Norovirus fever
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Norovirus Fever: Clinical and Epidemiological Insights
Norovirus Fever in Gastroenteritis Outbreaks
Norovirus is a leading cause of acute gastroenteritis outbreaks, often characterized by symptoms such as vomiting, diarrhea, and fever. The Kaplan criteria, which include vomiting in more than 50% of cases, a mean incubation period of 24-48 hours, and a mean illness duration of 12-60 hours, are highly specific (99%) but moderately sensitive (68%) in distinguishing norovirus from bacterial causes of gastroenteritis 14. Fever is a common symptom in norovirus infections, although its prevalence and intensity can vary.
Clinical Characteristics of Norovirus in Children
In hospitalized children under the age of three, norovirus infection frequently presents with vomiting (94%), diarrhea (81%), and fever (66%) . The infection can manifest as gastroenteritis with or without fever, with 47% of cases involving fever and 30% without it. Compared to rotavirus, norovirus infections in children show statistically significant differences in fever presence and intensity, with fever occurring in 66% of norovirus cases versus 97% in rotavirus cases .
Norovirus Fever in Hospitalized Children in Spain
A study conducted in Spain found that norovirus was the second most frequent cause of acute severe sporadic gastroenteritis in children, following rotavirus. Among the children affected, 48.3% experienced fever, and vomiting was present in 68% of cases . The study highlighted that norovirus infections were slightly less severe than rotavirus infections, with fever being less frequent in norovirus cases .
Norovirus Fever in Nosocomial Outbreaks
Nosocomial outbreaks of norovirus, particularly in elderly patients, often involve fever. In a study of outbreaks in Hong Kong, fever was reported in one-third of the cases . These outbreaks predominantly affected frail elderly patients with limited mobility, who experienced prolonged symptoms, including fever .
Predicting Norovirus Outbreaks Using Internet Search Trends
Internet search trends have been used to predict norovirus outbreaks. Terms such as "fever," "gastroenteritis," and "watery diarrhea" were found to correlate with norovirus trends on Google . This method provides a novel strategy for early detection and reporting of norovirus outbreaks, potentially aiding in timely public health responses .
Chronic Norovirus Infection and Fever in Immunocompromised Patients
In immunocompromised individuals, such as renal transplant recipients, norovirus can cause chronic infections. One case study reported a patient with severe symptomatic chronic infection, including fever, recurrent diarrhea, and weight loss. The symptoms and virus were only eliminated after reducing immunosuppression . This highlights the importance of considering norovirus in the differential diagnosis of both acute and chronic diarrhea in transplant patients .
Conclusion
Norovirus infections frequently involve fever, though its prevalence and intensity can vary based on the population and setting. The Kaplan criteria remain a useful tool for identifying norovirus outbreaks, and internet search trends offer a promising method for early outbreak detection. Understanding the clinical characteristics of norovirus, especially in vulnerable populations like young children and the elderly, is crucial for effective management and prevention strategies.
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Reevaluation of epidemiological criteria for identifying outbreaks of acute gastroenteritis due to norovirus: United States, 1998-2000.
The criteria of Kaplan et al. remain the most useful and discriminating diagnostic aid for identifying foodborne outbreaks of gastroenteritis due to noroviruses, even without readily available norovirus diagnostic tests.
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Peculiarities of Norovirus and Rotavirus Infections in Hospitalised Young Children
Norovirus and rotavirus infections in young children differ significantly in fever presence, intensity of diarrhoea and vomiting, and frequency of different syndromes.
Clinical and Epidemiologic Profiles for Identifying Norovirus in Acute Gastroenteritis Outbreak Investigations
The CART-derived profile is more sensitive and broader in distinguishing norovirus from nonviral acute gastroenteritis outbreaks than the Kaplan criteria, making it a more useful tool for outbreak investigations.
Chronic norovirus infection in renal transplant recipients.
Norovirus can cause both asymptomatic and symptomatic chronic infection in renal transplant recipients, with virus elimination requiring reduced immunosuppression in symptomatic cases.
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