Open AccessGenetic Diversity of Norovirus Infections, Coinfections, and Undernutrition in Children From Brazilian Semiarid Region
Author(s) -
Gondim Rafhaella D.G.,
Pankov Rafaela C.,
Prata Mara M.G.,
Medeiros Pedro H.Q.S.,
Veras Herlice N.,
Santos Ana K.S.,
Magalhães Lyvia M.C.,
Havt Alexandre,
Fumian Tulio M.,
Miagostovich Marize P.,
Leite José P.G.,
Lima Aldo A.M.
Publication year - 2018
Publication title -
journal of pediatric gastroenterology and nutrition
Language(s) - English
Resource type - Journals
eISSN - 1536-4801
pISSN - 0277-2116
DOI - 10.1097/mpg.0000000000002085
Subject(s) - norovirus , coinfection , medicine , genotype , malnutrition , population , diarrhea , genetic diversity , feces , biology , virology , environmental health , outbreak , microbiology and biotechnology , virus , genetics , gene
Background and Objective: Norovirus (NoV) infections are known to have high‐morbidity and mortality rates and are a major health problem globally. The impact of NoV on child development is, however, poorly understood. We evaluated the distribution of NoV genotypes in children from a low‐income Brazilian semiarid region, in relation with their clinical symptoms, nutritional status, and co‐pathogens. Methods: The test population included children aged 2 to 36 months from 6 cities of the Brazilian semiarid region. Fecal samples were collected from each child, along with the information regarding their socioeconomic/clinical conditions using a standardized questionnaire. Detection and quantification of NoV were performed by reverse‐transcription quantitative polymerase chain reaction, followed by molecular and phylogenetic analyses. Results: The NoV detection rate was 45.2%. Presence of NoV was associated with lower z scores for weight‐for‐age ( P = 0.03), weight‐for‐height ( P = 0.03), and body mass index‐for‐age ( P = 0.03). NoV infection was associated with more frequent respiratory illnesses ( P < 0.01). GII.P7 (polymerase) and GII.3 (capsid) were the most frequent NoV genotypes. Analysis of the open reading frame (ORF)1‐2 junction identified recombinant NoV strains in 80% of the sequenced samples. Enteroaggregative Escherichia coli coinfection was the major predictor for diarrhea in NoV‐positive samples ( P < 0.02). Moreover, Shigella spp was also associated with NoV‐positive diagnosis ( P = 0.02). Conclusions: This study highlights the genetic variability of NoV and, associated co‐infections and undernutrition in infants from low‐income Brazilian semiarid region.