A large outbreak of acute gastroenteritis in Shippensburg, Pennsylvania, 1972 revisited: evidence for common source exposure to a recombinant GII.Pg/GII.3 norovirus.

Historical outbreaks can be an important source of information in the understanding of norovirus evolution and epidemiology. Here, we revisit an outbreak of undiagnosed gastroenteritis that occurred in Shippensburg, Pennsylvania in 1972. Nearly 5000 people fell ill over the course of 10 days. Symptoms included diarrhea, vomiting, stomach cramps, and fever, lasting for a median of 24 h. Using current techniques, including next-generation sequencing of full-length viral genomic amplicons, we identified an unusual norovirus recombinant (GII.Pg/GII.3) in nine of 15 available stool samples from the outbreak. This particular recombinant virus has not been reported in recent decades, although GII.3 and GII.Pg genotypes have been detected individually in current epidemic strains. The consensus nucleotide sequences were nearly identical among the four viral genomes analysed, although each strain had three to seven positions in the genome with heterogenous non-synonymous nucleotide subpopulations. Two of these resulting amino acid polymorphisms were conserved in frequency among all four cases, consistent with common source exposure and successful transmission of a mixed viral population. Continued investigation of variant nucleotide populations and recombination events among ancestral norovirus strains such as the Shippensburg virus may provide unique insight into the origin of contemporary strains.

Viral load of human bocavirus-1 in stools from children with viral diarrhoea in Paraguay.

Since their discovery, four species of human bocavirus (HBoV) have been described in patients with respiratory and gastrointestinal diseases. However, a clear causal association between HBoV-1 and gastroenteritis has not been demonstrated. In this study, we describe the detection and quantification of HBoV-1 in stools from children with acute non-bacterial gastroenteritis using quantitative polymerase chain reaction. HBoV-1 genome was detected in 10.6% of stools with frequent association with rotavirus and norovirus. The median of HBoV-1 viral load was 1.88 × 104 genome/ml, lower than previously shown in secretions of patients with respiratory infections, without any obvious association between high viral load and presence of HBoV as single agent. Thus, although HBoV-1 was frequently detected in these patients, there is no clear causal association of this agent with diarrhoea. Indeed, HBoV-1 DNA in stools of patients with gastroenteritis without respiratory symptoms may be a remnant of previous infections or associated with prolonged shedding of virus in the respiratory or digestive tracts.

[Molecular characterization of calicivirus strains detected in outbreaks of gastroenteritis occurring in Argentina during 2005 and 2006]. / Caracterización molecular de calicivirus aislados de brotes de gastroenteritis ocurridos en la Argentina durante los años 2005 y 2006.

In order to determine the incidence of calicivirus, rotavirus and astrovirus in outbreaks of gastroenteritis occurring in different regions of Argentina during 2005 and 2006, fecal samples from seven nonbacterial outbreaks were analyzed. A commercial ELISA was used for rotavirus detection, while RT-PCRs were used for calicivirus and astrovirus. Of the 74 samples analyzed, 20 were calicivirus positive, 17 were rotavirus positive and one was astrovirus positive. No mixed infections were detected. A partial region of the RdRp gene was sequenced in five calicivirus positive-samples; 4 of them belonged to Norovirus genus and one to Sapovirus genus. The phylogenetic analysis of norovirus-positive-samples revealed the presence of strains from genogroups GI and GII; genotypes GII-4, GII-b and GII-17 were identified within the latter. Phylogenetic the sapovirus-positive-sample revealed the presence of genotype GI-1. This study represents a follow-up of the of molecular epidemiology analysis of calicivirus associated to gastroenteritis outbreaks that have been carried out by our group since 2004, and constitutes the first report of the circulation of genotype GII-17 in Argentina.

[Incidence of rotavirus in adults with diarrhea in Asunción, Paraguay]. / Presencia de rotavirus en adultos con diarrea en Asunción, Paraguay.

From October 2001 to March 2004, 92 out of 533 (17.3%) fecal samples of patients over 18 years of age were positive for rotavirus. There were not differences of rotavirus incidence between age groups. Although in Paraguay, rotavirus infections in children less than 5 years old present a seasonal peak pattern (since June to October), in adults rotavirus was present throughout the year with the same frequency. Results presented here reinforce the notion that rotavirus should be considered in the differential diagnosis of diarrhea in adults.

