Post-infectious gastroenterological pathology’s mechanisms in children with rotavirus infection

Introduction: Rotavirus infection (RVI) is one of the most common childhood illnesses in countries where routine vaccination against the disease isn`t introduced. The incidence of RVI in Russia remains at a consistently high level, leading to a huge socio-economic damage. In addition, in children who have undergone severe forms of the disease, have high risk of post-infectious functional disorders of the gastrointestinal tract (FD), leading to a decrease in the quality of life and prolonged persistence of dyspeptic phenomena. The pathogenetic mechanisms and factors predisposing to FD in RVI convalescents remain insufficiently studied.

The aim of the study was to establish the possible role of intestinal microbiocenosis disorders and immune response in the formation of gastroenterological pathology in children, convalescents of RVI.

Material and methods: The work was performed in 2014- 2019. in Pediatric Research and Clinical Center for Infectious Diseases. In the course of the implementation, a comprehensive clinical and laboratory examination was carried out for 60 children aged 1 to 7 years who had suffered RVI in a severe or moderate form, since the onset of infection followed by a three-year follow-up observation. Particular attention was paid to the assessment of intestinal microbiocenosis and immune response in the study group of patients. The interpretation of dyspeptic symptoms in the follow-up period was carried out on the basis of the Rome IV revision criteria. The structure of gastrointestinal tract disorders after rotavirus infection has been established.

Results: It was shown that with RVI, persistent changes in the intestinal microbiota are observed, characterized by a decrease in the number of symbiotic Bacteroides thetaiataomicron, Lactobacillus spp. and Faecalibacterium prausnitzii and overgrowth of semipathogenius microorganisms, including Bacteroides fragilis.

Conclusion: A close relationship of a number of factors (a decrease in the level of virus-induced production of IFNγ and serum IgA, overgrowth of Proteus spp., Bacteroides fragilis and a decrease in the level of Faecalibacterium prausnitzii and Bacteroides thetaiotaomicron) with the formation of FD in the follow-up period was revealed.

1. Gorelov, A.V. Rotavirusnaya infekciya u detej / A.V. Gorelov, D.V. Usenko // Vopr. sovrem. pediatrii. – 2008. – T. 7, № 6. – S. 78-84.

2. Denisyuk, N.B. Etiologicheskaya struktura i nekotorye klinicheskie osobennosti kishechnyh infekcij u detej, gospitalizirovannyh v infekcionnyj stacionar g. Orenburga / N.B. Denisyuk, YU.D. Kagan // Med. al’manah. – 2013. – T. 30, № 6. – S. 143-146.

3. Incidence of post-infectious irritable bowel syndrome and functional intestinal disorders following a water-borne viral gastroenteritis outbreak / B. Zanini [et al.] // The American journal of gastroenterology. – 2012. – Vol. 107, № 6. – P. 891-899.

4. Grigorovich, M.S. Osobennosti epidemiologicheskogo processa i mediko-social’nye faktory razvitiya ostryh kishechnyh infekcij i ih iskhodov u detej / M.S. Grigorovich, S.V. Slavinskaya // Vyatskij med. vestn. – 2015. – T. 46, № 2. – S. 34-37.

5. Nataro, J.P. Diarrhea among children in developing countries / J.P. Nataro // Hot Topics in Infection and Immunity in Children IX. – Springer New York, 2013. – P. 73-80.

6. Spiller, R. An update on post-infectious irritable bowel syndrome: role of genetics, immune activation, serotonin and altered microbiome / R. Spiller, C. Lam // J Neurogastroenterol Motil. – 2012. – Vol. 18, № 3. – P. 258-268.

7. Thabane, M. Systematic review and meta-analysis: The incidence and prognosis of post-infectious irritable bowel syndrome / M. Thabane, D.T. Kottachchi, J.K. Marshall // Aliment Pharmacol Ther. – 2007. – Vol. 26, № 4. – P. 535-544.

8. Bel’mer, S.V. Funkcional’nye i strukturnye narusheniya organov pishchevareniya u detej: v poiskah granic i kriteriev / S.V. Bel’mer // Ros. vestn. perinatologii i pediatrii. – 2013. – T. 58, № 1. – C. 4-7.

9. Moon, C. Viral interactions with the host and microbiota in the intestine / C. Moon, T.S. Stappenbeck // Current opinion in immunology. – 2012. – Vol. 24, № 4. – P. 405-410.

10. Ouwerkerk, J.P. Glycobiome: bacteria and mucus at the epithelial interface / J.P. Ouwerkerk, W.M. de Vos, C. Belzer // Best practice & research Clinical gastroenterology. – 2013. – Vol. 27, № 1. – P. 25-38.

11. Spiller, R.C. Infection, immune function, and functional gut disorders / R.C. Spiller // Clinical Gastroenterology and Hepatology. – 2004. – Vol. 2, № 6. – P. 445-455.

12. Low counts of Faecalibacterium prausnitzii in colitis microbiota / H. Sokol [et al.] // Inflammatory bowel diseases. – 2009. – Vol. 15, № 8. – P. 1183-1189.

13. Immune Activation in Irritable Bowel Syndrome: Can Neuroimmune Interactions Explain Symptoms&quest / P.A. Hughes [et al.] // The American journal of gastroenterology. – 2013. – Vol. 108, № 7. – P. 1066-1074.

14. Swain, S.L. Expanding roles for CD4+ T cells in immunity to viruses / S.L. Swain, K.K. McKinstry, T.M. Strutt // Nature Reviews Immunology. – 2012. – Vol. 12, № 2. – P. 136-148.

15. Calo-Mata P. et al. Intestinal microbiota: first barrier against gut-affecting pathogens //New Weapons to Control Bacterial Growth. – Springer, Cham, 2016. – S. 281-314.

16. Rabizadeh S. et al. Enterotoxigenic Bacteroides fragilis: a potential instigator of colitis //Inflammatory bowel diseases. – 2007. – T. 13. – №. 12. – S. 1475-1483.

17. Ulger Toprak N. et al. A possible role of Bacteroides fragilis enterotoxin in the aetiology of colorectal cancer //Clinical microbiology and infection. – 2006. – T. 12. – №. 8. – S. 782-786.

18. Twitchell E. L. et al. Modeling human enteric dysbiosis and rotavirus immunity in gnotobiotic pigs //Gut pathogens. – 2016. – T. 8. – №. 1. – S. 1-18.