CARBOHYDRATE MALABSORPTION SYNDROME IN CHILDREN WITH VIRAL GASTROENTERITIS

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Abstract

Background: Enteric viruses (mainly rotaviruses) are the most common cause of infectious diarrhea in infants. One  of the  pathophysiologic mechanisms in rotaviral gastroenteritis is the  reduction of the  surface  activity of enterocyte disaccharidases  and  osmotic  diarrhea. Aim: To determine the clinical significance of metabolic activity of intestinal microbiota in the formation of the osmotic component of viral diarrhea in children of various ages. Materials and methods: The study involved 139 children aged  from 1 month  to 14 years admitted to the hospital in the first 24 to 72 hours of moderate-degree  viral gastroenteritis.  Rotaviral infection was the most prevalent  (90%). Viral etiology was confirmed  by the  reaction  of indirect hemagglutination and multiplex real-time PCR (in feces). Total carbohydrate content in the feces was measured and fecal microflora was investigated by two methods: bacteriological and gas liquid chromatography with the determination of short-chain fatty acids. Results: The mean carbohydrate content in the feces of children below 1.5 years of age was higher than  that  in older children (p = 0.014). There was an inverse correlation between the concentration of rotaviral antigens  and carbohydrate   contents (r = -0,43, p < 0.05) and the production of acetic and propionic acids (R = -0,35, p < 0.01). The carbohydrate content in acute stage of the disease was linearly associated with time to normalization of the stool (r = +0,47, p < 0.01). Previous acute  respiratory or intestinal  infections within 2 months (odds ratio [OR], 14.10; 95% confidence interval [CI] 3.86–51.53), previous  hospitalizations  (OR = 14.17; 95% CI 2.74–74.32) and  past  history of intestinal dysfunction (OR 5.68; 95% CI 1.67–19.76) were predictive of severe  carbohydrate malabsorption in children below 1.5 years of age. Conclusion: The lack of microbiota functional activity (assessed by production of short-chain  fatty acids) determines the  development of osmotic  phenotype of diarrhea, that marks the total carbohydrate contents in the feces. Its predisposing factors should be taken into account  when making a decision to hospitalize.

About the authors

E. R. Meskina

Moscow Regional Research and Clinical Institute

Author for correspondence.
Email: meskinaelena@rambler.ru
Meskina Elena R. – MD, PhD, Professor, Head of Department of Pediatric Infections Россия

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