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. 2020 Oct:131:104565.
doi: 10.1016/j.jcv.2020.104565. Epub 2020 Aug 1.

Influenza virus detection in the stool of children with acute gastroenteritis

Jianling Xie  1 , Xiao-Li Pang  2 , Gillian A M Tarr  3 , Yuan Mu  4 , Ran Zhuo  5 , Linda Chui  2 , Bonita E Lee  6 , Otto G Vanderkooi  7 , Phillip I Tarr  8 , Samina Ali  6 , Shannon E MacDonald  9 , Stephen B Freedman  10
Affiliations

Influenza virus detection in the stool of children with acute gastroenteritis

Jianling Xie et al. J Clin Virol. 2020 Oct.

Abstract

Objectives: To determine if the clinical characteristics of children with gastroenteritis and influenza identified in their stool differ from those whose stool was influenza-negative.

Methods: Children <18-years with gastroenteritis whose stool tested negative for enteropathogen were tested for influenza in stool. The clinical features between influenza-positive and influenza-negative gastroenteritis cases were compared. Stools from controls without infection were also tested for influenza.

Results: Among the 440 gastroenteritis cases, those who were influenza test-positive were older [median age 4.0 (IQR: 2.3, 5.5) vs. 1.5 (IQR: 0.5, 4.0) years; P = 0.008], more likely to present in fall or winter (92.3 % vs. 48.0 %; P = 0.001), be febrile (84.6 % vs. 30.6 %; P < 0.001), have respiratory symptoms (91.7 % vs. 44.8 %; P = 0.002), have dehydration [median Clinical Dehydration Scale score: 4 (IQR: 1.5, 4.5) vs. 2 (IQR: 0, 3); P = 0.034], and have higher Modified Vesikari Scale scores [median: 13 (IQR: 10.5, 14.0) vs. 10 (IQR: 9.0, 13.0); P = 0.044], than those who tested negative. Thirteen gastroenteritis cases (13/440; 3.0 %) including one child without respiratory symptoms vs. one control (1/250; 0.4 %) were influenza stool positive.

Conclusions: Fever, respiratory symptoms, more severe illness, and older age were more common in children with gastroenteritis with influenza detected in stool, compared to those tested negative.

Keywords: Enteropathogens; Gastroenteritis; Influenza; Pediatrics; Reverse transcriptase- quantitative polymerase chain reaction.

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Conflict of interest statement

Declare of Interest: None.

Figures

Figure 1.
Figure 1.
Study Flow Diagram
Figure 2.
Figure 2.
Distribution of confirmed influenza strains in the province of Alberta (i.e. non-study participants) during the study period in comparison to strains detected in the stool of study participants (i.e. acute gastroenteritis cases and controls). In 2015-2016, the number of influenza positive subjects was 5311, 6, and 0 in the province of Alberta, study acute gastroenteritis cases, and study controls, respectively; in 2016-2017, the numbers were 4494, 1, and 1 respectively; in 2017-2018, the numbers were 9069, 6, and 0, respectively.
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