Intussusception is associated with the detection of adenovirus C, enterovirus B and rotavirus in a rotavirus vaccinated population

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Highlights

Abstract

Background

Intussusception, a condition where one segment of intestine invaginates into another, occurs predominantly in infants and young children. A number of potential causes have been identified including infectious agents and rotavirus vaccination. Following the introduction of rotavirus vaccination of infants in Western Australia, a laboratory surveillance programme testing notified intussusception cases for infectious agents was commenced. This led to a PCR-based study of the association between gastrointestinal viruses and intussusception.

Objectives

Conduct viral testing on stool samples from intussusception patients to determine viruses that may have an association with intussusception.

Study design

A retrospective case–control study was conducted using stool samples collected from children with intussusception (n = 74) and matched controls (n = 289) between 2008 and 2011. Samples were tested for rotavirus, norovirus, adenovirus, enterovirus, rhinovirus, astrovirus, parechovirus and bocavirus. Adenovirus, enterovirus and rhinovirus species were determined by DNA sequencing.

Results

Human adenovirus C was detected in significantly more cases than controls with 31/74 (41.9%) cases testing positive compared to 39/289 (13.49%) controls (OR = 4.38, p < 0.001). A significant difference was seen in Enterovirus B detections with 11/74 (14.9%) cases testing positive compared to 21/289 (7.3%) controls (OR = 2.24, p = 0.04). Rotavirus was detected in 7/74 (9.46%) cases and 11/289 (3.81%) controls, which was also a significant difference (OR = 2.88, p = 0.045).

Conclusions

Our results show that intussusception is associated with non-enteric adenovirus infections, and Enterovirus B infections. While a statistical association was seen with rotavirus and intussusception, we were not able to determine if this was related to vaccine strain or wild type rotavirus.

Section snippets

Background

Intussusception is a serious condition that occurs predominantly in infants and young children where one segment of the intestine prolapses into another, causing obstruction of the bowel. The incidence in Australia was recently estimated to be 71 per 100,000 infants less than 12 months [1]. The cause of intussusception in children often remains unidentified, although it has been proposed that intestinal invagination could be triggered by post-infection lymphoid hyperplasia in the wall of the

Objectives

The aim of this study was to conduct comprehensive viral testing on stool samples from intussusception patients to further elucidate viruses that may have an association with intussusception.

Study design

We conducted a retrospective case–control study on stool samples collected from children with intussusception between February 2008 and October 2011 in Western Australia. Samples were tested using the polymerase chain reaction (PCR) for adenoviruses, enteroviruses, rhinoviruses, norovirus, rotavirus, astrovirus, parechovirus and bocavirus. Adenovirus, enterovirus and rhinovirus speciation was determined by DNA sequencing.

Study participants

Between February 2008 and October 2011, 101 cases of intussusception were notified in Western Australia, of which 22 did not have a stool sample collected, or the sample was insufficient for virological testing. A further five samples were excluded as neither the sample nor matched controls could be obtained for subsequent testing. Therefore, 74 cases (46 male, 28 female) were able to be included in the study, of which 61 still had the original specimens available at the time of the study for

Discussion

We conducted a case control study using comprehensive viral testing on stool samples to identify viruses that may have an etiological role in intussusception. This is the largest published study of this type conducted on the Australian population and to the best of our knowledge, the first to include an analysis of enteroviral species identification. We found that the odds of intussusception were increased 2.54 times when one or more viruses were detected in faecal samples. Our results provide

Funding

This study was supported by internal funding.

Competing interests

None declared.

Ethical approval

Not required.

Authors contribution

Cara A. Minney-Smith: Ms. Minney-Smith assisted design of the study, performed virological testing, cleaned and analysed the data and wrote the first draft of the manuscript.

Avram Levy: Dr. Levy identified and stored intussusception samples, assisted with design of the study, supervised virological testing, maintained the database of intussusception patients and assisted with writing the manuscript.

Meredith Hodge: Dr Hodge assisted design of the study and writing of the manuscript.

Peter Jacoby:

Acknowledgements

We acknowledge Dr. Gerry Harnett for the development of the PCRs used in this study.

This work has been previously presented as a poster at the Australian Society for Microbiology Conference, Brisbane, 2012.

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    Present address: Center for Infection and Immunity, Mailman School of Public Health, Columbia University, New York, NY 10032, United States.

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