Browsing by Subject "Gastroenteritis"

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    Gastroenteritis aguda por rotavirus en la población infantil atendida en el Hospital Universitario Virgen de la Arrixaca
    (Universidad de Murcia, 2018-02-06) Sánchez López, Pedro Francisco; Segovia Hernández, Manuel; Salvador García, Carmen; Facultad de Biología
    Objetivos Objetivo principal: determinar la carga de morbilidad y la epidemiología del rotavirus A en la población pediátrica atendida en el Hospital Universitario Virgen de la Arrixaca (HUVA). Objetivos específicos: 1. Estimar la incidencia de gastroenteritis aguda por rotavirus A en niños menores de 5 años atendidos en el HUVA. 2. Describir las características clínico-epidemiológicas de las gastroenteritis comunitarias y nosocomiales por rotavirus. 3. Caracterizar molecularmente los genotipos G (VP7) y P (VP4) de las cepas de rotavirus. 4. Detectar fallos vacunales y caracterizar las cepas relacionadas con ellos. Metodología El estudio de incidencia de gastroenteritis por rotavirus A se realizó con los pacientes diagnosticados microbiológicamente con test rápido VIKIA® Rota-Adeno en el HUVA de 2010-2013. Se incluyeron todos los casos de 2012 para el estudio de las características clínico-epidemiológicas, recogiendo la información de las historias clínicas, y para el análisis molecular de genotipos G y P, realizado mediante RT-PCR multiplex semianidadas. El estudio de gastroenteritis por rotavirus A en niños vacunados se llevó a cabo de 2010-2013, utilizando los datos de vacunación facilitados por la Consejería de Salud de la Región de Murcia. Se caracterizaron dos cepas de rotavirus que habían infectado en el hospital a dos niños previamente vacunados, que habían compartido cama con dos días de diferencia. Se secuenció el genoma completo de estas cepas mediante técnicas de secuenciación masiva en una plataforma Illumina HiSeq 2500 en el Institute of Infection and Global Health de Liverpool. Las secuencias se analizaron utilizando los programas Geneious R8 y MEGA v7. Conclusiones 1. Un 21,2% de las gastroenteritis fue positiva a rotavirus A. De éstas, el 82,9% se detectó en menores de 2 años. 2. La tasa acumulada anual de incidencia de gastroenteritis por rotavirus A fue de 1,03-1,88 casos por cada 100 menores de 5 años. 3. Los picos de incidencia se produjeron entre febrero y abril en los cuatro años. 4. El 77,3% de los casos detectados fue de adquisición comunitaria, mientras que el 21,4% fue de adquisición nosocomial. 5. El 58,2% de infecciones comunitarias se dio en niños de entre 6 meses y 1 año de edad, sin diferencias entre sexos. El 40,4% de casos nosocomiales se dio en niños menores de 6 meses y el 68,1% en niños de sexo masculino. El 55,3% de las infecciones nosocomiales se produjo en el área de lactantes del hospital pediátrico. 6. Los genotipos más prevalentes en 2012 en los casos comunitarios fueron el G1P[8] y el G4P[8], con un 30,4% y un 26,8% respectivamente. El G4P[8] constituyó un 36,7-37,8% en menores de 1 año. Los genotipos más frecuentes en los casos nosocomiales fueron el G4P[8] y el G1P[8], con un 25,6% y un 20,9% de todos los casos. 7. Las gastroenteritis por rotavirus A comunitarias fueron más severas en el primer semestre del año (OR 15,61-25,67), y en los niños de entre 6 meses y 2 años de edad (OR 9,09-10,26). No se encontró asociación entre severidad y genotipo de la cepa. 8. Las características epidemiológicas y los genotipos de las cepas relacionadas con los fallos vacunales fueron muy heterogéneos. 9. El análisis del genoma completo de los rotavirus de los dos casos de infección nosocomial en niños vacunados demostró que se trataba de la misma cepa. Fue una cepa típicamente humana tipo Wa, con cepas relacionadas en los cinco continentes. 10. Se encontraron dos aminoácidos distintos en la proteína VP4 de la cepa transmitida entre los niños vacunados y la de la cepa WI79-4 de Rotateq®, ambas con genotipo P[8], en los epítopos 5-1 y 8-1, con cambios significativos en la polaridad de los residuos en esas posiciones Objectives Main objective: Assess the disease burden and epidemiological features of rotavirus A infections in children admitted to the University Hospital Virgen de la Arrixaca (UHVA). Specific objectives: 1. Assess the incidence of rotavirus A acute gastroenteritis in children under 5 years old attended at the UHVA. 2. Molecular characterize G (VP7) and P (VP4) genotypes of the rotavirus strains. 3. Describe the clinical and epidemiological features of community and nosocomial rotavirus gastroenteritis. 