Astroviruses and caliciviruses: emerging enteric pathogens.

Acute, infectious gastroenteritis is an extremely common disease that contributes significantly to morbidity and mortality worldwide. In the United States, it is the second most frequent illness encountered in families. While this illness generally runs a self-limited course, it may be temporarily incapacitating and impact substantially on numbers of days lost from work or school. At present, 30-40% of infectious gastroenteritis cases in the United States are attributable to viral agents, while 20-30% are due to bacteria and parasites. These estimates are almost certainly low, since the cause of gastroenteritis is not discernible in approximately 40% of the cases, and gastroenteritis may be caused by viruses or other pathogens that cannot be identified at this time. Rotavirus and enteric adenovirus are two of the most prevalent and well-studied of the viral agents and have been reviewed extensively elsewhere. This review focuses on two broad groups of small round structured viruses (SRSV), astroviruses and caliciviruses (classic, Norwalk, and Norwalk-like). Although recognized in association with acute, nonbacterial gastroenteritis since the early 1970s, the study of these viruses has been hampered by the relatively low levels of viral shedding in feces, difficulty in propagating the virus in cell or organ culture, and the lack of widely available, well-standardized reagents for their detection. In spite of these obstacles, much has been learned about these viruses using standard virologic (electron microscopy, biophysical characterization, immunoassays) and epidemiologic methods. More recently, substantial progress has been made in studying astroviruses and caliciviruses at the molecular level. Molecular techniques are now being used as diagnostic aids to characterize the epidemiology of these agents in greater detail.