الفهرس 
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Abstract
Acute gastroenteritis is common among children who visited medical institutions. The norovirus is one of the leading pathogens of acute gastroenteritis across all age groups, and accounts for 18% of acute gastroenteritis cases worldwide. Furthermore, the norovirus became the predominant pathogen in pediatric viral gastroenteritis cases in the United States after the introduction of successful rotavirus vaccines.
This study was a case control study conducted at Beni-Suef University Hospital to evaluate the role of interleukin-6 in patients with norovirus gastroenteritis.
The children were classified according to the pathogen recovered from the stool by direct viral antigen detection by enzyme immunoassay (EIA) into 60 gastroenteritis cases with positive norovirus and 60 gastroenteritis cases with non-norovirus and 60 free healthy controls. Patients who fulfilled the inclusion criteria were subjected to full history taking in the form of clinical history was taken from the patient’s relatives, the clinical symptoms of gastroenteritis, nutritional state of the patients. The severity of illness was assessed using the 20-point Vesikari scoring system. Laboratory investigations including the routine CBC, CRP, serum electrolytes in addition to serum IL-6 level.
The main findings of our study were:
According to the socio-demographic data of the patients, this study showed that there was no significant difference between cases in all groups regarding their age, sex and residence. The mean age for patients with positive norovirus was 12.3±8.7 years, most of them were males (62.1 %) and those living in rural areas was 91.4 % of cases. Similarly, patients with negative norovirus their mean age was 10.7±7.3 years, males represented 50 % of cases and most of them were living in rural areas (75 %).
Patients usually present with diarrhea which may be associated with fever, vomiting and abdominal cramps. For patients with positive norovirus fever was recorded in 55 cases representing 91.6 % of cases. About 50 patients (83.3 %) of cases complained from abdominal cramps and all patients had vomiting. There was a significant association of fever, abdominal cramps, and vomiting with cases with positive antigen of norovirus. As regards the systemic manifestations of norovirus, 11.7 % of patients with positive norovirus had chest manifestations and neurological and cardiac manifestations were recorded in 6.7 % of patients for each.
The degree of dehydration was assessed using the Vesikari modified severity score that showed a score of 9.4±1.3 for patients with positive norovirus versus 8.4±2 for patients with negative norovirus. According to the degree of dehydration, 53.3 % of patients with positive norovirus had moderate dehydration and 30 % had mild dehydration while only 16.7 % of patients had severe dehydration.
The mean platelet level was 281.1±89.5 for patients with positive norovirus. The mean TLC count was 8.9±1.5 for cases with positive norovirus and CRP reached 6±2.9. Regarding the hemoglobin level, it was significantly higher in control than negative norovirus and positive norovirus. The mean serum sodium level for cases with positive norovirus was 141.3±3.6 and the mean potassium level was 4.4±0.6.
Also, there was a significant association of improvement in gastroenteritis with norovirus than gastroenteritis cases without norovirus. Of the 60 cases with positive norovirus 40 cases (66.7%) improved, and 20 cases (33.3%) not improved.
The mean level of IL-6 for patients with positive norovirus was 164.7±37 and for cases with negative norovirus antigen was 113.6±35.9 compared to the healthy control cases where the mean level was 54.4±17.2. There was a significant difference between cases regarding the IL 6 level.
At a cut off more than or equal 81.4, IL-6 can predict the gastroenteritis (irrelevant on the cause vs control) with 95% sensitivity and 90% specificity. At a cut off more than or equal 73.1, IL-6 can predict the non-Norvo GE (vs control) with 91.7% sensitivity and 87.5% specificity. At a cut off more than or equal 85.3, IL-6 can predict the Norvo gastroenteritis (vs control) with 97.4% sensitivity and 92.5% specificity. At a cut off more than or equal 108.3, IL-6 can predict the Norvo gastroenteritis (vs non-Norvo gastroenteritis) with 94% sensitivity and 55% specificity.