Acute diarrhea in Paraguayan children population: detection of rotavirus electropherotypes.

Group A rotavirus infections were detected in 93 of 410 fecal samples from children with acute diarrhea, admitted in three main hospitals of Asunción, Paraguay, from August 1998 to August 2000. Most of the rotavirus-infected patients were admitted during the winter season in the three epidemic years. The rotavirus infection rate was highest in infants from 6 to 23 months of age. In the 93 samples examined, 10 different rotavirus electropherotypes were recognized, but two of them largely predominated. Only one sample showed a short electropherotype pattern, thus indicating a minor involvement of the rotavirus subgroup I in rotaviral acute diarrhea in the area and the time during which the survey was carried out.

Complete genome analyses of G4P[6] rotavirus detected in Argentinean children with diarrhoea provides evidence of interspecies transmission from swine.

Rotaviruses are dynamic pathogens that have been shown to infect multiple species. In 2006, two G4P[6] rotavirus strains with porcine characteristics were detected in Santa Fe, Argentina. To further characterize and determine the origin of these strains, nearly the full length of their genome was sequenced. While most of the genome segments were from porcine origin, the two strains grouped in different phylogenetic clusters in five out of the 11 genes, suggesting two independent interspecies transmission events. This study expands our knowledge of G4 rotavirus and reinforces the use of complete genome analyses as a key tool for diversity and evolution mechanicisms.

Phylogenetic analyses of typical bovine rotavirus genotypes G6, G10, P[5] and P[11] circulating in Argentinean beef and dairy herds.

Group A rotavirus (RVA) is one of the main causes of neonatal calf diarrhea worldwide. RVA strains affecting Argentinean cattle mainly possess combinations of the G6, G10, P[5] and P[11] genotypes. To determine RVA diversity among Argentinean cattle, representative bovine RVA strains detected in diarrheic calves were selected from a survey conducted during 1997-2009. The survey covered the main livestock regions of the country from dairy and beef herds. Different phylogenetic approaches were used to investigate the genetic evolution of RVA strains belonging to the prevalent genotypes. The nucleotide phylogenetic tree showed that all genotypes studied could be divided into several lineages. Argentinean bovine RVA strains were distributed across multiple lineages and most of them were distinct from the lineage containing the vaccine strains. Only the aminoacid phylogenetic tree of G6 RVA strains maintained the same lineages as observed at the nucleotide level, whereas a different clustering pattern was observed for the aminoacid phylogenetic trees of G10, P[5] and P[11] suggesting that the strains are more closely related at the aminoacid level than G6 strains. Association between P[5] and G6(IV), prevalent in beef herd, and between P[11] and G6(III) or G10 (VI and V), prevalent in dairy herds, were found. In addition, Argentinean G6(III), G10, P[5] and P[11] bovine RVA strains grouped together with human strains, highlighting their potential for zoonotic transmission. Phylogenetic studies of RVA circulating in animals raised for consumption and in close contact with humans, such as cattle, contribute to a better understanding of the epidemiology of the RVA infection and evolution.

Sequence and phylogenetic analysis of the VP4 gene of human rotaviruses isolated in Paraguay.

Nucleotide and amino acid analyzes of the VP4 gene of human rotaviruses isolated both in Paraguay and worldwide were carried out in order to increase our knowledge about the complex pattern of evolution of this virus in nature. Paraguayan strains bearing the P[8] genotype were grouped in the lineages P[8]-1, P[8]-2, and P[8]-3. Regardless of the year of detection, all of the G4 and G9 strains were related to lineage P[8]-3, whereas the G1 strains were related to the three lineages detected in Paraguay; this fact reinforces the notion of the existence of constraints within specific populations of rotavirus strains except for the G1 strains. In addition, we propose a phylogenetic classification for the P[4] strains in five different lineages (i.e. P[4]-1 to P[4]-5). The findings presented in this paper reinforce the importance of a continuous surveillance of rotavirus strains in order to predict the possible variants that will circulate in a country, and ultimately improve current vaccination programs.

