Pediatrics & Neonatology
Volume 50, Issue 1 , Pages 8-12, February 2009

Concomitant Rotavirus and Salmonella Infections in Children with Acute Diarrhea

  • Wen-Tzong Lan

      Affiliations

    • Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan
    • ,
  • Hung-Chang Lee

      Affiliations

    • Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan
    • Department of Pediatrics, Taipei Medical University, Taipei, Taiwan
    • Corresponding Author InformationCorresponding author. Department of Pediatrics, Mackay Memorial Hospital, 92 Section 2, Chung-Shan North Road, Taipei 104, Taiwan
    • ,
  • Chun-Yan Yeung

      Affiliations

    • Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan
    • ,
  • Chuen-Bin Jiang

      Affiliations

    • Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan
    • ,
  • Hsin-An Kao

      Affiliations

    • Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan
    • ,
  • Han-Yang Hung

      Affiliations

    • Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan
    • ,
  • Nan-Chang Chiu

      Affiliations

    • Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan

Received 5 July 2007; received in revised form 7 July 2008; accepted 1 December 2008.

Article Outline

Background and purpose

The incidence of concomitant rotavirus and Salmonella infection has been reported to be 1.3% to 7.4%. We designed this study to compare the clinical manifestations in children infected with rotavirus, Salmonella, or both.

Methods

The medical records of admitted children with acute rotavirus or Salmonella gastroenteritis in 2001 were reviewed. They were divided into group R (rotavirus), group S (Salmonella) and group C (concomitant infection with both). The differences of clinical manifestations and laboratory data among the three groups were analyzed via chi-squared, analysis of variance (ANOVA), Bonferroni and Kruskal-Wallis tests, and odds ratios with 95% confidence intervals (95% CI).

Results

Among the 895 cases reviewed, 550 were group R, 312 group S, and 33 (3.7%) group C. Group C had more vomiting compared with group S (p = 0.0017). Comparing with group R, group C had more prolonged and high fever (≥ 39°C) (p< 0.05), more percentage of green coloration, with mucus and blood contained in the stool (p < 0.001). The C-reactive protein (CRP) value was significantly higher in group C (9.70 ± 11.05 mg/dL) than in group R (1.33 ± 3.62 mg/dL) or S (5.22 ± 6.11 mg/dL) (p < 0.05). Hypokalemia was found most frequently in group C (C: 30.0%, S: 8.8%, R: 7.3%) (p = 0.0026).

Conclusion

Concomitant rotavirus and Salmonella infections accounted for 3.7% of cases in this study. Patients in group C (30.0%) had a significantly higher incidence of hypokalemia than group R (7.3%) or S (8.8%). Group C consisted of 33 cases of the 895 reviewed cases (3.7%). In a child with rotavirus gastroenteritis, concomitant infection with Salmonella should be considered if the child has sustained a high fever (≥ 39°C) for over 4 days and a green stool with mucus and blood.

Key Words:  acute gastroenteritis , concomitant infection , rotavirus , Salmonella

No full text is available. To read the body of this article, please view the PDF online.

 

