A Clinical and Epidemiological Study of Enterovirus Associated Diarrhea in Hospitalized Children

Abstract

Background: Diarrhea is a leading cause of morbidity and mortality in children less than five years of age. The etiology of diarrhea is unknown in nearly 40% of the cases. Enterovirus as a cause of diarrhea is well known, but there are few studies till date focusing on the epidemiological and clinical variables. Objectives: To determine the prevalence and seasonal variation and to study the clinical profile and course of enterovirus associated diarrhea in children up to five years of age. Methods: A hospital based prospective study was carried out at Vanivilas Childrens' Hospital and Bowring and Lady Curzon Hospital, Bangalore during the period November 2009 to May 2011. Enterovirus in fecal samples of 122 children with acute gastroenteritis was detected by its cytopathic effects in rhabdomyosarcoma and / or HeLa cells, followed by reverse transcription (RT)-PCR and sequence analysis of the VP1 gene. All the enterovirus positive samples were tested for wild and OPV poliovirus strains. As rotavirus is the most common cause of viral diarrhea in India, the stool samples were also analyzed for rotavirus using polyacrylamide gel electrophoresis. Results: Out of the 122 samples analyzed, 14 (11.5%) were confirmed enterovirus positive. The enterovirus detection was maximal in the months of June to August (monsoon), with a rate of 30.8%. Rotaviral detection rate was 22% and with maximal prevalence in winter months of December to February. Enterovirus detection rate was highest in the age group of less than six months, with a rate of 50%. The primary symptom was watery diarrhea with mean duration of four days and frequency of 7 per day. Fever and vomiting were present in 50% of the cases. Moderate dehydration was observed in 57.1% of the cases.  A significant association was observed between enterovirus associated diarrhea and absence of breastfeeding (p = 0.016), contact with individuals having diarrhea (p = 0.009), and advanced protein energy malnutrition (p = 0.045). Conclusions: Enterovirus associated diarrhea has a significant prevalence among children less than five years and is common in the monsoon season.