Caracterización molecular de calicivirus aislados de brotes de gastroenteritis ocurridos en la Argentina durante los años 2005 y 2006 / Molecular characterization of calicivirus strains detected in outbreaks of gastroenteritis occurring in Argentina during 2005 and 2006

Con el objetivo de determinar la incidencia de calicivirus, rotavirus y astrovirus en brotes de gastroenteritis ocurridos en diversas regiones de la Argentina durante los años 2005 y 2006, se analizaron muestras de materia fecal provenientes de 7 brotes con resultado de coprocultivo negativo. Para el diagnóstico de rotavirus se utilizó un ELISA comercial, mientras que para el diagnóstico de calicivirus y astrovirus se utilizó el método de RT-PCR. De las 74 muestras analizadas, 20 fueron positivas para calicivirus, 17 para rotavirus y una para astrovirus. No se identificaron infecciones virales mixtas. En 5 muestras positivas para calicivirus se secuenció una región del gen de la polimerasa; 4 de ellas correspondieron al género Norovirus y una al género Sapovirus. El análisis filogenético de las muestras secuenciadas determinó la presencia de norovirus de los genogrupos GI y GII; dentro de este último, se identificaron los genotipos GII-4, GII-b y GII-17. El análisis de la muestra en la cual se identificó sapovirus reveló la presencia del genotipo GI-1. Este estudio representa una continuación del análisis epidemiológico molecular de calicivirus asociados a brotes de gastroenteritis iniciado en 2004 y constituye la primera comunicación de la circulación de norovirus del genotipo GII-17 en la Argentina.

In order to determine the incidence of calicivirus, rotavirus and astrovirus in outbreaks of gastroenteritis occurring in different regions of Argentina during 2005 and 2006, fecal samples from seven nonbacterial outbreaks were analyzed. A commercial ELISA was used for rotavirus detection, while RT-PCRs were used for calicivirus and astrovirus. Of the 74 samples analyzed, 20 were calicivirus positive, 17 were rotavirus positive and one was astrovirus positive. No mixed infections were detected. A partial region of the RdRp gene was sequenced in five calicivirus positive-samples; 4 of them belonged to Norovirus genus and one to Sapovirus genus. The phylogenetic analysis of norovirus-positive-samples revealed the presence of strains from genogroups GI and GII; genotypes GII- 4, GII-b and GII-17 were identified within the latter. Phylogenetic the sapovirus-positive-sample revealed the presence of genotype GI-1. This study represents a follow-up of the of molecular epidemiology analysis of calicivirus associated to gastroenteritis outbreaks that have been carried out by our group since 2004, and constitutes the first report of the circulation of genotype GII-17 in Argentina.

Sensibilidad y especificidad del método inmunocromatográfico utilizado para el diagnóstico de rotavirus / Sensibility and specificity of the immunochromatographic method used for rotavirus diagnosis

El rotavirus (RV) es el principal agente viral causante de diarrea aguda en niños menores de 5 años y es responsable de aproximadamente el 6% de las muertes en este grupo etáreo, lo que conlleva la necesidad de utilizar métodos de diagnósticos rápidos y confiables. El objetivo del estudio es evaluar la sensibilidad y especificidad del método inmunocromatográfico (ICG), en el que se basan muchos kits comerciales utilizados para el diagnóstico de rotavirus grupo A, tomando como referencia el método de electroforesis en gel de poliacrilamida (PAGE). Se seleccionaron muestras de heces de 317 pacientes con diarrea aguda que concurrieron a un laboratorio privado de mayo a noviembre del 2006, con pedido de análisis de rotavirus y todos los datos de los pacientes fueron manejados de manera confidencial Se utilizaron kits de las marcas comerciales Operón simple (n=154) o SD Bioline rotavirus (n=163), siguiendo estrictamente las instrucciones del fabricante. Las muestras fueron conservadas en frío y remitidas al IICS para la realización de los estudios moleculares. La sensibilidad obtenida por el método ICG fue de 97,8% y la especificidad de 84%. La concordancia absoluta fue del 90%. Las muestras que dieron resultados discrepantes entre ICG y PAGE, fueron confirmadas por nRT-PCR, resultados que coincidieron con los obtenidos por PAGE. La sensibilidad del método ICG es muy buena, si bien la especificidad es moderada el método puede ser utilizado como screening para el diagnóstico rápido de rotavirus y sería aconsejable utilizar métodos más específicos como los moleculares para estudios epidemiológicos.

