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research letter

Indian Pediatr 2016;53: 652-653

Immunochromatography-based Diagnosis of Rotavirus Infection in Acute Diarrhea

 

*Vipin M Vashishtha, Sandeep Thacker and Gajanan Sudhir Namjoshi

Mangla Hospital and Research Center, Bijnor, UP, India.
Email: vipinipsita@gmail.com

  

 

Documentation of rotavirus diarrhea in a rural, resource-poor setting is a difficult task. We analyzed stool samples of 103 children admitted for acute diarrhea in a pediatric hospital in Bijnor, UP, India, using a simple bedside immunochromatography kit. Rotavirus infection was detected in 47 out of total of 103 children (45.6%).

Keywords: Dehydration, Epidemiology, Surveillance.



E
stimates suggest that India has a high burden of rotavirus diarrhea, and related mortality [1-3]. Most studies evaluating rotavirus infection used the standard diagnostic techniques like ELISA. Documentation of rotavirus disease in semi-urban and rural areas presents challenges due to non-availability of this diagnostic facility. Immunochromatography is a relatively economical bedside method to detect rotavirus infection.

This study was conducted at a pediatric hospital based in a semi-urban area in Bijnor district of Western Uttar Pradesh, India during 2010 and 2011. Rotavirus detection was performed using VIKIA Rota-Adeno kit (M/s BioMérieux) on stool samples of children less than 5 years of age, suffering from acute diarrhea and requiring hospitalization. Acute diarrheal illness was defined as occurrence of ³3 watery stools and/or forceful vomiting, and severity was categorized as per Clarke and Vesikari scoring systems [4,5]. Statistical analysis was conducted using chi-square and unpaired t-tests. The study was cleared by hospital’s ethics committee, and informed consent was obtained from the parents of all included children.

During the study period, 103 under-five children hospitalized due to acute diarrhea were tested. Key demographic features are listed in Table I. Most of the testing occurred in months of May, June and July in both the years (about 98% of total testing for year 2010 and 73% of total testing for year 2011). Rotavirus was detected in 47 (45.6%) children. The disease characteristics, except severity, were similar for rotavirus-positive and rotavirus-negative cases as per Clarke and Vesikari scoring system. However, these two scales differ greatly in categorizing the severity. As the Clarke score does not include direct assessment of dehydration, it is less likely to identify an episode of disease as severe, as compared to Vesikari score [6].

TABLE I Characteristics of the Study Participants
Rotavirus Rotavirus
positive (n=47) pegative (n=56)
Age (mo)* 7.6 (4.6) 7.8 (5.4)
Male gender, n (%)   38 (80.8) 38 (67.8)
Lower SES 11 (23.4) 17 (30.36)
Rural residence, n(%) 29 (61.7) 36 (64.3)
Diarrhea duration* 6.1 (5.3) 4.5 (4.3)
Vomiting 24 (51%) 32 (57.1%)
Severity as per Clarke scoring system    
Mild, n (%) 11 (23.4) 13 (23.2)
Moderate, n (%) 33 (70.2) 42 (75.0)
Severe, n (%) 3 (6.4) 1 (1.8)
Severity as per Vesikari Scoring system    
Moderate, n (%) 5 (10.6) 7 (12.5)
Severe, n (%) 42 (89.4) 49 (87.5)
*Mean (SD); SES: Socioeconomic status; all P >0.05.

The rotavirus disease proportion in this study is close to the earlier reported studies in hospitalized children using ELISA for diagnosis of infection. An earlier study showed good sensitivity and specificity of rapid diagnostic kit when compared to standard diagnostic test [7], whereas another study reported high false positivity [8]. Limitations of the study include small sample size, and lack of comparison of the results with the standard diagnostic method. These results might not be generalized or representative of the actual epidemiology. In conclusion, the study re-affirms that significant proportion of acute diarrhea in hospitalized under-five children is caused by rotavirus. There is a need to evaluate the rapid diagnostic kits vis-à-vis standard diagnostics.

References

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