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Simultaneous investigation of influenza and enteric viruses in the stools of adult patients consulting in general practice for acute diarrhea

Christophe Arena1234*, Jean Pierre Amoros1234, Véronique Vaillant5, Katia Balay6, Roxane Chikhi-Brachet7, Laurent Varesi3, Jean Arrighi4, Thierry Blanchon12, Fabrice Carrat128, Thomas Hanslik19 and Alessandra Falchi1234

Author Affiliations

1 INSERM, UMR-S 707, 75012, Paris, France

2 UPMC Université Paris 06, UMR-S U707, 75012, Paris, France

3 Laboratory of Virology, University of Corsica, Corsica, France

4 Regional Observatory of Health of Corsica, Ajaccio, France

5 Department of Infectious Diseases, Institut de Veille Sanitaire (InVS) (French Institute for Public Health Surveillance), Saint-Maurice, France

6 National Reference Center for Enteric Viruses, Laboratory of Virology, CHU of Dijon, Dijon, France

7 French National Agency for Research on AIDS and viral hepatitis, Paris, France

8 Public health department, Saint-Antoine hospital, APHP, Paris, France

9 UVSQ, Université de Versailles Saint Quentin, Versailles, France

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Virology Journal 2012, 9:116  doi:10.1186/1743-422X-9-116

Published: 18 June 2012

Abstract

Background

Gastrointestinal symptoms are not an uncommon manifestation of an influenza virus infection. In the present study, we aimed to investigate the presence of influenza viruses in the stools of adult patients consulting their general practitioner for uncomplicated acute diarrhea (AD) and the proportion of concurrent infections by enteric and influenza viruses.

Method

A case-control study was conducted from December 2010 to April 2011. Stool specimens were collected and tested for influenza viruses A (seasonal A/H3N2 and pandemic A/H1N1) and B, and for four enteric viruses (astrovirus, group A rotavirus, human enteric adenovirus, norovirus of genogroups I – NoVGI - and genogroup II - NoVGII).

Results

General practitioners enrolled 138 cases and 93 controls. Of the 138 stool specimens collected, 92 (66.7%) were positive for at least one of the four enteric viruses analysed and 10 (7.2%) tested positive for one influenza virus. None of these 10 influenza positive patients reported respiratory symptoms. In five influenza-positive patients (3.6%), we also detected one enteric virus, with 4 of them being positive for influenza B (2 had co-detection with NoVGI, 1 with NoVGII, and 1 with astrovirus). None of the 93 controls tested positive for one of the enteric and/or other influenza viruses we investigated.

Conclusions

In this study we showed that the simultaneous detection of influenza and enteric viruses is not a rare event. We have also reported, for the first time in general practice, the presence of seasonal and pandemic influenza viruses in the stools of adult patients consulting for uncomplicated AD. A simultaneous investigation of enteric and influenza viruses in patients complaining of gastrointestinal symptoms could be useful for future studies to better identify the agents responsible for AD.

Keywords:
Influenza virus; Enteric virus; Stools; Co-infection; General practice