Variability in clinical manifestation of noroviral infection in a newborn: from fulminant necrotizing enterocolitis to asymptomatic course
Authors:
J. Malý 1; J. Melek 1; P. Bréšková 1; K. Hanousková 1; V. Štěpánová 2; Lenka Ryšková 2; Z. Kokštein 1; J. Koudelka 3; R. Štichhauer 3; O. Pozler 1
Authors‘ workplace:
Dětská klinika LF UK a FN, Hradec Králové, přednosta prof. MUDr. M. Bayer, CSc.
1; Ústav klinické mikrobiologie LF UK a FN, Hradec Králové, přednosta doc. RNDr. V. Buchta, CSc.
2; Oddělení dětské chirurgie a traumatologie FN, Hradec Králové, primář MUDr. J. Koudelka, CSc.
3
Published in:
Čes-slov Pediat 2012; 67 (3): 178-186.
Category:
Original Papers
Overview
Introduction:
Noroviruses are most frequent agents causing gastroenteritis worldwide. They are high infective non-capsulated RNA viruses classified in the Caliciviridae family spreading out by the fecal-oral route and by aerosol. Clinical manifestation in the newborns is not known very well.
Methods:
The clinical observation study was performed at the Neonatal Intensive Care Unit (NICU) of University Hospital in Hradec Kralove. The diagnostics employed antigenic tests based on immunochromatography using the Immunocard Stat Norovirus (Meridian, Bioscience Europe, Milano, Italy and RIDAQUICK Norovirus test (R-Biopharm, AG, Darmstadt, Germany). The results were confirmed at the National Reference Laboratory for Electron Microscopy, National Institute of Public Health, Prague. At the same time all patients underwent the test demonstrating the rotavirus and adenovirus antigens in stools by the cassette immunochromatographic Rota-Adeno-Card test (Vidia, Certest, Spain). The cultivation examination of stools was executed by means of standard microbiological procedures. Necrotizing enterocolitis (NEC) was defined as a disease in the maximum stage IIa according to Bell criteria modified by Walsh and Kliegman at least.
Results:
Noroviral antigen was demonstrated in the stools of 21 patients, electron microscopy was positive in another patient despite negative antigen test. Immunochromatographic tests were confirmed by electron microscopy in 17 cases, agreement was in 75%. The age median in developed clinical symptoms or first positivity was on day 17.5 with variance of 5 to 38 days, the median of gestation weeks and birth weight was 29 gestation weeks (24–28) resp. 1073 g (530–3260). Six patients lacked clinical symptoms. Enterorrhagia was the most frequent symptom of the disease in nine patients (56%). Desaturations and apnea were also very frequent – 8 (50%) or 5 (31%) patients; six patients (38%) required mechanical ventilation. Clinical and radiological signs of necrotizing enterocolitis were observed in 7 patients (44%).
Conclusions:
The symptoms of noroviral infections in newborns are different from those encountered in adults and older children. The most frequent include abdominal distension, enterorrhagia, respiration instability with increased demand for oxygen therapy, and apneas, which take place in different time order. Necrotizing enterocolitis requiring surgical treatment is not an exceptional solution of noroviral infection. The diagnostics of noroviral infection is complicated and the authors recommend confirmation of antigenic tests by RT-PCR or electron microscopy. A complete cohort arrangement of the patients and personnel and strict adherence to hygienic-epidemiological measures is a prerequisite for controlling the infection in the NICU.
Key words:
noroviruses, newborn, necrotizing enterocolitis, outbreak, NICU
Sources
1. Hall AJ, Vinjé J, Lopman B, et al. Updated norovirus outbreak management and disease prevention guidelines. MMWR Recomm Rep 2011; 60 (3): 1–9.
2. Kirby A, Gurgel RQ, Dove W, et al. An evaluation of the RIDASCREEN and IDEIA enzyme immunoassays and the RIDAQUICK immunochromatographic test for the detection of norovirus in faecal specimen. J Clin Virol 2010; 49: 254–257.