The rotavirus (RV) is the major causative agent of acute viral diarrhea in children under 5 years old and is responsible for approximately 6% of the deaths in this age group making necessary the use of quick and reliable diagnosis methods. The aim of this study is to evaluate the sensibility and specificity of the immunochromatographic method (ICG) on which many commercial kits used for the diagnosis of A rotavirus group are based taking as a reference the polyacrylamide gel electrophoresis (PAGE). Feces samples were collected from 317 patients with acute that attended a private laboratory from May to November, 2006 for rotavirus analysis. All the information of the patients was managed confidentially. Kits of the commercial brands simple Operón (n=154) or SD Bioline rotavirus (n=163) were used strictly following the instructions of the manufacturers. Samples were maintained in cold and sent to the IICS for the performance of the molecular studies. The sensibility obtained by the method ICG was 97.8%, the specificity was 84% and the absolute concordance was 90 %. The samples that gave discrepant results between ICG and PAGE were confirmed by nRT-PCR that provided results similar to those obtained by PAGE. The sensibility of the ICG method is very good and though the specificity is moderated it can be used as screening for the quick diagnosis of rotavirus and it would be advisable to use more specific methods, as the molecular ones, for epidemiological studies.

Humanización del cuidado de Enfermería / Nursing care humanization

Como marco de referencia para el análisis del tema se hará inicialmente una reflexión acerca del cuidado de Enfermería el cual se fundamenta en la relación interpersonal humanizada que establece la Enfermera con el sujeto de cuidado; así mismo se analiza el enfoque humanístico del cuidado teniendo como referente lo planteado por algunas teoristas en Enfermería. Finalmente se proponen posibles caminos que contribuyan a la humanización del cuidado para lo cual se han tenido en cuenta los valores y los principios éticos que guían el desempeño de la Enfermera en Colombia, los derechos del sujeto de cuidado y la importancia del trabajo en equipo de las personas que participan en la atención de salud de quienes la requieren.

In order to analyze the issue, the initial step is a reflexion of the nursing care, which is based on the interpersonal relation between the nurse and the care subject, besides the human approach of the care is analyzed, regarding to some of the nursing theorizers. Finally is proposed some possible paths to humanize the patient care, for which is taking into account the ethic values and principles that guides the nurse practice in Colombia, the patient rights and the importance of team work of the persons that take part in health attention for the one who need it.

Perspectiva Bioética del cuidado de Enfermería / Ethics. Moral. Bioethics. Care Ethics and Nursing.

En el presente artículo se presenta una aproximación a la perspectiva bioética del cuidado de Enfermería, se plantean inicialmente algunos elementos de reflexión acerca de la ética y la moral y sus aportes a la reflexión bioética; seguidamente se analizan elementos conceptuales de la bioética: origen, concepto, rasgos característicos, áreas de estudio, tendencias de la bioética en América latina y el Caribe y su relación con la ética del cuidado, propio de Enfermería

An approach to the nursing care bioethics perspective is shown in the present article, initially reflection elements about the ethics and the moral are taking into account, together with a bioethics reflection, followed by the analysis of bioethics conceptual elements: origin, concept, characteristics, different study fields, Latin America and Caribbean bioethics tendencies and the relation of the bioethics with the care ethics of nursing.

Presencia de rotavirus en adultos con diarrea en Asunción, Paraguay / [Incidence of rotavirus in adults with diarrhea in Asunción, Paraguay]

From October 2001 to March 2004, 92 out of 533 (17.3

) fecal samples of patients over 18 years of age were positive for rotavirus. There were not differences of rotavirus incidence between age groups. Although in Paraguay, rotavirus infections in children less than 5 years old present a seasonal peak pattern (since June to October), in adults rotavirus was present throughout the year with the same frequency. Results presented here reinforce the notion that rotavirus should be considered in the differential diagnosis of diarrhea in adults.