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ROTAVIRUS ASSOCIATED WITH ACUTEGASTROENTERITIS IN ADULTS

SIR,—Several reports point to a considerable proportion ofacute non-bacterial gastroenteritis in children being caused bya reovirus-like agent’ now generally referred to as rotavirus.2Cnlike the Norwalk agent, another diarrhoea-associated virus,3the rotavirus is generally considered to infect only infants andyoung children.4 Rotavirus infection in schoolchildren (6-12years old) has also been noted’ but, to our knowledge, only oneexperimental case in an adult has hitherto been reported.6During an outbreak of gastroenteritis (March to April,

1976) at a pxdiatric ward for non-infectious diseases some ofthe staff also contracted the disease. Stool samples were sus-pended in phosphate-buffered saline and, after brief centrifu-gation, negatively stained preparations were examined by elec-tron microscopy. Typical rota virus particles were found inseveral children and in one of the two nurses from whom sam-

ples were obtained. Tests for pathogenic bacteria were nega-tive.A similar situation was discovered at Rinnekoti, an institute

for mentally retarded children. During an outbreak of gastro-enteritis rotavirus was found in stool samples of severalchildren. In two nurses with severe acute gastroenteritis rota-virus was present in stool samples taken between the secondand fifth day from the onset of the disease. In later samples novirus was found. Immune electron microscopy4 revealed thedevelopment of rotavirus coating and aggregating antibodiesin serum obtained from one of these patients.The above findings suggested that adults may contract rota-

virus infections, at least when exposed to rotavirus-excretingchildren. To find out whether rotavirus might occur moregenerally in connection with adult gastroenteritis, stool andserum samples were collected from cases of acute gastroenter-itis at the hospital staff occupational health station of the Hel-sinki University Central Hospital. During a 6-week period inApril and May, 1976, adequate samples were obtained from 42patients. In 11 of these rotavirus could be visualised in thestool samples taken from one up to nine days after the onsetof the dtsease. By immune electron microscopy it was foundthat antibodies developed in all 7 rota virus-positive patientsstudied. The diarrhoea in these patients was often severe, as-sociated with relatively high fever (>39°C), and lasted forabout two days. These patients were from several differentclinics and wards; only 2 of them had occupational contactwith children.Our results clearly indicate that rota virus can be associated

with acute gastroenteritis of adults. This does not contrastwith the high incidence of rota virus-specific antibodies foundin adults.’ 9 It cannot at present be judged, however, whetherthe observed clinical symptoms are caused primarily by theviral multiplication in the intestines, especially since rotavirushas been found in symptom-free newborn babies.1O In ourmaterial the rota virus incidence in adult gastroenteritis wascomparable to that found in 115 children examined during thesame time period (26 and 40%, respectively). More extendedstudies are needed to establish whether rotavirus is a commoncausative agent of adult gastroenteritis in the community.These findings also call for attention to be paid to the possible

1 Bishop, R F, Davidson, G. P., Holmes, I. A., Ruck, B. J. Lancet, 1974, i,149

2 Almeida, J D , Zackerman, A. J Nature, 1976, 260, 393.3 Kapikian, A Z, Wyatt, R. G., Dolin, R., Thornhill, T. S., Kalica, A. R.,

Chanock, R M. J. Virol. 1972, 10, 1075.4 Kapikian, A. Z Prev. Med. 1974, 3, 535.5 Hara, M, Mukoyama, J., Tsuruhara, T., Saito, Y., Tagaya, I. Lancet, 1976,

i, 3116 Middleton, P J , Szymanski, M T., Abbott, G. D., Bortolussi, R., Hamilton,

J R ibid 1974, i, 1241.7 Almeida, J D., Waterson, A. P Adv. Virus Res. 1967, 15, 307.8 Middleton, P J, Petnc, M., Hewitt, C. M , Szymanski, M. T., Tam, I. S.

J clin. Path 1976, 29, 191.9 ∅rstavik, I, Figenschan, K. J., Haug, K. W., Ulstrup, J. C. Scand. J. infect.

Dis. 1976, 8, 1.10 Wkly. Epidem Rec. 1976, 51, 131.

role of staff members in transmitting rotavirus infections inchildren’s wards.

Department of Virology,University of Helsinki,00290 Helsinki 29, Finland

C. -H. VON BONSDORFFT HOVI

Helsinki University Central Hospital P. MÅKELÅ

Children’s Hospital,University of Helsinki

L. HOVIM. TEVALVOTO-AARNIO

IMMUNOSUPPRESSION BY FATTY ACIDS

SIR--Smith and his colleagues (July 31, p. 254) emphasisethat a wide range of long-chain fatty acids have an immuno-suppressive effect, by reference to results obtained with hepta-decanoic acid. Its effect seems unlikely to be very differentfrom that of the common hexadecanoic acid (palmitic acid).

At any rate, Mertin and Hughes’ chose to study unsaturatedfatty acids because they were attracted to the idea that a pro-staglandin-like action might account for the immuno-

suppressive effects. I would like to point out that a non-specificdetergent action of the long-chain fatty acids has been invokedto explain events in enzyme regulation2 and notably in thefeedback control of fatty-acid synthetase.3 If the fatty acidswere to enter the immunocytes one could envisage alterationof the catalytic efficiency or the synthesis-rate of a variety ofenzymes. However, more attractive to me is the idea thatminute concentrations of fatty acids can easily alter the mem-brane distribution of immunocyte receptor groups in a waycomparable to the means whereby IgG has been shown on Tcells.4

When, in due course, more clinical trials are mounted on theeffects of the various fatty acids, attention will have to be paidto the devastating effects that they are liable to have on vascu-lar endothelium.5 In renal transplantation a combined lipid-lowering and immunosuppressive agent would be of value. Hasanybody examined clofibrate or halofenate for an immuno-suppressive action?33 Hawthorn Gardens,Kenton,Newcastle upon Tyne NE3 3DE E. N. WARDLE

LOW-DOSE HEPARIN IN TOTAL HIPREPLACEMENT

SIR,—Of the 84 patients in the study by Sagar et al.,’ only41 had venograms. Since at least 22 of these venograms weredone on patients in the control group, at most only 19 veno-grams could have been done in the 52 patients in the treatedgroup.Our study7 clearly showed that fibrinogen scanning will not

detect major thrombi in the thigh in most instances after hipsurgery. Thus the true prevalence of thigh thrombi in thetreated group is unknown in 33 of the 52 treated patients.

This is a serious weakness of this study. We feel that, in hippatients, venography must be done routinely in all patients inorder to ascertain the true prevalence of deep venous throm-bosis.

Orthopædic Research Laboratories,Massachusetts General Hospital,Boston, Massachusetts 02114, U.S.A. WILLIAM H. HARRIS

1. Mertin, J., Hughes, D. Int. Archs Allergy. 1975, 48, 203.2. Taketa, K., Pogell, B. M. J. biol. Chem. 1966, 241, 720.3. Dorsey, J. A., Porter, J. W. ibid. 1968, 243, 3512.4. Cone, R. E., Brown, W. C. Immunochemistry, 1976, 13, 571.5. Bloom, W. L. Metabolism, 1967, 16, 777.6. Sagar, S., Nairn, D., Stamatakis, J. D., Maffti, F. H., Higgins, A. F.,

Thomas, D. P., Kahhar, V. V. Lancet, 1976, i, 1151.7. Harris, W. H., and others. New Engl. J. Med. 1975, 29, 665.