Indan Journal of Medical Research Indan Journal of Medical Research Indan Journal of Medical Research Indan Journal of Medical Research
  Home About us Editorial board Search Ahead of print Current issue Archives Submit article Instructions Subscribe Contacts Login  
  Home Print this page Email this page Small font sizeDefault font sizeIncrease font size Users Online: 92       

   Table of Contents      
ORIGINAL ARTICLE
Year : 2015  |  Volume : 141  |  Issue : 4  |  Page : 469-472

Aetiology of childhood viral gastroenteritis in Lucknow, north India


1 Department of Microbiology, King George's Medical University, Lucknow, India
2 Community Empowerment Laboratory, Lucknow, India

Date of Submission15-May-2013
Date of Web Publication24-Jun-2015

Correspondence Address:
Amita Jain
Department of Microbiology, King George's Medical University, Lucknow 226 003, Uttar Pradesh
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0971-5916.159298

Rights and Permissions
   Abstract 

Background & objectives: Due to limited availability of data on viral aetiology of acute gastroenteritis in north India, the present study was planned to detect rotavirus, norovirus, sapovirus and astrovirus in stool samples of both in hospitalized and non-hospitalized children less than five years of age presenting with acute gastroenteritis.
Methods: A total of 278 stool samples from equal number of children were tested for rotavirus antigen using ELISA and for norovirus, sapovirus and astroviruses by reverse transcription (RT)-PCR.
Results: Of the 169 samples from hospitalized patients, rotavirus, norovirus, sapovirus and astrovirus were detected in 19.5, 2.3, 3.5 and 2.9 per cent samples, respectively. Of the 109 samples collected from the non-hospitalized patients, frequency of rotavirus and sapovirus detection was 9.1 and 1.8 per cent, respectively while norovirus and astrovirus were not detected.
Interpretation & conclusions: Rotavirus was the most frequent cause of viral gastroenteritis in both hospitalized and non-hospitalized children. Maximum positivity of the viruses was seen in children less than two years of age.

Keywords: Astrovirus - diarrhoea - norovirus - rotavirus - sapovirus - stool samples - viral gastroenteritis


How to cite this article:
Gupta S, Singh K P, Jain A, Srivastava S, Kumar V, Singh M. Aetiology of childhood viral gastroenteritis in Lucknow, north India. Indian J Med Res 2015;141:469-72

How to cite this URL:
Gupta S, Singh K P, Jain A, Srivastava S, Kumar V, Singh M. Aetiology of childhood viral gastroenteritis in Lucknow, north India. Indian J Med Res [serial online] 2015 [cited 2019 Nov 13];141:469-72. Available from: http://www.ijmr.org.in/text.asp?2015/141/4/469/159298

Acute gastroenteritis is one of the most common childhood diseases, especially in developing countries. Annually 2.5 million deaths are estimated to occur due to enteric infections, greatly impacting children younger than five years of age [1]. Over 20 different types of viruses have been identified as aetiological agents for gastroenteritis [2] . Group A rotaviruses are considered to be the main agents followed by calicivirus, adenovirus and astrovirus [3] . In a corss-sectional study conducted at Lucknow, Uttar Pradesh, India, rotavirus was shown to be associated with dehydrating diarrhoea, particularly in children 0-7 months of age [4] . Another study conducted in the same city [5] also reported rotavirus as a major cause of acute diarrhoea in children aged two months to two years.

This study was performed to detect rotavirus, norovirus, sapovirus and astrovirus in stool samples of both hospitalized and non-hospitalized children, less than five years of age presenting with acute gastroenteritis in Lucknow, north India.


   Material & Methods Top


This cross-sectional study was conducted in the Virology Laboratory, Post Graduate Department of Microbiology, King George's Medical University (KGMU), Lucknow, Uttar Pradesh, India, during August 2010 to July 2012. A total of 278 stool samples from the equal number of consecutive children less than five years of age, presenting with acute gastroenteritis were enrolled. A case of acute gastroenteritis was defined as a child less than five years of age presenting with watery diarrhoea of less than 14 days duration. Written informed consent was obtained from the parents and the study was approved by the ethics committee of the institution. Cases from either paediatric wards/emergency centre of the Gandhi Memorial and associated hospital or Shivgarh area in Lucknow district (non-hospitalized community patients screened through house-to-house survey) were enrolled. Patients presenting with bloody diarrhoea/with diarrhoea of more than 14 days/or parents declining consent were excluded. Relevant clinical data on age, sex, details of diarrhoea, presence of fever, vomiting and clinical signs and symptoms of dehydration were collected from either patient's records or from the patient's attendant.

