Concomitant Rotavirus and Salmonella Infections in Children with Acute Diarrhea

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% Cl). 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 degrees 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 +/- 11.05mg/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 degrees C) for over 4 days and a green stool with mucus and blood.