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Published on: July 22, 2012
Using Multiplex Molecular Testing to Determine the Etiology of Acute Gastroenteritis in Children
Maribeth R Nicholson1, Gerald T Van Horn2, Yi-Wei Tang3
1Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Vanderbilt University School of Medicine, Nashville, TN.
Insights
Broad molecular testing detected high rates of norovirus genogroup II and Clostridium difficile in children with acute gastroenteritis (AGE). Coinfections were common but did not alter clinical presentation.
Area of Science:
- Pediatric infectious diseases
- Molecular diagnostics
- Microbiology
Background:
- Acute gastroenteritis (AGE) is a common illness in children.
- Accurate etiologic diagnosis is crucial for effective management and surveillance.
- Molecular techniques offer enhanced sensitivity for pathogen detection.
Purpose of the Study:
- To identify causative agents of AGE in children using comprehensive molecular methods.
- To compare clinical symptoms across different identified etiologies.
- To assess the prevalence of coinfections in pediatric AGE cases.
Main Methods:
- Prospective population-based surveillance of children under 6 years with AGE.
- Stool sample analysis using a Gastrointestinal Pathogen Panel and RT-qPCR for specific viruses.
- Testing for 21 gastrointestinal pathogens.
Main Results:
- 152 out of 216 (70.4%) AGE cases tested positive for a pathogen.
- Norovirus genogroup II (36.1%) and Clostridium difficile (16.2%) were the most frequent pathogens.
- Coinfections were detected in 22.7% of cases, with C. difficile frequently involved.
Conclusions:
- Molecular testing reveals high enteropathogen detection rates in pediatric AGE.
- Norovirus genogroup II and C. difficile are dominant pathogens.
- Coinfections did not significantly impact clinical presentation, highlighting the need for further research into clinical significance.
Objective:
To detect the etiologic agents of acute gastroenteritis (AGE) in children using broad molecular-based techniques, and compare clinical presentations among etiologies.
Study Design:
This was a prospective population-based surveillance study of children aged <6 years with AGE conducted between 2008 and 2011 as part of the New Vaccine Surveillance Network. Stools from patients and healthy controls were tested for 21 gastrointestinal pathogens using the analyte-specific reagent Gastrointestinal Pathogen Panel and an additional reverse transcription real-time polymerase chain reaction assay for sapovirus and astrovirus.
Results:
Of the 216 stool samples from patients with AGE, 152 (70.4%) tested positive for a pathogen, with norovirus genogroup II (n = 78; 36.1%) and Clostridium difficile (n = 35; 16.2%) the most common pathogens detected. Forty-nine patients (22.7%) tested positive for more than 1 pathogen, including 25 (71%) with a C difficile detection. There were no significant clinical differences among the patients with no pathogen detected, those with a single pathogen detected, and those with ≥2 pathogens detected.
Conclusion:
Using a broad molecular testing approach, high rates of enteropathogens were detected in children with AGE, dominated by norovirus genogroup II and C difficile. Coinfections were common but had no identifiable impact on clinical manifestations. As routine diagnostics of AGE progressively evolve toward nucleic acid-based pathogen detection, ongoing systematic studies are needed to better analyze the clinical significance of results.
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