694. Enteric Viral Infections as Potential Risk Factors for Intussusception
Session: Abstracts: Virology
Friday, October 22, 2010
Background: Intussusception (ISS) is the most common cause of bowel obstruction in infants worldwide. This study aimed to identify potential risk factors for ISS including enteric viral infections.

Methods: A case control study was conducted in Cairo and Alexandria University pediatric hospitals in Egypt. Children < 3 years old with ISS (confirmed radiologically and/or surgically) were enrolled and matched by age and sex to controls (up to 3) admitted with acute non-abdominal surgical illnesses. Stool samples were collected and tested for rotavirus, enteric adenoviruses (EA, 40 and 41), and astroviruses using commercially available ELISA diagnostic kits. Routine bacterial culture was also performed.  Risk factors for ISS were expressed using conditional odds ratios (OR) and 95% confidence intervals (CI).

Results: From December 2004 to May 2009, 158 cases and 425 matched controls were enrolled. 94% of cases were <1 year of age and 63% were males. 91% of ISS cases were diagnosed radiographically and 9% by surgery. A reported history of diarrhea in last 14 days was more common in cases (n=29, 18%) than controls (n=47, 11%) (OR 1.8; 95% CI, 1.1–2.9).   EA infection (regardless of diarrhea history), identified in 8% of cases (n=11) and 3% of controls (n=10), was found to be associated with ISS (OR 3.6; 95% CI 1.4-9.3).   Rotavirus (detected in 13% of cases and 9% of controls) was not associated with ISS (OR 1.6; 95% CI 0.9-2.9), nor was astrovirus (2% of cases and 4% of controls; OR 0.4; 95% CI 0.1-1.6).  No bacterial pathogens were identified from ISS cases; only Salmonella spp. was isolated from 3 controls.

Conclusion: A history of diarrhea in the last 14 days is a potential risk factor for ISS. While neither rotavirus nor astrovirus infection were identified as risk factors for ISS, EA infection is a potential risk factor for ISS. Additional studies are needed to assess the immune response in EA infection and its role in the pathogenesis of ISS.


Subject Category: C. Clinical studies of bacterial infections and antibacterials including sexually transmitted diseases and mycobacterial infections (surveys, epidemiology, and clinical trials)

Speakers:
Adel M. Mansour, MD , Clinical Trial and Militery studies, U.S.Naval Medical Research Unit No3, Cairo, Egypt
Mohamed El Barabary, MD , Paediatric surgery, Cairo University, Cairo, Egypt
Wisam M. Mahmoud, MD , Paediatric Surgery, Cairo University, Cairo, Egypt
Montasser ML Elkoutby, MD , Paediatric Surgery, Cairo University, Cairo, Egypt
Sameh Shehata, MD , Paediatric Surgery, Alexandria University, Alexandria, Egypt
Hanan El Mohammady, MD , Clinical Trial and Militery studies, NAMRU3, Cairo, Egypt
Manal Mostafa, Msc , Clinical Trial and Militery studies, NAMRU3, Cairo, Egypt
Mark Riddle, MD , Naval Medical Research Center, Silver Spring, MD
Peter Sebeny, MD , Clinical Trial and Militery studies, NAMRU3, Cairo, Egypt
Sylvia Young, MD , Clinical Trial and Militery studies, NAMRU3, Cairo, Egypt
Ibraheem Abdel-Messih, MD , Novartis Vaccines and Diagnostics, Siena, Italy

Disclosures:

A. M. Mansour, None

M. El Barabary, None

W. M. Mahmoud, None

M. M. Elkoutby, None

S. Shehata, None

H. El Mohammady, None

M. Mostafa, None

M. Riddle, None

P. Sebeny, None

S. Young, None

I. Abdel-Messih, None

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