Stool sample was collected as mentioned in CDC (Centers for Disease Control and Prevention) guidelines [6] . At least 10 ml of liquid, watery stool and one sample per patient was collected in a clean and dry screw capped, wide mouth plastic container. Samples from the hospital were transported to the laboratory immediately. The samples from the community were transported to the laboratory on the same day maintaining the cold chain.

Samples were processed without delay. ELISA for rotavirus group specific antigen (VP6) detection was done by a commercial kit (RIDASCREEN Rotavirus supplied by R- b0 iopharm AG, Darmstadt, Germany). One step reverse transcription (RT)-PCR assays for norovirus, sapovirus and astrovirus detection were performed using specific primers [7],[8],[9] . s0 tool suspension (10%) was prepared in 0.01 M phosphate-buffered saline (PBS) (pH 7.2), vortexed and centrifuged. The supernatant was transferred to a sterile, diethyl pyro-carbonate treated centrifuge tube. RNA extraction was done using a commercial kit (QIAamp viral RNA mini kit, QIAGEN, Gmbh Hilden, Germany) and the extracted RNA was subjected to reverse transcription to form cDNA using random hexamer primer (Amersham-Pharmacia Biotech, USA). Total 35 cycles of amplification were performed and results were analyzed by 1.5 per cent (w/v) agarose gel electrophoresis using molecular weight marker (MBD-13J 100bp DNA ladder, Bangalore, Genei, India) using 264 nm wavelength UV transilluminator and Gel Doc (Alphamager 3400 HP, Alpha Innotech, USA). A band of 329 bp for norovirus, 320 bp for sapovirus and 449 bp for astrovirus of amplified cDNA if visualized along with the band of positive control at the same base pair was considered positive. p0 ositive, negative and extraction controls were run with each batch.

Statistical analysis: c0 hi-square test was applied to find the risk of viral positivity by age of the patients. The relative risk (RR) with its 95% confidence interval (CI) was calculated to find the risk of viral positivity by symptoms. The data analysis was carried out by using EPI INFO Windows version 7 (http://www.cdc.gov/epiinfo).


   Results & Discussion Top


Of the total of 278 patients, 169 (60.8%) were enrolled from hospital and 109 (29.2%) from the community. Of the 278 stools samples, 54 (19.4%) were found positive for the tested viruses. Viral detection was more frequent in hospitalized (n=43, 25.4%) than in non-hospitalized (n=11, 10.1%) children [Table 1]. The relative risk of viral positivity by symptoms of fever, vomiting and dehydration is shown in [Table 2]. Dehydration could not be properly assessed in non-hospitalized patients, hence, not shown in data.
Table 1. Viral aetiology of gastroenteritis in patients from hospital and community


Click here to view
Table 2. Clinical features in children with virus positivity in patients.


Click here to view


The viral positivity was higher among hospitalized children less than two years of age (data on age not shown). Overall, the viruses were isolated during the cooler months of year with a peak in month between October and December among hospitalized patients (data not shown). Seasonal distribution among non-hospitalized patients could not be assessed due to small number of samples in each month.

Our study demonstrated that rotavirus was the leading cause of viral gastroenteritis with positivity rate of 16.6 per cent in hospitalized children and 8.3 per cent in non-hospitalized children followed by sapovirus (2.9%), astrovirus (1.8%), norovirus (1.2%) in hospitalized children. The rotavirus positivity in this study was comparable with the previous studies from Lucknow [4],[5] , although higher rates have been reported from Kolkata (48.1%) [10] and Delhi (39.2%) [11] . In developing countries norovirus is recognised as the second most frequent viral cause of childhood gastroenteritis after rotavirus [12] . We found a low positivity of norovirus (1.2%), in hospitalized children compared with the other regions like Pune (8.6%), Maharashtra [13] and Kolkata (4.8%) [10] . Sapovirus is known to cause symptomatic infection predominantly in infants and young children [8] . The detection rate of sapovirus reported from Vellore (5.1%) and Kolkata (2.3%) was similar to that found in our study (2.9%), while Delhi reported it to be 10.1 per cent in hospitalized patients [10],[14],[15] . Prevalence of human astrovirus infection ranges from 0.3-10 per cent in children worldwide [16] . Its positivity in the present study (1.8%) among hospitalized patients was close to that reported from Pune (3.1%) and Kolkata (5.8%) [17],[18] . The conditions like season of sampling, socio-economic level of the population may explain differences in the detection rates.

As seen in our study fever, vomiting and dehydration are usually associated features of acute gastroenteritis more so of viral gastroenteritis [19] . The existence of co-infections makes the determination of the primary aetiologic agent, as well as the determination of virus specific symptoms difficult, however, the mixed infections were low in the present study and rotavirus was always the common detected pathogen.

