# Impact of virus-mediated bacterial interactions on acute gastroenteritis symptoms: A new scoring system for clinical assessment

## TL;DR

This study explores how viruses causing acute gastroenteritis interact with gut bacteria to worsen symptoms and introduces a new scoring system to assess disease severity.

## Contribution

A novel scoring system is introduced to evaluate the severity of virus-induced acute gastroenteritis based on clinical symptoms and microbial interactions.

## Key findings

- Patients with single or dual viral infections had higher clinical symptom scores than those without viruses.
- Microbial community composition differed significantly between single and dual-virus groups.
- Higher Prevotella/Bacteroides index correlated with more severe symptoms in viral AGE patients.

## Abstract

Acute gastroenteritis (AGE) exerts a substantial healthcare burden and economic loss annually, mainly due to viral infections. The objective of the study was to elucidate the impact of the interactions between the AGE virus and gut microbiota on patient clinical symptoms, thereby facilitating the early diagnosis and treatment of AGE. Clinical information and fecal samples were collected from 289 AGE patients (exclude fungal, parasitic, and bacterial infections), of whom 23.5% were infected with AGE viruses. A scoring method was developed to assess the severity of virus-induced AGE in patients. The results indicate significant differences (p < 0.05 indicates a significant difference, as determined by Kruskal–Wallis test, p = 0.03) in clinical symptom scores among the None-virus, Single-virus, and Dual-virus group. The Single-virus (14.82) and Dual-virus (15.33) groups exhibited more severe clinical symptom, with scoring values higher than None-virus group (12.40). Although significant differences in microbial community composition were observed between the Single-virus and Dual-virus groups (as determined by Adonis analysis, Variation = 0.11, p = 0.034), the diversity index (e.g. Chao1) did not significantly differ among the None-virus (288.14), Single-virus (345.74), and Dual-virus (282.70) groups. Notably, the patients with a higher Prevotella/Bacteroides index displayed more severe clinical symptom, as the index in the Single-virus and Dual-virus groups was over 10-times greater than in the None-virus group. In summary, this study shows that clinical symptoms of patients with viral AGE could be exacerbated through promoting bacterial competitions, and this understanding would facilitate the early diagnosis and treatment of viral AGE.