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 place of work:
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 the journal:
Čes-slov Pediat 2012; 67 (3): 178-186.
Category:
Original Papers
Summary
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
Zdroje
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Štítky
Neonatology Paediatrics General practitioner for children and adolescentsČlánok vyšiel v časopise
Czech-Slovak Pediatrics
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