Clinical Characteristics and Outcome in Norovirus Gastroenteritis

Objective To examine differences in clinical characteristics among children with norovirus, rotavirus, and bacterial gastroenteritis and investigate the outcomes in children with sporadic norovirus gastroenteritis. Methods The study included patients aged 4 mo to 14 y who had acute gastroenteritis and were admitted to a tertiary care center between April 2008 and July 2009. The clinical features and laboratory findings of acute gastroenteritis were recorded. Fecal specimens were collected and tested for viruses, bacteria, and parasites. Results A total of 198 children (median age, 2.1 y) with acute gastroenteritis were studied. The pathogens identified included norovirus (n=38), rotavirus (n=47), adenovirus (n=5), astrovirus (n=1), bacteria (n=43), and mixed infections (n=7). No causative organisms were identified in 57 patients. The norovirus-infected group had a significantly higher proportion of those still vomiting 1 d after the onset of vomiting (p<0.001, OR 5.0, 95 % CI 1.9-12.8), cessation of diarrhea 4 d after the onset of diarrhea (p<0.001, OR 15.5, 95% CI 5.1-47.0) and no fever 3 d after the onset of fever (p<0.001, OR 27.5, 95 % CI 5.8-129.7) compared with the bacteria-infected group. The length of hospital stay of the norovirus-infected patients was positively correlated with the number of diarrhea episodes, duration of diarrhea, and severity score. Conclusions The clinical manifestations on the day after onset of diarrhea, vomiting and fever reflected the occurrence of norovirus infection in children with sporadic gastroenteritis.