The electron microscope is an integral component of a laboratory engaged in the study of gastroenteritis viruses. Two major groups of gastroenteritis viruses--the 27nm Norwalk virus and the 70nm human rotaviruses--were discovered at NIH and in Australia, respectively, (as well as the hepatitis A virus at NIH, in collaboration with the Hepatitis Section) by the use of electron microscope techniques. Indeed, in this era of tissue culture virology, these agents were discovered without the use of an in vitro tissue culture system, because they could not be grown from clinical specimens in cell culture. The term, """"""""direct virology,"""""""" is apt to describe this method of examining viruses from clinical specimens by electron microscopy. Although second and third generation tests have been developed for the detection of the Norwalk group of viruses and the rotaviruses, the electron microscope is still an indispensable tool for the study of these gastroenteritis viruses. It is also the most rapid diagnostic method for detection of rotavirus from a clinical specimen and is the only method available for detecting infection with certain 27nm or similiar small round virus-like particles from individuals with viruses associated with epidemic nonbacterial gastroenteritis. In addition, it is the only method that is capable of detecting all known gastroenteritis viruses (e.g., group A or non-group A rotavirus, Norwalk-like viruses, adenoviruses, astroviruses, caliciviruses) by examination of a single stool specimen. This became especially apparent when stools from Desert Storm troops who developed acute gastroenteritis needed to be evaluated for the presence of viral agents. It also is important for: (i) providing direct visualization of virus particles from density gradients (to establish their morphologic appearance, e.g., single or double capsid, integrity of capsid structure, and to determine presence or absence of particles or their quantitation); (ii) providing direct visualization of particles from unusual clinical specimens to determine their identity, if feasible; (iii) attempting to visualize the site of activity of antibodies such as monoclonal antibodies or recombinant virus induced antibodies; and (iv) serologic studies performed by immune electron microscopy to determine the antigenic relationships of fastidious gastroenteritis agents that cannot be propagated in cell culture such as the human group C rotaviruses, and the Norwalk group of agents. However, its most important and creative role is in its application to the detection of new, heretofore unknown, agents of acute infectious gastroenteritis and other diseases as well.