Diarrhoea causing adenoviruses are known to be associated with gastroenteritis in children [19] . Diarrhoeal pathogens occur at a high frequency in developing countries thus, may be present in a notable proportion of control subjects as well as patients [20] . Thus, inclusion of control in diarrhoeal studies play a major role, especially when comparing the relative contribution of different pathogens to the overall burden of disease.

In conclusion, rotavirus was the major viral pathogen in both hospitalized and non-hospitalized children with acute gastroenteritis. Other viruses like norovirus, sapovirus and astrovirus were found to be associated with acute gastroenteritis in a small number of hospitalized children.


   Acknowledgment Top


The author express sincere gratitude to Late Dr G. K. Malik, Professor, PG department of Paediatrics, KGMU, Lucknow, for his guidance and support during the study. Authors thank Dr. Triveni Krishnan, National Institute of Cholera and Enteric Diseases (NICED), Kolkata for providing positive controls for the respective viruses. The financial support received from the Indian Council of Medical Research, New Delhi, is acknowledged also.

 
   References Top

1.
Girard MP, Steele D, Chaignat CL, Kieny MP. A review of vaccine research and development: human enteric infections. Vaccine 2006; 24 : 2732-50.  Back to cited text no. 1
    
2.
Money NN, Maves RC, Sebeny P, Kasper MR4, Riddle MS, the AFHSC-GEIS Enteric Surveillance Writing Group. Enteric disease surveillance under teh AFHSC-GEIS: Current efforts, landscape analysis and vision forward. BMC Public Health 2011; 11 (Suppl 2): 572-11.  Back to cited text no. 2
    
3.
Andreasi MS, Cardoso Dd, Fernandes SM, Tozetti IA, Borges AM, Fiaccadori FS, et al. Adenovirus, calicivirus and astrovirus detection in fecal samples of hospitalized children with acute gastroenteritis from Campo Grande, MS, Brazil. Mem Inst Oswaldo Cruz 2008; 103 : 741-4.  Back to cited text no. 3
    
4.
Mishra V, Awasthi S, Nag VL, Tandon R. Genomic diversity of group A rotavirus strains in patients aged 1-36 months admitted for acute watery diarrhoea in northern India: a hospital-based study. Clin Microbiol Infect 2010; 16 : 45-50.  Back to cited text no. 4
    
5.
Nag VL, Khare V, Awasthi S, Agrawal SK. Clinical profile and prevalence of rotavirus infection in children presented with acute diarrhea at tertiary care referral hospital at northern part of India. J Commun Dis 2009; 41 : 183-8.  Back to cited text no. 5
    
6.
Centers for d0 isease c0 ontrol and p0 revention, Atlanta. Guidelines for specimen collection, 2011. Available from: http:// www.cdc.gov/outbreaknet/references.../guide_specimen_collection, accessed on July 4, 2012.  Back to cited text no. 6
    
7.
Vinje J, Vennema H, Maunula L, Von Bonsdorff CH, Hoehne M, Schreier E, et al. International collaborative study to compare reverse transcriptase PCR assays for detection and genotyping of noroviruses. J Clin Microbiol 2003; 41 : 1423-33.  Back to cited text no. 7
    
8.
Vinje J, Deijl H, van der Heide R, Lewis D, Hedlund KO, Svensson L, et al. Molecular detection and epidemiology of Sapporo-like viruses. J Clin Microbiol 2000; 38 : 530-6.  Back to cited text no. 8
    
9.
Noel JS, Lee TW, Kurtz JB, Glass RI, Monroe SS. Typing of human astroviruses from clinical isolates by enzyme immunoassay and nucleotide sequencing. J Clin Microbiol 1995; 33 : 797-801.  Back to cited text no. 9
    
10.
Nair GB, Ramamurthy T, Bhattacharya MK, Krishnan T, Ganguly S, Saha DR, et al. Emerging trends in the etiology of enteric pathogens as evidenced from an active surveillance of hospitalized diarrhoeal patients in Kolkata, India. Gut Pathog 2010; 2 : 4.  Back to cited text no. 10
    
11.
Kang G, Arora R, Chitambar SD, Deshpande J, Gupte MD, Kulkarni M, et al. Multicenter, hospital-based surveillance of rotavirus disease and strains among Indian children aged <5 years. J Infect Dis 2009; 200 (Suppl 1): 147-53.  Back to cited text no. 11
    
12.
Sdiri-Loulizi K, Gharbi-Khe´lifi H, de Rougemont A, Chouchane S, Sakly N, Ambert-Balay K, et al. Acute infantile gastroenteritis associated with human enteric viruses in Tunisia. J Clin Microbiol 2008; 46 : 1349-55.  Back to cited text no. 12
    
