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Diarrhoeagenic microbes by real-time PCR in Rwandan children under 5 years of age with acute gastroenteritis

J-C Kabayiza1, M E Andersson, S Nilsson

  • 1Department of Infectious Diseases, University of Gothenburg, Gothenburg, Sweden; Department of Paediatrics, National University of Rwanda, Kigali, Rwanda.

Clinical Microbiology and Infection : the Official Publication of the European Society of Clinical Microbiology and Infectious Diseases
|June 4, 2014
PubMed

Insights

In Rwandan children, rotavirus and enterotoxigenic E. coli (ETEC) caused severe diarrhea, while Shigella led to bloody stools. Multiple pathogens were common, and antibiotic use was frequent but often inappropriate.

Area of Science:

  • Pediatric Infectious Diseases
  • Molecular Epidemiology
  • Gastroenterology

Background:

  • Acute gastroenteritis is a significant cause of childhood morbidity and mortality in low-income nations.
  • The specific causative agents and their prevalence in acute diarrhea among young children in Rwanda are not well-understood.

Purpose of the Study:

  • To identify the etiological agents of acute diarrhea in children under five years old in Rwanda.
  • To determine the association between specific pathogens, co-infections, and clinical outcomes like dehydration and bloody stools.
  • To investigate the relationship between pathogen microbial load and symptom severity, as well as the appropriateness of antibiotic use.

Main Methods:

  • Real-time PCR was employed to detect 16 diarrheal pathogens in stool samples from 880 children (≤5 years) with acute diarrhea in Rwanda.
  • Clinical data, including dehydration severity, stool characteristics, and antibiotic treatment, were collected and correlated with pathogen detection.

Main Results:

  • A high prevalence of pathogen detection was observed, with 92% of children having at least one pathogen and 63% having multiple agents.
  • Rotavirus (36.9%) and enterotoxigenic Escherichia coli (ETEC) (31.3% for eltB, 19.0% for estA) were highly prevalent. Shigella (17.5%) and Cryptosporidium (7.8%) were also detected.
  • Rotavirus and ETEC-estA were linked to severe dehydration, while Shigella was associated with bloody stools and elevated C-reactive protein (CRP). Pathogen load correlated with symptom severity.

Conclusions:

  • Rotavirus and ETEC-estA are primary drivers of dehydrating diarrhea in this Rwandan cohort.
  • Shigella infections cause bloody diarrhea, and pathogen load is a key indicator of disease severity.
  • Antibiotic use was common (42%) and frequently misaligned with microbiological findings, suggesting a need for improved diagnostic stewardship.

Keywords:
Diarrhoeaepidemiologyfaecesgastroenteritisreal-time PCR

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