JCM Accepts, published online ahead of print on 18 June 2008

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J. Clin. Microbiol. doi:10.1128/JCM.00505-08
Copyright (c) 2008, American Society for Microbiology and/or the Listed Authors/Institutions. All Rights Reserved.

Pediatric Norovirus Diarrhea in Nicaragua

Filemon Bucardo, Johan Nordgren, Beatrice Carlsson, Margarita Paniagua, Per-Eric Lindgren, Felix Espinoza, and Lennart Svensson^*

Department of Microbiology University of León, Nicaragua (UNAN-León); Division of Molecular Virology, Department of Clinical and Experimental Medicine, Linköping University, Sweden; Microbiology, Tumor and Cell Biology Centre, Karolinska Institutet, S-171 77 Stockholm, Sweden; Division of Medical Microbiology, Department of Clinical and Experimental Medicine, Linköping University, Sweden

^* To whom correspondence should be addressed. Email: lensv{at}imk.liu.se.

Information about norovirus (NoV) infections is limited from Central America. Through a passive community and hospital surveillance program of pediatric diarrhea a total of 542 stool samples were collected between March 2005 and February 2006 in Leon, Nicaragua. NoV was detected in 12% (65/542) of the children; 11% (45/409) in the community and 15% (20/133) in the hospital with most strains belonging to genogroup GII (88%). NoV infections were age and gender associated with children <2 years age (P<0.05) and girls (P<0.05) being most affected. Breast feeding did not reduce the number of NoV infections. An important proportion (57%), of NoV infected children were co-infected with Diarrhoeagenic E. coli. A significant proportion (18/31) of NoV-positive children with dehydration required intra-venous re-hydration. Nucleotide sequence analysis (38/65) of the N-terminal and Shell region in the capsid gene revealed that at least six genotypes (GI.4, GII.2, GII.4, GII.7, GII.17 and a potential novel cluster, termed "GII.18-Nica") circulated during the study period with GII.4 virus being predominant (26/38). The majority (20/26) of those GII.4 strains shared high nucleotide homology (99%) with the globally emerging Hunter strain. The mean viral load was approximately 15-fold higher in children infected with GII.4 virus compared with other G.II viruses, with the highest viral load observed in the group of children infected with GII.4 requiring intravenous re-hydration. This study, the first from a Central American country suggests that norovirus is an important etiological agent of acute diarrhea among children <2 years of age in Nicaragua.

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