Genotyping and clinical factors in pediatric diarrhea caused by rotaviruses: one-year surveillance in Surabaya, Indonesia

Subijanto Marto Sudarmo; Katsumi Shigemura; Alpha Fardah Athiyyah; Kayo Osawa; Oktavian Prasetia Wardana; Andy Darma; Reza Ranuh; Dadik Raharjo; Soichi Arakawa; Masato Fujisawa; Toshiro Shirakawa

doi:10.1186/s13099-015-0048-2

Genotyping and clinical factors in pediatric diarrhea caused by rotaviruses: one-year surveillance in Surabaya, Indonesia

Gut Pathog. 2015 Feb 8:7:3. doi: 10.1186/s13099-015-0048-2. eCollection 2015.

Affiliations

¹ Department of Child Health, Soetomo Hospital, Airlangga University, Surabaya, Indonesia ; Indonesia-Japan Collaborative Research Center for Emerging and Re-emerging Infectious Diseases, Institute of Tropical Disease, Airlangga University, Surabaya, Indonesia.
² Department of Urology, Kobe University Graduate School of Medicine, Kobe, Japan ; Department of Infection Control and Prevention, Kobe University Hospital, Kobe, Japan.
³ Division of Infectious Diseases, Department of International Health, Kobe University Graduate School of Health Science, Kobe, Japan ; Department of Infection Control and Prevention, Kobe University Hospital, Kobe, Japan.
⁴ Indonesia-Japan Collaborative Research Center for Emerging and Re-emerging Infectious Diseases, Institute of Tropical Disease, Airlangga University, Surabaya, Indonesia ; Institute of Tropical Disease, Airlangga University, Surabaya, Indonesia.
⁵ Department of Urology, Kobe University Graduate School of Medicine, Kobe, Japan.
⁶ Indonesia-Japan Collaborative Research Center for Emerging and Re-emerging Infectious Diseases, Institute of Tropical Disease, Airlangga University, Surabaya, Indonesia ; Department of Urology, Kobe University Graduate School of Medicine, Kobe, Japan ; Division of Infectious Diseases, Department of International Health, Kobe University Graduate School of Health Science, Kobe, Japan ; Center for Infectious Diseases, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-cho, Chuo-ku, Kobe, 650-0017 Japan.

Abstract

Background: Rotavirus infections are a major cause of diarrhea in children in both developed and developing countries. Rotavirus genetics, patient immunity, and environmental factors are thought to be related to the severity of acute diarrhea due to rotavirus in infants and young children. The objective of this study was to provide a correlation between rotavirus genotypes, clinical factors and degree of severity of acute diarrhea in children under 5 years old in Surabaya, Indonesia.

Methods: A cross-sectional study was conducted in children aged 1-60 months with acute diarrhea hospitalized in Soetomo Hospital, Surabaya, Indonesia from April to December 2013. Rotavirus in stool specimens was identified by ELISA and genotyping (G-type and P-type) using multiplex reverse transcription PCR. Severity was measured using the Ruuska and Vesikari scoring system. The clinical factors were investigated included patient's age (months), hydration, antibiotic administration, nutritional state, co-bacterial infection and co-viral infection.

Results: A total of 88 children met the criteria; 80.7% were aged 6-24 months, watery diarrhea was the most common type (77.3%) and 73.6% of the subjects were co-infected with bacteria, of which pathogenic Escherichia coli was the most common (42.5%). The predominant VP7 genotyping (G-type) was G2 (31.8%) and that of VP4 genotyping (P-type) was P[4] (31.8%). The predominant rotavirus genotype was G2P[4] (19.3%); G1P[4] and G9P[4] were uncommon with a prevalence of 4.5%. There were significant differences between the common genotype and uncommon genotype with respect to the total severity score of diarrhea (p <0.05). G3, G4 and G9 were significantly correlated with severe diarrhea (p = 0.009) in multivariate analyses and with frequency of diarrhea (>10 times a day) (p = 0.045) in univariate analyses, but there was no significant correlation between P typing and severity of diarrhea. For combination genotyping of G and P, G2P[4] was significantly correlated with severe diarrhea in multivariate analyses (p = 0.029).

Conclusions: There is a correlation between rotavirus genotype and severity of acute diarrhea in children. Genotype G2P[4] has the highest prevalence. G3, G4, G9 and G2P[4] combination genotype were found to be associated with severe diarrhea.

Keywords: Clinical factors; Genotyping; Pediatrics; Rotavirus diarrhea.