4. Identify vaccine failures and characterize the related strains. Methodology The incidence study of rotavirus A gastroenteritis included all the patients microbiologically diagnosed at the UHVA between 2010-2013. For the clinical, epidemiological and genotyping study all patients from 2012 were included, extracting the information from the clinical histories. The strains from these patients were G- and P-genotyped by seminested multiplex RT-PCR. The study of rotavirus gastroenteritis in vaccinated children included all cases between 2010-2013, using the vaccination data from the Health Department of the Murcia Regional Health Council. Two strains from two previously vaccinated children who became infected at the hospital after both were allocated the same bed with only two days between stays, were characterized. The whole genome of these strains was sequenced with next generation sequencing methods, using a HiSeq 2500 Illumina platform at the Institute of Infection and Global Health of Liverpool. The sequences were analyzed using Geneious R8 and MEGA v7 softwares. Conclusions 1. Rotavirus A antigen was detected in 21.2% of the gastroenteritis cases. Out of them, 82.9% were detected in children under 2 years old. 2. Annual cumulative incidence rate of rotavirus A gastroenteritis was 1.03-1.88 cases for each 100 children under 5 years. 3. Incidence peaks occurred between February and April in the four year period. 4. 77.3% of the cases were community-acquired, while 21.4% were nosocomial-acquired. 5. 58.2% of community infections occurred in children between 6 months and 1 year of age, with no differences between sexes. 40.4% of nosocomial cases occurred in children under 6 months of age, and 68.1% in boys. 55.3% of nosocomial infections came from the infant area at the pediatric hospital. 6. G1P[8] and G4P[8] were the most prevalent genotypes of the community infections, making up to 30.4% and 26.8% of the total cases respectively. G4P[8] was between 36.7-37.8% in children under 1 year of age. The most frequently found genotypes in nosocomial infections were G4P[8] and G1P[8], making 25.6% and 20.9% of all cases. 7. Community-acquired rotavirus A gastroenteritis were more severe in the first semester of the year (OR 15.61-25.67), and in children between 6 months and 2 years of age (OR 9.09-10.26). No association was found between severity and the genotype of the strains. 8. The epidemiological features and the genotypes of the strains related to vaccine failures were very heterogenous. 9. The whole genome of the rotavirus strains from the two vaccinated children proved that they were the same strain. It appeared as a typical human Wa strain, with related strains throughout the world. 10. Two amino acid differences were found in the VP4 proteins in the strain from the previously vaccinated, nosocomial-infected children and the WI79-4 strain contained in the vaccine Rotateq® , both of them with P[8] genotype, in the epitopes 5-1 and 8-1, with significant changes in the polarity of the residues in those positions.
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    Quantification of eosinophils in the lower gastrointestinal tract of adults: a review of surgical specimens with normal histology from the Free State province, South Africa
    (Universidad de Murcia, Departamento de Biologia Celular e Histiologia, 2024) Duncan, Jane; Joubert, Gina; Goedhals, Jacqueline
    Aim. Eosinophils are normal residents of the gastrointestinal tract (GIT). They are noted in small numbers with significant variation between anatomic locations. An idiopathic increase of eosinophils is known as eosinophilic gastrointestinal disease (EGID). EGIDs are a heterologous group of disorders that produce a range of enteric and colonic syndromes. Their incidence has been increasing worldwide. Our study aimed to quantify eosinophils in each segment of the GIT in surgical specimens with normal histology to facilitate the histological diagnosis of EGID. Similarly, we aimed to describe the effect of race and gender on gastrointestinal eosinophil numbers. Methods. A retrospective, quantitative comparative study was performed. We assessed 360 surgical specimens with normal histology from the lower gastrointestinal tract of African and Caucasian adults from the Free State Province, South Africa. The number of eosinophils per mm2 was counted. Results. Overall, comparable eosinophil values were noted for both males and females, and African and Caucasian South Africans. However, Caucasians recorded a higher concentration of eosinophils in the appendix and the left colon. Eosinophils were most numerous in the lamina propria, with only small numbers present in the epithelium. Our results show that the South African population has similar eosinophil distribution trends to international studies. However, South Africans had far fewer eosinophils than Japanese and North American adults in each segment. Conclusions. Specific eosinophil reference ranges were formulated to quantify reference ranges of eosinophils in the lower GIT, allowing for the accurate diagnosis of EGIDs in our population in future