Back to Article Outline

References 

  1. Blacklow NR , Greenberg HB . Viral gastroenteritis . N Engl J Med . 2001;325:252–264
  2. Bass DM . Rotavirus and other agents of viral gastroenteritis . In:  Behrman RE ,  Kliegman RM ,  Jenson HB editor. Nelson Textbook of Pediatrics . 16th ed.. Philadelphia: WB Saunders; 2003;p. 996–998
  3. Quak SH . Gastrointestinal infections in Singapore children . Ann Acad Med Singap . 1991;20:265–268
  4. Chyou SC , Leu YJ , Huang FY , et al.   An etiological study of infectious diarrhea in infants and children in Taipei area . Acta Paediatr Sin . 1988;29:213–220
  5. Chen HJ , Chen BS , Wang SF , et al.   Rotavirus gastroenteritis in children: a clinical study of 125 patients in Hsin-Tien area . Acta Paediatr Sin . 1991;32:73–78
  6. Chiu TF , Lee CN , Lee PI , et al.   Rotavirus gastroenteritis in children: 5-year experience in a medical center . J Microbiol Immunol Infect . 2000;33:181–186
  7. Tsai CH , Chiu HH , Abe T . Epidemiologic features of rotavirus infection in Taiwan: a review . Pediat Int . 2000;42:411–414
  8. Yang MT , Chi CS . Salmonella infections in infants and children . Chin Med J (Taipei) . 1994;54:38–43
  9. Chang JS , Tsai CH , Chang YC , Lin HC . Non-typhoidal Salmonella bacteremia and gastroenteritis in infancy: a five-year retrospective study . J Infect Dis Assoc ROC . 1990;3:35–38
  10. Cleary TG . Salmonella . In:  Behrman RE ,  Kliegman RM ,  Jenson HB editor. Nelson Textbook of Pediatrics . 16th ed.. Philadelphia: WB Saunders; 2000;p. 842–848
  11. Guandalini S . Acute diarrhea . In:  Walker WA ,  Durie PR ,  Hamilton JR ,  Walker-Smith JA ,  Watkins JB editor. Pediatric Gastrointestinal Disease . 3rd ed.. Ontario: BC Decker; 2000;p. 28–36
  12. Ling JM , Cheng AF . Infectious diarrhoea in Hong Kong . J Trop Med Hyg . 1993;96:107–112
  13. Khuffash FA , Sethi SK , Shaltout AA . Acute gastroenteritis: clinical features according to etiology agents . Clin Pediatr . 1988;27:365–368
  14. Chen SM , Ni YH , Chang MH , et al.   Microbial etiology of acute gastroenteritis in hospitalized children in Taiwan . J Formos Med Assoc . 2006;105:964–970
  15. Peng CF . Incidence and antimicrobial resistance of Salmonella serotypes in southern Taiwan from 1978 through 1987 . Kaohsiung J Med Sci . 1992;8:247–254
  16. Man NV , Trang NV , Lien HP . The epidemiology and disease burden of rotavirus in Vietnam . J Infect Dis . 2001;183:1707–1712
  17. Nelson EA , Mork TC , Yu LM . Retrospective comparison of management of gastroenteritis in hospitalized children . Ann Trop Paediatr . 2002;22:165–167
  18. Wong V . Acute gastroenteritis-related encephalopathy . J Child Neurol . 2001;16:906–910
  19. Contino MF , Lebby T , Arcinue EL . Rotaviral gastroenteritinal infection causing afebrile seizures in infancy and childhood . Am J Em Med . 1994;12:94–95
  20. Lin SH , Hsu HY , Wang SM , et al.   Rotavirus gastroenteritis associated with afebrile seizure in childhood . Acta Paediatr Sin . 1996;37:204–207
  21. Schumacher RF , Forster J . The CNS symptoms of rotavirus infections under the age of two . Klinische Padiatrie . 1999;211:61–64
  22. Meloni GF , Tomasi PA , Spanu P , et al.   C-reactive protein levels for diagnosis of Salmonella gastroenteritis . Pediatr Infect Dis J . 1999;18:471–473
  23. Borgnolo F , Barbone F , Guidobaldi G , et al.   C-reactive protein in viral and bacterial gastroenteritis in childhood . Acta Paediatr . 1996;85:670–674
  24. Chi H , Sun W , Chan WT , et al.   Pediatric Salmonella enterocolitis in a teaching hospital in Taitung: a four-year analysis . Acta Paediatr Taiwan . 2001;42:297–300
  25. Sheu CL , Wu TC , Hwang BT . Retrospective study of Salmonella gastroenteritis in infants . Chin Med J (Taipei) . 1990;46:232–236
  26. Huang FY , Huang SH , Lin CH , et al.   Bacteremia in infants with Salmonella enterocolitis . Acta Paediatr Sin . 1991;32:358–364
  27. Huang IF , Wagener MM , Chiou CC , et al.   Nontyphoid salmonellosis in Taiwan children: clinical manifestations, outcome and antibiotic resistance . J Pediatr Gastroenterol Nutr . 2004;38:518–523
  28. Bukholm G . Human rotavirus infection enhances invasiveness of enterobacteria in MA-104 cells . APMIS . 1988;96:1118–1124

PII: S1875-9572(09)60023-1

doi:10.1016/S1875-9572(09)60023-1

Refers to erratum:

  • Erratum

    Pediatrics & Neonatology April 2009 (Vol. 50, Issue 2, Page 82)

Pediatrics & Neonatology
Volume 50, Issue 1 , Pages 8-12, February 2009

Article Tools