3. Walsh MC, Kliegman RM. Necrotizing enterocolitis: treatment based on staging criteria. Pediatr Clin N Am 1986; 33: 179–201.
4. Bryce J, Bosch-Pinto C, Sibuya K, Blafl RE. WHO estimates of the cause of death in children. Lancet 2005; 365: 1147–1152.
5. Kapikian AZ, Wyatt RG, Dolin R, et al. Visualization by immune electron microscopy of the 27-nm particle associated with acute nonbacterial gastroenteritis. J Virol 1972; 10 (5): 1075–1081.
6. Castriciano S, Luinstra K, Petrich A, et al. Comparison of the RIDASCREEN norovirus enzyme immunoassay to IDEIA NLV GI/GII by testing stools also assayed by RT-PCR and electron microscopy. J Virol Methods 2007; 141: 216–219.
7. Harris JP, Edmunds WJ, Pebody R, et al. Deaths from norovirus among elderly, England and Wales. Emerg Infect Dis 2008; 14: 1546–1552.
8. Melek J, Malý J, Štefáčková Š, et al. Benigní infantilní křeče asociované s norovirovou gastroenteritidou. Čes-slov Pediat 2012; 67 (3): 186–190.
9. Simon A, Schildgen O, Eis-Hubinger M, et al. Norovirus outbreak in a paediatric oncology unit. Scand J Gastroenterol 2006; 41 (6): 693–699.
10. Turcios-Ruiz RM, Axelrod P, John KS, et al. Outbreak of necrotizing enterocolitis caused by norovirus in a neonatal intensive care unit. J Pediatr 2008; 153: 339–344.
11. Bagci S, Eis-Hübinger AM, Yassin AF, et al. Clinical characteristics of viral intestinal infection in preterm and term neonates. Eur J Clin Microbiol Infect Dis 2010; 29: 1079–1084.
12. Armbrust S, Kramer A, Olbertz D, et al. Norovirus infections in preterm infants: wide variety of clinical courses. BMC Research Notes 2009; 2: 96–101.
13. Ito S, Takeshita S, Nezu A, et al. Norovirus-associated encephalopathy. Pediatr Infect Dis J 2006; 25: 651–652.
14. Stuart RL, Tan K, Mahar JE, et al. An outbreak of necrotizing enterocolitis associated with norovirus genotype GII.3. Pediatr Infect Dis J 2010; 29: 644–647.
15. Lindesmith L, Moe C, Marionneau S, et al. Human susceptibility and resistance to Norwalk virus infection. Nat Med 2003; 9: 548–553.
16. Menon VK, George S, Ramani S, et al. Genogroup IIb norovirus infections and association with enteric symptoms in a neonatal nursery in Southern India. J Clin Microbiol 2010; 48: 3212–3215.
17. Köhler H, Jüngert J, Korn K. Norovirus pseudo-outbreak in a neonatal intensive care unit. J Pediatr Gastroenterol Nutr 2008; 46 (4): 471–472.
18. Kaplan JE, Gary GW, Baron RC, et al. Epidemiology of Norwalk gastroenteritis and the role of Norwalk virus in outbreaks of acute nonbacterial gastroenteritis. Am J Publ Health 1982; 72: 1329–1332.
19. Turcios RM, Widdowson MA, Sulka AC, et al. Reevaluation of epidemiological criteria for identifying outbreaks of acute gastroenteritis due to norovirus: United States, 1998–2000. Clin Infect Dis 2006; 42: 964–969.
20. Sommer C, Mueller W, Resch B. Two nosocomial outbreaks in the neonatal intensive and intermediate care unit. Eur J Clin Microbiol Infect Dis 2009; 28: 1133–1136.
Labels
Neonatology Paediatrics General practitioner for children and adolescentsArticle was published in
Czech-Slovak Pediatrics
2012 Issue 3
Most read in this issue
- Unusual manifestations of parvovirus B19 infection in children
- Pyruvate kinase deficiency in children
- Variability in clinical manifestation of noroviral infection in a newborn: from fulminant necrotizing enterocolitis to asymptomatic course
- Benign infantile seizures associated with noroviral gastroenteritis