International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases · 2026
High levels of co-detection of norovirus and other enteric pathogens in patients with and without acute gastroenteritis in a hospital-based surveillance study in Bangladesh, 2018-2021.
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Fariha Farzana, Hassan Adiba, Urmi Sharmeen Akter, Hossain Mohammad Enayet, Ghosh Probir Kumar, Rahman Md Mahfuzur, Abdulla Faruq, Chowdhury Kamal Ibne Amin, Abdullah Zarin, Gautam Rashi, Banu Sayera, Vinjé Jan, Mirza Sara A, Rahman Mustafizur, Gastañaduy Paul A, Parashar Umesh D, Satter Syed Moinuddin
Аннотация
OBJECTIVES: The contribution of various enteropathogens to the occurrence of acute gastroenteritis (AGE) remains uncertain in highly endemic settings. We describe the frequency of norovirus-only detections and norovirus co-detections in hospitalized patients in Bangladesh and compare their clinical severity and viral load.
METHODS: From March 2018 to October 2021, 1250 AGE cases and 1250 non-AGE controls of all ages were enrolled at 10 tertiary care hospitals in Bangladesh. All norovirus-positive AGE cases (n = 111) and non-AGE controls (n = 182), and a randomly selected subset of 126 norovirus-negative AGE cases, were tested for other enteric viral, bacterial, and parasitic co-pathogens with quantitative real-time PCR assays. We used cycle threshold (Ct)-values as a proxy for viral load and Vesikari scale to assess disease severity.
RESULTS: Among 111 norovirus-positive AGE cases, 29 (26%) were norovirus-only detections and 82 (74%) were norovirus co-detections, and among 182 norovirus-positive non-AGE controls, 59 (32%) were norovirus-only detections and 123 (68%) were norovirus co-detections. Norovirus-rotavirus was the predominant co-detection, found in 140 (68%) of 205 norovirus co-detections. No differences in clinical severity were observed among AGE cases with norovirus-only versus norovirus co-detections. The median (interquartile range) Ct-values among genogroup II norovirus-only AGE cases, norovirus co-detection AGE cases, and norovirus-positive non-AGE controls were 25 (22-30), 25 (21-30), and 26 (21-30), respectively.
CONCLUSION: The frequent co-detection of norovirus with other enteropathogens, especially rotavirus, along with overlapping Ct-values in patients with and without AGE, and between norovirus-only and norovirus co-detections, complicates the attribution of norovirus as a cause of AGE in Bangladesh.
METHODS: From March 2018 to October 2021, 1250 AGE cases and 1250 non-AGE controls of all ages were enrolled at 10 tertiary care hospitals in Bangladesh. All norovirus-positive AGE cases (n = 111) and non-AGE controls (n = 182), and a randomly selected subset of 126 norovirus-negative AGE cases, were tested for other enteric viral, bacterial, and parasitic co-pathogens with quantitative real-time PCR assays. We used cycle threshold (Ct)-values as a proxy for viral load and Vesikari scale to assess disease severity.
RESULTS: Among 111 norovirus-positive AGE cases, 29 (26%) were norovirus-only detections and 82 (74%) were norovirus co-detections, and among 182 norovirus-positive non-AGE controls, 59 (32%) were norovirus-only detections and 123 (68%) were norovirus co-detections. Norovirus-rotavirus was the predominant co-detection, found in 140 (68%) of 205 norovirus co-detections. No differences in clinical severity were observed among AGE cases with norovirus-only versus norovirus co-detections. The median (interquartile range) Ct-values among genogroup II norovirus-only AGE cases, norovirus co-detection AGE cases, and norovirus-positive non-AGE controls were 25 (22-30), 25 (21-30), and 26 (21-30), respectively.
CONCLUSION: The frequent co-detection of norovirus with other enteropathogens, especially rotavirus, along with overlapping Ct-values in patients with and without AGE, and between norovirus-only and norovirus co-detections, complicates the attribution of norovirus as a cause of AGE in Bangladesh.