Chen Shih-Yen, Tsai Chi-Neu, Lai Ming-Wei, Chen Chih-Yen, Lin Kuang-Lin, Lin Tzou-Yien, Chiu Cheng-Hsun
Divisions of 1Pediatric Gastroenterology, Chang Gung Children's Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan.
Clin Infect Dis. 2009 Apr 1;48(7):849-55. doi: 10.1086/597256.
Norovirus and rotavirus cause outbreaks of diarrheal disease worldwide. This prospective observational study was undertaken to investigate the clinical characteristics and complications, with a focus on convulsive disorders, of gastroenteritis caused by norovirus and rotavirus in hospitalized pediatric patients in northern Taiwan.
Children hospitalized with acute gastroenteritis in Chang Gung Children's Hospital from August 2004 through January 2007 were enrolled in the study. Rotavirus and norovirus were detected by reverse-transcriptase polymerase chain reaction with fecal specimens and were genotyped by sequence analysis. The symptoms and complications, in particular convulsions, of acute gastroenteritis caused by rotavirus and norovirus were reviewed and compared. The occurrence of convulsions associated with norovirus infection was specifically analyzed and discussed. The neurological outcomes for all norovirus-infected patients with or without convulsions were followed up for 1 year. Results. Among the 353 patients with acute viral gastroenteritis without coinfection, rotavirus and norovirus isolates were detected in 101 patients (28.6%) and 64 patients (18.1%), respectively. We compared the symptoms between the 2 groups and found that rotavirus caused a higher frequency and longer duration of vomiting and a higher body temperature than did norovirus. Norovirus infection, on the other hand, caused significantly longer hospital stays (mean duration of stay [interquartile range], 6 [5-8] days vs. 5 [4-7] days; P <.001) and a significantly higher incidence of convulsions than did rotavirus infection (29.7% vs. 5%; P <.001). Three of the 19 patients with convulsions showed an abnormal record on electroencephalogram, but none had any neurological sequelae at the subsequent 1-year follow-up. The majority of norovirus strains (41 of the 56 genotypeable strains) belonged to genogroup GGII/4. Conclusions. Norovirus is a major cause of acute gastroenteritis in children. This study identified norovirus as an emerging agent causing convulsive disorder in children, particularly in young infants. Long-term neurological sequelae are uncommon.
诺如病毒和轮状病毒在全球范围内引发腹泻病暴发。本前瞻性观察性研究旨在调查台湾北部住院儿科患者中由诺如病毒和轮状病毒引起的胃肠炎的临床特征及并发症，重点关注惊厥性疾病。
纳入2004年8月至2007年1月在长庚儿童医院因急性胃肠炎住院的儿童。采用逆转录聚合酶链反应检测粪便标本中的轮状病毒和诺如病毒，并通过序列分析进行基因分型。回顾并比较轮状病毒和诺如病毒引起的急性胃肠炎的症状及并发症，尤其是惊厥情况。对诺如病毒感染相关惊厥的发生情况进行具体分析和讨论。对所有诺如病毒感染患者，无论有无惊厥，均进行1年的神经学转归随访。结果：在353例无合并感染的急性病毒性胃肠炎患者中，分别在101例（28.6%）和64例（18.1%）患者中检测到轮状病毒和诺如病毒分离株。我们比较了两组症状，发现轮状病毒引起的呕吐频率更高、持续时间更长，体温也高于诺如病毒。另一方面，诺如病毒感染导致的住院时间显著更长（平均住院时间[四分位间距]，6[5 - 8]天对5[4 - 7]天；P<.001），惊厥发生率显著高于轮状病毒感染（29.7%对5%；P<.001）。19例惊厥患者中有3例脑电图记录异常，但在随后的1年随访中均无神经学后遗症。大多数诺如病毒株（56株可基因分型菌株中的41株）属于基因群GGII/4。结论：诺如病毒是儿童急性胃肠炎的主要病因。本研究确定诺如病毒是导致儿童惊厥性疾病的新兴病原体，尤其是在幼儿中。长期神经学后遗症并不常见。
