Published online November 1, 2006
PEDIATRICS Vol. 118 No. 5 November 2006, pp. 2256-2257 (doi:10.1542/peds.2006-2272)
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LETTER TO THE EDITOR

Rotavirus Gastroenteritis Leading to Secondary Bacteremia in Previously Healthy Infants: In Reply

Alexander Lowenthal, MD, MSc
Department of Pediatrics A
Schneider Children's Medical Center of Israel
Petach Tikva 49202, Israel

Gilat Livni, MD
Shai Ashkenazi, MD, MSc
Department of Pediatrics A and Unit of Infectious Diseases
Schneider Children's Medical Center of Israel
Petach Tikva 49202, Israel
Sackler School of Medicine
Tel Aviv University
Tel Aviv 69978, Israel

We appreciate the comments of González-Carretero et al regarding our article1 and would like to add some new insights to this issue. It is gratifying to see that their experience concerning secondary bacteremia after rotavirus gastroenteritis in infancy is similar to ours, particularly the similar typical clinical picture of this complication: a second peak of fever in young infants during actual improvement of their initial gastrointestinal symptoms.

González-Carretero et al have calculated the incidence rate of this complication as 0.22% (2 of 891) in all children younger than 6 years who had been hospitalized with rotavirus gastroenteritis. Two comments can be made with respect to this estimated rate. First, their 2 patients with secondary bacteremia were infants (6 weeks and 10 months old), as were the 4 patients reported by us. It seems, therefore, that this complication is found mainly in infants, in whom the incidence rate is obviously higher than in older children. The high incidence of bacteremia in young infants has been documented in other similar settings (eg, Salmonella bacteremia after gastroenteritis2). Second, because this was not a prospective study, one can assume that blood cultures were not obtained for every child with rotavirus gastroenteritis on recurrence of fever.

To have an estimate of the incidence of this complication in our institution, we retrospectively reviewed the number of cases of rotavirus gastroenteritis over 2 years, the time in which our 4 cases of secondary bacteremia were detected. During the 2-year period we had 1145 children (<6 years) hospitalized with rotavirus gastroenteritis, of whom 588 were infants under the age of 1 year. Thus, the estimated incidence of secondary bacteremia after rotavirus gastroenteritis among children hospitalized in our medical center was 0.35% (4 of 1145), but the incidence in infants (<1 year) was 0.68% (4 of 588). Again, this is probably an underestimate, because our analysis was retrospective and we are not sure that every child had a blood culture drawn on recurrence of fever.

To date, 11 cases of secondary bacteremia after rotavirus gastroenteritis have been reported from different locations.1,3–5 It can be concluded that this complication of rotavirus gastroenteritis is uncommon but real, especially in neonates and young infants, and can be complicated by sepsis3,4 or even septic shock.5 Pediatricians should be aware of this rare but potentially serious complication of rotavirus gastroenteritis. When suspected, blood cultures should be obtained and empiric antibiotic therapy should be considered.

REFERENCES

  1. Lowenthal A, Livni G, Amir J, Samra Z, Ashkenazi S. Secondary bacteremia after rotavirus gastroenteritis in infancy. Pediatrics. 2006;117 :224 –226[Abstract/Free Full Text]
  2. Torrey S, Fleisher G, Jaffe D. Incidence of Salmonella bacteremia in infants with Salmonella gastroenteritis. J Pediatr. 1986;108 :718 –721[CrossRef][ISI][Medline]
  3. Adler A, Wollach B, Kilman A, Gottesman G. Enteric Gram-negative sepsis complicating rotavirus gastroenteritis in previously healthy infants. Clin Pediatr (Phila). 2005;44 :351 –354[Free Full Text]
  4. Cicchetti R, Iacobini M, Midulla F, Papoff P, Mancuso M, Moretti C. Pantoea agglomerans sepsis after rotavirus gastroenteritis. Pediatr Infect Dis J. 2006;25 :280 –281[Medline]
  5. Carneiro NB, Diniz-Santos DR, Amorim C, et al. Septic shock complicating acute rotavirus-associated diarrhea. Pediatr Infect Dis J. 2006;25 :571 –572[CrossRef][ISI][Medline]
PEDIATRICS (ISSN 1098-4275). ©2006 by the American Academy of Pediatrics




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