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. 2019 Jun 27;11(7):585.
doi: 10.3390/v11070585.

Novel Human Astroviruses: Prevalence and Association with Common Enteric Viruses in Undiagnosed Gastroenteritis Cases in Spain

Diem-Lan Vu  1   2   3 , Aurora Sabrià  4   5 , Nuria Aregall  4 , Kristina Michl  4 , Virginia Rodriguez Garrido  6 , Lidia Goterris  6 , Albert Bosch  4   5 , Rosa Maria Pintó  4   5 , Susana Guix  7   8
Affiliations

Novel Human Astroviruses: Prevalence and Association with Common Enteric Viruses in Undiagnosed Gastroenteritis Cases in Spain

Diem-Lan Vu et al. Viruses. .

Abstract

A remarkable percentage of acute gastroenteritis cases remain etiologically undiagnosed. The aim of the study was to determine the prevalence of common and emerging enteric viruses, such as novel human astroviruses, among undiagnosed samples from children with acute gastroenteritis. Epidemiological studies for novel human astroviruses are still scarce. Stool samples collected over two consecutive winter seasons (2016-2017) from children with gastroenteritis in Spain, which were negative for bacteria, rotavirus, and adenovirus by routine diagnostics were screened by real-time RT-PCR assays for the presence of classical and novel astrovirus, rotavirus, norovirus GI and GII, sapovirus, and adenovirus. Overall, 220/384 stool samples (57.3%) were positive for at least one virus. Co-infections were identified in 21% of cases. Among a total of 315 viruses identified, adenovirus was the most prevalent (n = 103), followed by rotavirus (n = 51), sapovirus (n = 50), classical astrovirus (n = 43), novel astroviruses (n = 42), and norovirus (n = 26). Novel astroviruses were present in 13.3% of virus-positive cases. Most novel astroviruses were found in children <2-year-old (30/39 children, 77%, p = 0.01) and were found in co-infection (66%). Only classical astroviruses demonstrated significant differences in the Cq values during mono-infections compared to co-infections. In conclusion, common enteric viruses may be frequently found in children with undiagnosed gastroenteritis, indicating the need to implement more sensitive diagnostic methods. Novel astroviruses circulate in the community and could be the cause of gastroenteritis among young children.

Keywords: adenovirus; children; classic astrovirus; epidemiology; gastroenteritis; norovirus; novel human astrovirus; real time RT-PCR; rotavirus; sapovirus.

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Conflict of interest statement

The authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results.

Figures

Figure 1
Figure 1
(A) Distribution of positive samples for any viral target by age groups. Percentages above each bar indicate the positivity rate in each group category. (B) Percentage distribution of positive samples by age group for each viral target. The number in brackets indicates the total number of positive samples for each virus. AdV: adenovirus; RV: rotavirus; SaV: sapovirus; HAstV-C: classic human astrovirus; HAstV-N: novel human astrovirus; NoV: norovirus: GI: genogroup I; GII: genogroup II.
Figure 2
Figure 2
Number of cases identified in mono- and co-infections, respectively, for each virus in 2016 (A) and 2017 (B). Percentages indicate the proportion of co-infections. HAstV-MLB: MLB human astrovirus; HAstV-VA: VA human astrovirus HAstV-C: classic human astrovirus; NoV: norovirus: GI: genogroup I; GII: genogroup II; SaV: sapovirus; RV: rotavirus; AdV: adenovirus.
Figure 3
Figure 3
Median Cq values and confidence intervals for novel astroviruses (A) and other enteric viruses (B) according to mono- or co-infection status. Rotavirus and adenovirus were excluded from the analysis, as samples positive for these viruses by immunochromatography were excluded from the study. There was a statistical difference when comparing the Cq value during co-infection and mono-infection for classical HAstVs (p = 0.042 by Pearson chi2 test with continuity correction). HAstV-MLB: MLB human astrovirus; HAstV-VA: VA human astrovirus HAstV-C: classic human astrovirus; NoV: norovirus: GI: genogroup I; GII: genogroup II; SaV: sapovirus.
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