ASTROVIRUS INFECTION IN ASSOCIATION WITH ACUTE, PERSISTENT AND NOSOCOMIAL DIARRHEA IN BANGLADESH

Background Diarrhea is an important public health concern in developin g countries such as Bangladesh. Diarrhea in children that persists for 14 days or more occurs in 7% of patients in Bangladesh and frequently results in death. Astrovirus has been demonstrated as a cause of acut e and nosocomial diarrhea and can be excreted for prolonged periods, y et its importance as a cause of diarrhea among children in a developin g country like Bangladesh has not been investigated. Methods. We teste d 629 stool specimens from patients with acute diarrhea, 153 from pati ents with persistent diarrhea, 175 specimens from 76 patients hospital ized for diarrhea who were sampled repeatedly to detect nosocomial inf ection and 428 from nonhospitalized healthy children (controls). All c hildren enrolled in the study were <5 years of age. Astrovirus was det ected by enzyme immunoassay and other enteropathogens were detected by standard techniques. Results, The detection of astrovirus increased s ignificantly with the duration of diarrhea. Astrovirus was found in 23 (15%) specimens from patients with persistent diarrhea, 26 (4%) patie nts with acute diarrhea, but only 8 (2%) healthy controls. This trend remained when we limited our analysis to infants <12 months of age and to episodes in which astrovirus was the sole pathogen. Among patients with nosocomial diarrhea, 16% of postadmission specimens were positiv e for astrovirus when the admission specimen was negative. Conclusion. The observation that astrovirus is detected more frequently with diar rhea of increasing duration suggests the need for further studies to d etermine whether astrovirus plays a causative role in persistent diarr hea or is a secondary agent.