disease was seen in rotaviral infections; 74.07 % of the children presenting with rotaviral gastroenteritis required rehydration, either i.v. or with a nasogastric tube. The longest hospital stay (5.29 days) was with adenoviruses. Nosocomial infections caused by rotaviruses were found in 5 cases-they substantially prolonged the mean time of hospital stay (13 days). Electron microscopy proved more sensitive than latex agglutination in the diagnosis of rotaviruses and adenoviruses.


CONCLUSIONS
The results of our trial confirmed the key role of viruses in the aetiology of diarrhoeal disorders in children in the Czech Republic. Given their frequently severe course, especially in the case of rotaviral infections, it is advisable to launch regular vaccinations against rotaviruses, once the new vaccine is on the market. It would also be appropriate to improve the diagnosis of rotaviruses and their reporting in the Czech Republic and, last but not least, to apply-at least on a limited scale-modern procedures, i.e. molecular-genetic methods, in the diagnosis of viral intestinal disorders.
Ambrozová
Helena
H
Department of Infectious Diseases 2nd, Medicine Faculty, Charles University of Prague, Czech Republic. ambrozoh@fnb.cz
Schramlová
Jana
J
D000293:Adolescent; D001419:Bacteria / Q000302:isolation & purification; D001424:Bacterial Infections / Q000175:diagnosis / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D018153:Czech Republic / Q000453:epidemiology; D003967:Diarrhea / Q000821:virology; D005759:Gastroenteritis / Q000175:diagnosis / Q000453:epidemiology / Q000382:microbiology / Q000821:virology*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D014777:Virus Diseases / Q000175:diagnosis / Q000453:epidemiology; D014780:Viruses / Q000302:isolation & purification