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. 2021 Nov 3;16(11):e0258680.
doi: 10.1371/journal.pone.0258680. eCollection 2021.

From a case-control survey to a diagnostic viral gastroenteritis panel for testing of general practitioners' patients

Lesla E S Bruijnesteijn van Coppenraet  1 , Jacky Flipse  1 , Janny A Wallinga  1 , Marloes Vermeer  2 , Wil A van der Reijden  3 , Jan F L Weel  4 , Adri G M van der Zanden  5 , Theo A Schuurs  4 , Gijs J H M Ruijs  1
Affiliations

From a case-control survey to a diagnostic viral gastroenteritis panel for testing of general practitioners' patients

Lesla E S Bruijnesteijn van Coppenraet et al. PLoS One. .

Abstract

Objective: To evaluate the pathogenicity of a broad range of 11 possible gastroenteritis viruses, by means of statistical relationships with cases vs. controls, or Ct-values, in order to establish the most appropriate diagnostic panel for our general practitioner (GP) patients in the Netherlands (2010-2012).

Methods: Archived stool samples from 1340 cases and 1100 controls were retested using internally controlled multiplex real-time PCRs for putative pathogenic gastroenteritis viruses: adenovirus, astrovirus, bocavirus, enterovirus, norovirus GI and GII, human parechovirus, rotavirus, salivirus, sapovirus, and torovirus.

Results: The prevalence of any virus in symptomatic cases and asymptomatic controls was 16.6% (223/1340) and 10.2% (112/1100), respectively. Prevalence of astrovirus (adjusted odds ratio (aOR) 10.37; 95% confidence interval (CI) 1.34-80.06) and norovirus GII (aOR 3.10; CI 1.62-5.92) was significantly higher in cases versus controls. Rotavirus was encountered only in cases. We did not find torovirus and there was no statistically significant relationship with cases for salivirus (aOR 1,67; (CI) 0.43-6.54)), adenovirus non-group F (aOR 1.20; CI 0.75-1.91), bocavirus (aOR 0.85; CI 0.05-13.64), enterovirus (aOR 0.83; CI 0.50-1.37), human parechovirus (aOR 1.61; CI 0.54-4.77) and sapovirus (aOR 1.15; CI 0.67-1.98). Though adenovirus group F (aOR 6.37; CI 0.80-50.92) and norovirus GI (aOR 2.22, CI: 0.79-6.23) are known enteropathogenic viruses and were more prevalent in cases than in controls, this did not reach significance in this study. The Ct value did not discriminate between carriage and disease in PCR-positive subjects.

Conclusions: In our population, diagnostic gastroenteritis tests should screen for adenovirus group F, astrovirus, noroviruses GI and GII, and rotavirus. Case-control studies as ours are lacking and should also be carried out in populations from other epidemiological backgrounds.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Flow scheme of the materials used in this study and [3,4].
Fig 2
Fig 2. Distribution and frequency of PCR positive samples for astrovirus, Adenovirus non-group-F, adenovirus group F, sapovirus, rotavirus, and noroviruses (genogroup I & genogroup II).
Shown are the results for adenovirus-F (A), adenovirus-non-F (B), noroviruses (C), rotavirus (D), astroviru (E) and sapovirus (F). Shown is the number of positive materials from cases (black bars) and controls (grey bars) per category of Ct values (bin size 2.5 Ct).
See this image and copyright information in PMC

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