From the Guidelines
When testing for viral gastroenteritis, the most common viruses to check for include norovirus, rotavirus, adenovirus, astrovirus, and sapovirus, with norovirus being the leading cause in adults and rotavirus historically being the primary cause in children, as indicated by the 2017 Infectious Diseases Society of America clinical practice guidelines for the diagnosis and management of infectious diarrhea 1.
Key Viruses to Test For
- Norovirus
- Rotavirus
- Adenovirus
- Astrovirus
- Sapovirus
Testing for these viruses typically involves collecting stool samples for PCR testing, which can detect viral genetic material, as well as enzyme immunoassays, particularly for rotavirus 1. The identification of the specific virus can help with infection control measures, especially in healthcare or institutional settings, and may guide management decisions in certain populations like immunocompromised patients.
Testing Recommendations
Testing is usually reserved for severe cases, outbreaks, immunocompromised patients, or when the diagnosis is unclear, as most viral gastroenteritis cases are self-limiting and don't require specific treatment beyond supportive care 2. The 2017 guidelines for the prevention and treatment of travelers' diarrhea also support this approach, recommending microbiologic diagnosis in returning travelers with severe or persistent symptoms, bloody diarrhea, or mucus in the stools 2.
Diagnostic Methods
The use of multi-pathogen molecular-based clinical assays, such as the xTAG Gastrointestinal Pathogen Panel (GPP) or the FilmArray GI panel, can detect a variety of relevant bacteria, viruses, and parasites, providing quick identification and potential impact on treatment decisions 2. However, the clinical outcomes advantage and financial impact of these molecular panels have not yet been fully evaluated, and interpretation may be difficult due to the potential for detecting colonization rather than infection.
Infection Control Measures
The updated norovirus outbreak management and disease prevention guidelines emphasize the importance of good hand hygiene, excluding ill staff and residents from certain positions, and reinforcing effective preventive controls and employee practices to prevent the spread of norovirus and other viral gastroenteritis causes 3.
From the Research
Viruses to be Tested for in Acute Gastroenteritis
The following viruses should be considered for testing in cases of acute gastroenteritis:
- Norovirus genogroups I and II 4, 5, 6
- Rotavirus group A 4, 5, 7, 8
- Astrovirus 4, 5, 7, 8, 6
- Adenovirus (particularly serotypes 40 and 41) 4, 5, 7, 8, 6
- Sapovirus 4, 5, 7
Diagnostic Methods
Various diagnostic methods are available for detecting these viruses, including:
- Multiplex real-time PCR assays 4, 5, 7, 8
- Reverse transcription-PCR and nucleotide sequencing 5
- Commercial immunoassays (e.g., Vikia(®) Rota/Adeno test) 4
- Fast-Track Diagnostic (FTD) viral gastroenteritis assay 5
- RIDA®GENE RT-PCR assays 7
- InGenius Gastrointestinal Viral (GV) Elite Panel multiplex RT-PCR assay 8
Importance of Testing
Testing for these viruses is crucial for accurate diagnosis and effective patient care, particularly in vulnerable populations such as the elderly 6. Early identification of the causative virus can help reduce unnecessary treatments and hospital stays.