13.
Chhabra P, Dhongade RK, Kalrao VR, Bavdekar AR, Chitambar SD. Epidemiological, clinical, and molecular features of norovirus infections in western India. J Med Virol 2009; 8 : 922-32.  Back to cited text no. 13
    
14.
Monica B, Ramani S, Banerjee I, Primrose B, Iturriza-Gomara M, Gallimore CI, et al. Human caliciviruses in symptomatic and asymptomatic infections in children in vellore, south India. J Med Virol 2007; 79 : 544-51.   Back to cited text no. 14
    
15.
Rachakonda G, Choudekar A, Parveen S, Bhatnagar S, Patwari A, Broor S. Genetic diversity of noroviruses and sapoviruses in children with acute sporadic gastroenteritis in New Delhi, India. J Clin Virol 2008; 43 : 42-8.   Back to cited text no. 15
    
16.
Pativada MS, Chatterjee D, Mariyappa NS, Rajendran K, Bhattacharya MK, Ghosh M, et al. Emergence of unique variants and inter-genotype recombinants of human astroviruses infecting infants, children and adults in Kolkata, India. Int J Mol Epidemiol Genet 2011; 2 : 228-35.  Back to cited text no. 16
[PUBMED]    
17.
Verma H, Chitambar SD, Gopalkrishna V. Astrovirus associated acute gastroenteritis in western India: predominance of dual serotype strains. Infect Genet Evol 2010; 10 : 575-9.   Back to cited text no. 17
    
18.
Bhattacharya R, Sahoo GC, Nayak MK, Ghosh S, Dutta P. Bhattacharya MK, Mitna U, et al. Molecular epidemiology of human astrovirus infections in Kolkata, India. Infect Genet Evol 2006; 6 : 425-35.  Back to cited text no. 18
    
19.
Christensen ML. Human viral gastroenteritis. Clin Microbiol Rev 1989; 2 : 51-89.  Back to cited text no. 19
    
20.
Robins-Browne RN, Levine MM. Laboratory diagnostic challenges in case/control studies of diarrhoea in developing countries. Clin Infect Dis 2012; 55 (Suppl 4): S312-6.  Back to cited text no. 20
    



 
 
    Tables

  [Table 1], [Table 2]


This article has been cited by
1 Norovirus Infections and Disease in Lower-Middleand Low-Income Countries, 1997–2018
Harish Mans
Viruses. 2019; 11(4): 341
[Pubmed] | [DOI]
2 Global Burden of Rheumatic Heart Disease
New England Journal of Medicine. 2018; 378(1): e2
[Pubmed] | [DOI]
3 Partnering with women collectives for delivering essential women’s nutrition interventions in tribal areas of eastern India: a scoping study
Vani Sethi,Arti Bhanot,Surbhi Bhalla,Sourav Bhattacharjee,Abner Daniel,Deepika Mehrish Sharma,Rajkumar Gope,Saba Mebrahtu
Journal of Health, Population and Nutrition. 2017; 36(1)
[Pubmed] | [DOI]
4 Changing pattern of prevalence, genetic diversity, and mixed infections of viruses associated with acute gastroenteritis in pediatric patients in New Delhi, India
Shipra Gupta,Anuja Krishnan,Sumit Sharma,Praveen Kumar,Satinder Aneja,Pratima Ray
Journal of Medical Virology. 2017;
[Pubmed] | [DOI]
5 Epidemiological profile and genetic diversity of sapoviruses (SaVs) identified in children suffering from acute gastroenteritis in Pune, Maharashtra, Western India, 2007–2011
N. LASURE,V. GOPALKRISHNA
Epidemiology and Infection. 2016; : 1
[Pubmed] | [DOI]
6 The prevalence and predisposing factors of norovirus and astrovirus infection among diarrheic children in north east, Nigeria
S. O. Oyinloye,M. Aminu,E. E. Ella,E. D. Jatau
Journal of Public Health and Epidemiology. 2016; 8(10): 204
[Pubmed] | [DOI]
7 Prevalence of rotavirus, norovirus and enterovirus in diarrheal diseases in Himachal Pradesh, India
Swapnil Jain,Nutan Thakur,Neelam Grover,Jitendraa Vashistt,Harish Changotra
VirusDisease. 2016; 27(1): 77
[Pubmed] | [DOI]



 

Top
 
 
  Search
 
    Similar in PUBMED
 Related articles
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
    Abstract
   Material & Methods
   Results & Discussion
   Acknowledgment
    References
    Article Tables

 Article Access Statistics
    Viewed1058    
    Printed6    
    Emailed0    
    PDF Downloaded366    
    Comments [Add]    
    Cited by others 7    

Recommend this journal