Acute gastroenteritis (AGEs) are currently mostly caused by the human norovirus in the majority of nations around the world. The scientific and medical communities still produce new understanding about the whole biology and...
Acute gastroenteritis (AGEs) are currently mostly caused by the human norovirus in the majority of nations around the world. The scientific and medical communities still produce new understanding about the whole biology and illness spectrum of norovirus infection nearly 50 years after Kapikian and colleagues first identified the "Norwalk virus" in humans. Due to the severe limitations on how well the virus can replicate and spread, a number of areas are still poorly understood.
Here, we provide a narrative historical perspective and summarise our current understanding. We also provide insights and observations on contemporary topics of relevance for a large medical community, such as clinical and molecular epidemiology, viral-host-microbiota interactions, antivirals, and vaccine prototypes. We also offer some analysis of the COVID-19 pandemic's current and potential effects on Norovirus infection and illness.
Human caliciviruses, which are currently divided into two genera: the Norovirus and Sapovirus, have been studied by the scientific and medical communities for more than 50 years to learn more about their broad biology and clinical spectrum. The norovirus (NoV), which is currently the most often found human pathogen in the family, will be the main focus of this review.
We will concentrate on significant historical developments and contemporary understanding that may be of interest to a large medical readership, and we will suggest what we perceive to be the fundamental obstacles to more effective management of NoV-associated disease.
NoV has become a leading cause of AGE in most regions and age groups in recent years, thanks to advancements achieved in its detection by sensitive molecular diagnostic techniques and the development of the rotavirus vaccine.
It is linked to an estimated 685 million episodes, 212,000 fatalities each year, and close to 20% of all acute diarrhoea cases worldwide. NoV causes 19 to 21 million illnesses in the US each year, resulting in 900 fatalities, 103,000 hospitalisations, 460,000 trips to the ER, and 2.6 million outpatient visits. It has been identified as the main agent of AGE outbreaks affecting people of all ages as well as a relevant cause of acute endemic diarrhoea in children under the age of five.
All socioeconomic classes are susceptible to NoV infections, which are widespread in both developed and developing nations. However, socioeconomic status is associated to the likelihood of contracting and the severity of NoV infections. In lower middle- and low-income countries, the detection rates of NoV in AGE episodes dropped from 18% (95% CI: 16-20%) to 15% (13-18%) and 6% (3-10%), respectively, according to a systematic study . NoV was found in 11% (95% CI 10-12%) of those in low-income countries (vs. 9% of asymptomatic controls) and 15% (95% CI 15-16%) of children with AGE in low-middle-income countries (vs. 8% of healthy controls).
Norovirus has been compared to a "shape-shifter" (18), a fantastical creature that has the ability to change its appearance. This description relates to its diversity, with the VP1 amino acid sequence identifying at least 6 genogroups (genogroup I [GI] to GVI) and >40 genotypes (18, 19), as well as its ongoing evolution, which is thought to have been triggered by the selection pressure put on it by the human immune system (20).
GII (mainly GII.4), GI, and, to a very limited extent, GIV (certain genotypes of which also infect pigs) are the three noroviruses that most frequently infect humans, in decreasing order of frequency (21, 22). Additionally, antibodies to GVI (a genogroup that has only been identified in canines) and GIII (a bovine norovirus) have both been found in about 22% of humans and canines, respectively .
NOROVIRUS IN IMMUNOCOMPROMISED HOSTS
Immunocompromised people may also experience longer disease durations and more severe symptoms from norovirus infections, and some of these people may also have extremely persistent viral excretion.
Recipients of hematopoietic stem cell transplants. The frequent occurrence and variety of causes of diarrhoea in hematopoietic stem cell transplant (HSCT) recipients, including gastrointestinal graft-versus-host disease (GVHD), make it difficult to diagnose norovirus in these individuals.
In 6 of 8 patients in a bone marrow transplant facility who had watery diarrhoea, a minor epidemic of norovirus was identified .In two of these individuals, gastrointestinal graft-versus-host disease coexisted with norovirus infection. All of the patients had a fever. For 8 to 33 days, digestive issues continued. No fatalities have been linked to norovirus infection.
11 patients and 11 staff personnel were impacted by an outbreak of the norovirus GII.4 variant strain in a haematology and transplantation centre (54). Five of the patients had received treatment Ultrasound Whole Abdomen for acute leukaemia, and six had received lymphoma treatment. Seven patients had neutropenia, five underwent hematopoietic stem cell transplantation (2 autologous and 3 allogeneic), three had chemotherapy, and one had simply received rituximab.
Although the median symptom duration was just 3 days in the staff, it was 7 days (with a range of 2 to 36 days) in the patients. While 8 of the 11 patients experienced vomiting, 6 had a fever, and all 11 individuals had diarrhoea. CECT Abdomen Evidence of small intestinal edoema was seen in two patients who underwent abdominal computerised tomography.
The primary goals of supportive care for norovirus gastroenteritis are to reverse electrolyte imbalances and dehydration. Some patients may benefit from the use of antiemetics and anti motility drugs.
The availability of a particular therapy would be beneficial for patients with lingering symptoms, notably newborns, the elderly, and immunocompromised individuals, but no medication has been conclusively proven to be efficient.
The administration of nitazoxanide was linked to a shorter duration of sickness, including in a subset of patients with norovirus infection, according to a small, blind, placebo-controlled trial of kids with viral gastroenteritis (85). After receiving nitazoxanide, Siddiq and colleagues reported that a norovirus-infected patient with refractory acute myelogenous leukaemia and HSCT no longer experienced diarrhoea
. Eight patients had both rotavirus and Clostridium difficile coinfection. Immunoglobulin administration was linked (P = 0.09) to a Stool Routine and Microscopy numerical reduction in stool production Stool Culture after 7 days. However, whereas this 7-day period was calculated from the time of treatment in cases, it was calculated from the time of diagnosis in controls, which may have resulted in a bias favouring the administration of immunoglobulin.
Despite this potential bias, there was no appreciable difference in the duration of diarrhoea between patients and controls, which was around 12 days. There was a numerically higher frequency of diarrheic resolution in cases (P = 0.078), but there was no difference in the overall time to resolution of diarrhoea or the length of hospital stay that was statistically or clinically significant.
In hospitals and the general public, norovirus is a significant contributor to morbidity from acute gastroenteritis. The disease has a large negative impact on the health care system even though mortality is mainly restricted to the oldest and youngest people.
Therapeutic therapy is often supportive, and developments in molecular diagnostics may help to identify epidemics sooner and reduce person-to-person transmissions, especially in patient populations who are more susceptible to infection. New diagnostic techniques will boost ongoing global reporting activities.
The expanding understanding of the clinical ramifications of distinct norovirus strains will also aid global control efforts. The link between the virus strain, the CBC host human blood group antigen type, and illness susceptibility has lately been clarified in a number of ways, however