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Is prolonged rotavirus infection a common cause of protracted diarrhoea?
  1. J A WALKER-SMITH,
  2. A D PHILLIPS
  1. University Department of Paediatric Gastroenterology
  2. Royal Free and University College Medical School
  3. Rowland Hill Street, London NW3 2PF, UK

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    Editor,—The possible link between rotavirus and the postenteritis syndrome was highlighted in the recent editorial1 about Richardson et al’s paper concerning the finding of prolonged rotavirus excretion in the stool using reverse transcription–polymerase chain reaction.2 We feel it is important to be circumspect about this link as the evidence to date is circumstantial.

    The symptom duration in Richardson et al’s study ranged up to, but not beyond, 14 days. This is at the minimum limit for diagnosing persistent diarrhoea.3 Following this there were only two intermittent episodes of mild diarrhoea and/or vomiting in three children, one episode in five, and no episode in three of the cases who were shown to have rotavirus RNA in their stool for > 21 days after the onset of severe rotavirus diarrhoea. A comprehensive screen for other pathogens was not carried out, so that infection by another agent cannot be excluded. No growth was obtained in MA104 cells so that the viability of the stool rotavirus could not be established, and the finding may represent the excretion of degenerate particles.

    A stronger case would be made if rotavirus had been found in the mucosa of children who had protracted diarrhoea at the time and who had prolonged excretion of rotavirus, as shown in the classic paper of Bishop et al.4 Extended stool excretion, in the absence of clinical symptoms, has been shown for rotavirus and other gastrointestinal viruses5-10 and this may be a common phenomenon in viral gastroenteritis, just as excretion of pathogenic bacteria in asymptomatic individuals (the carrier state) is recognised. This is a potentially important observation in terms of cross infection, but not necessarily in terms of chronic, postenteritis diarrhoea.

    Our retrospective review of cases of the postenteritis syndrome in a hospital setting11 has shown intercurrent viral infection and persistent bacterial infection to be important associations with the diagnosis, and our earlier report of degenerate rotavirus particles in the stool of two children with protracted diarrhoea using electron microscopy12 probably represented nosocomial infection rather than persistent rotavirus infection. While it may be tempting to conclude that rotavirus can cause the postenteritis syndrome, the evidence presented to date does not make it more than a hypothesis awaiting rigorous examination.

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