title: NSP4 antibody levels in rotavirus gastroenteritis patients with seizures.
abstract: BACKGROUND
  Rotavirus nonstructural protein 4 (NSP4) has been suggested as a pathogen of rotavirus-associated seizures. We investigated pre-existing serum antibodies against NSP4 and VP6 (the most highly immunogenic rotavirus protein) in patients with rotavirus gastroenteritis and its correlation with the occurrence of seizures.
  
  
  METHODS
  With an enzyme-linked immunosorbent assay, IgG and IgA titers against NSP4 (genotype [A] and [B]) and VP6 were measured in acute-phase sera of 202 children aged 0.5-6.0 years with rotavirus gastroenteritis. The clinical characteristics and antibody levels were compared between patients with (seizure group) and without seizures (non-seizure group).
  
  
  RESULTS
  The non-seizure and seizure groups comprised 173 and 29 patients, respectively. Age, sex, hospital stay, presence of fever, white blood cell counts, C-reactive protein, vaccine status, IgG/IgA titers for VP6, and IgA titers for both NSP4s did not differ between the groups. The seizure group showed a lower level of IgG against NSP4 [A] (184.5 vs. 163.0 U/mL; P = 0.03) and NSP4 [B] (269.0 vs. 196.0 U/mL; P = 0.02). Delayed sampling time from the onset of gastroenteritis symptoms (3 vs. 2 days; P = 0.02) and lower serum sodium level (133.4 vs. 136.3 mEq/L; P < 0.01) were observed in the seizure group. Even after adjusting these factors, anti-NSP4 [A] IgG (OR 2.56 per 100 U/mL increment; 95% CI, 1.20-5.26, P = 0.01) and anti-NSP4 [B] IgG (OR 1.51 per 100 U/mL-increment; 95% CI, 1.04-2.22, P = 0.03) were independently associated with protection against seizures.
  
  
  CONCLUSIONS
  Serum anti-NSP4 IgG might protect rotavirus-associated seizures.
authors.affiliation: Department of Pediatrics, Gyeongsang National University School of Medicine, Jinju, South Korea; Gyeongsang Institute of Health Science, Jinju, South Korea.
authors.forename: Jung Sook
authors.initials: JS
authors.lastname: Yeom
authors.affiliation: Department of Neurology, Gyeongsang National University School of Medicine, Jinju, South Korea.
authors.forename: Young-Soo
authors.initials: YS
authors.lastname: Kim
authors.affiliation: Gyeongsang Institute of Health Science, Jinju, South Korea.
authors.forename: Jin-Su
authors.initials: JS
authors.lastname: Jun
authors.affiliation: Department of Pediatrics, Gyeongsang National University School of Medicine, Changwon, South Korea.
authors.forename: Hyun Jung
authors.initials: HJ
authors.lastname: Do
authors.affiliation: Department of Pediatrics, Gyeongsang National University School of Medicine, Jinju, South Korea; Gyeongsang Institute of Health Science, Jinju, South Korea.
authors.forename: Ji Sook
authors.initials: JS
authors.lastname: Park
authors.affiliation: Department of Pediatrics, Gyeongsang National University School of Medicine, Jinju, South Korea; Gyeongsang Institute of Health Science, Jinju, South Korea.
authors.forename: Ji-Hyun
authors.initials: JH
authors.lastname: Seo
authors.affiliation: Department of Pediatrics, Gyeongsang National University School of Medicine, Jinju, South Korea; Gyeongsang Institute of Health Science, Jinju, South Korea.
authors.forename: Eun Sil
authors.initials: ES
authors.lastname: Park
authors.affiliation: Department of Pediatrics, Gyeongsang National University School of Medicine, Jinju, South Korea; Gyeongsang Institute of Health Science, Jinju, South Korea.
authors.forename: Jae-Young
authors.initials: JY
authors.lastname: Lim
authors.affiliation: Department of Pediatrics, Gyeongsang National University School of Medicine, Jinju, South Korea; Gyeongsang Institute of Health Science, Jinju, South Korea.
authors.forename: Hyang-Ok
authors.initials: HO
authors.lastname: Woo
authors.affiliation: Gyeongsang Institute of Health Science, Jinju, South Korea; Department of Pediatrics, Gyeongsang National University School of Medicine, Changwon, South Korea.
authors.forename: Chan-Hoo
authors.initials: CH
authors.lastname: Park
authors.affiliation: Department of Pediatrics, Gyeongsang National University School of Medicine, Jinju, South Korea; Gyeongsang Institute of Health Science, Jinju, South Korea. Electronic address: hsyoun@gnu.ac.kr.
authors.forename: Hee-Shang
authors.initials: HS
authors.lastname: Youn
mesh_terms: D000914:Antibodies, Viral / Q000097:blood* / Q000276:immunology; D000956:Antigens, Viral / Q000276:immunology; D036022:Capsid Proteins / Q000276:immunology; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D005260:Female; D005759:Gastroenteritis / Q000097:blood / Q000150:complications* / Q000276:immunology* / Q000821:virology; D005838:Genotype; D006023:Glycoproteins / Q000276:immunology*; D006801:Humans; D007070:Immunoglobulin A / Q000097:blood; D007074:Immunoglobulin G / Q000097:blood; D007223:Infant; D008297:Male; D065840:Protective Factors; D012400:Rotavirus Infections / Q000097:blood / Q000150:complications / Q000276:immunology*; D012640:Seizures / Q000097:blood / Q000150:complications* / Q000276:immunology* / Q000517:prevention & control; D012964:Sodium / Q000097:blood; D014118:Toxins, Biological / Q000276:immunology*; D017361:Viral Nonstructural Proteins / Q000276:immunology*
chemical_list: D000914:Antibodies, Viral; D000956:Antigens, Viral; D036022:Capsid Proteins; D006023:Glycoproteins; D007070:Immunoglobulin A; D007074:Immunoglobulin G; C081369:NS28 protein, rotavirus; D014118:Toxins, Biological; C061332:VP6 protein, Rotavirus; D017361:Viral Nonstructural Proteins; D012964:Sodium
keywords: Children; Gastroenteritis; NSP4; Rotavirus; Seizures