title: Norovirus RNA in the blood of a child with gastroenteritis and convulsions--A case report.
abstract: Potential extra-intestinal spread is an important issue in understanding the pathogenesis of NoV disease. A previously healthy 14-month-old boy was admitted to the Pediatric Emergency Department of the University-Hospital of Parma, Italy, for afebrile convulsions in a gastroenteritis episode. Bacterial culture and microscopic examination on cerebrospinal fluid (CSF) yielded negative results as well as PCRs and reverse-transcription PCRs (RT-PCRs) for neurotropic viruses performed either on CSF or plasma. Stools were subjected to electron microscopy and conventional cell culture, yielding negative results. NoV was found in stools and plasma by nested RT-PCR targeting the NoV polymerase gene. The nucleotide sequences obtained from the two specimens showed 100% identity, demonstrating that the strain invading the blood stream was from the intestine, and, in comparison with GenBank sequences, they belonged to NoV genotype GII.4, "2006b" variant. The child had no abnormal electrolyte balance and no fever that could justify seizures, encouraging the hypothesis that NoV could be the cause of the neurologic disorder. These findings further induce to review the current concept of human NoV focused on intestinal infection.
authors.affiliation: Section of Microbiology, Department of Pathology and Laboratory Medicine, University of Parma School of Medicine, Viale Antonio Gramsci 14, 43100 Parma, Italy. mariacristina.medici@unipr.it
authors.forename: Maria Cristina
authors.initials: MC
authors.lastname: Medici
authors.forename: Laura Anna
authors.initials: LA
authors.lastname: Abelli
authors.forename: Icilio
authors.initials: I
authors.lastname: Dodi
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Dettori
authors.forename: Carlo
authors.initials: C
authors.lastname: Chezzi
mesh_terms: D000818:Animals; D001769:Blood / Q000821:virology*; D017250:Caliciviridae Infections / Q000150:complications* / Q000821:virology; D005243:Feces / Q000821:virology; D005759:Gastroenteritis / Q000150:complications* / Q000821:virology; D006801:Humans; D007223:Infant; D007558:Italy; D008297:Male; D008969:Molecular Sequence Data; D029322:Norovirus / Q000302:isolation & purification*; D012367:RNA, Viral / Q000097:blood* / Q000737:chemistry; D020133:Reverse Transcriptase Polymerase Chain Reaction; D012640:Seizures / Q000821:virology*; D017422:Sequence Analysis, DNA
chemical_list: D012367:RNA, Viral