Prevalence of Norovirus Coinfection in Clostridioides difficile Toxin Positive Patients

Abstract

Objective: In this study we aimed to evaluate the prevalence of norovirus genogroups I and II and C.difficile coinfection among patients with gastroenteritis symptoms. Method: A total of 76 patients with diarrhea were included in the study. Of these, 40 are children (<18y), 23 are adults between the ages of 18-65y, and 13 are patients older than 65 years. All these were C.difficile toxin GDH/Toxin A+B (BIOTEC, Spain) positive. In these toxin positive stool samples, Norovirus GI and GII antigen was studied by 2 methods; i.ELISA (R Biopharm, Darmstadt, Germany) and ii.polymerase chain reaction (RT – PCR). We compared the results of the antigen test (ELISA) with those of PCR for the detection of norovirus in stool specimens. SPSS 19.0 statistical program was used to evaluate the data of the research. Results: Out of 76 stool samples tested, 3 (3.9%) were positive for norovirus by ELISA. Subsequent RT-PCR identified norovirus GI and GII in 7 samples (9.2%). Concerning RT-PCR, the sensitivity of the ELISA test was 42.8%, and the specificity was found as 96%. Conclusion: The study identified a 9.2% rate of co-infection with C. difficile and norovirus, with this co-infection being particularly prevalent in children. This finding emphasizes the critical need to consider both co-infection and C. difficile infection as potential causes of diarrhea in hospitalized patients, especially those under 18 or over 65 years old. Keywords: C. difficile, Coinfection, ELISA, Norovirus, PCR