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Multiple etiologies of infectious diarrhea and concurrent infections in a pediatric outpatient-based screening study
Arpit Kumar Shrivastava1, Subrat Kumar1, Nirmal Kumar Mohakud2
1Infection Biology Laboratory, School of Biotechnology, KIIT University, Bhubaneswar, Odisha 751024 India.
Insights
Diarrheagenic Escherichia coli and Rotavirus were the most common causes of acute diarrhea in children under five. Concurrent infections were frequent, especially in younger children, highlighting the need for comprehensive diagnosis.
Area of Science:
- Microbiology
- Pediatric Infectious Diseases
- Molecular Diagnostics
Background:
- Acute diarrhea is a significant cause of childhood morbidity and mortality globally.
- Infectious gastroenteritis has multiple, often underdiagnosed, etiologies in young children.
Purpose of the Study:
- To identify the viral, bacterial, and parasitic causes of acute diarrhea in children under five.
- To investigate the prevalence of single and multiple pathogen infections.
Main Methods:
- Fecal samples from 130 children under five with acute diarrhea were analyzed.
- Rotavirus and Adenovirus were detected using immunochromatographic tests.
- Diarrheagenic Escherichia coli, Shigella, Salmonella, Vibrio cholera, Cryptosporidium, and Giardia were identified via gene-specific PCR.
Main Results:
- Escherichia coli (30.07%) was the leading cause, followed by Rotavirus (26.15%) and Shigella (23.84%).
- Concurrent infections with two or more pathogens occurred in 33.84% of cases, predominantly in children under two (65.90%).
- Significantly higher detection rates were observed for dual and triple infections (p=0.004915 and p=0.03917, respectively).
Conclusions:
- Accurate diagnosis of multiple infectious agents is crucial for effective pharmacological management of childhood diarrhea.
- Concurrent infections may involve synergistic pathogenetic strategies, warranting further investigation in experimental models.
Background:
There are multiple etiologies responsible for infectious gastroenteritis causing acute diarrhea which are often under diagnosed. Also acute diarrhea is one of the major causes of morbidity and mortality among children less than 5 years of age.
Methods:
In our study, fecal samples (n = 130) were collected from children (<5 years) presenting with symptoms of acute diarrhea. Samples were screened for viral, bacterial, and parasitic etiologies. Rotavirus and Adenovirus were screened by immunochromatographic tests. Diarrheagenic Escherichia coli (EPEC, EHEC, STEC, EAEC, O157, O111), Shigella spp., Salmonella spp., Vibrio cholera, Cryptosporidium spp., and Giardia spp. were detected by gene-specific polymerase chain reaction.
Results:
Escherichia coli was detected to be the major etiological agent (30.07%) followed by Rotavirus (26.15%), Shigella (23.84%), Adenovirus (4.61%), Cryptosporidium (3.07%), and Giardia (0.77%). Concurrent infections with two or more pathogens were observed in 44 of 130 (33.84%) cases with a predominant incidence particularly in <2-year-old children (65.90%) compared to children of 2-5 years age group (34.09%). An overall result showed significantly higher detection rates among children with diarrhea in both combinations of two as well as three infections concurrently (p = 0.004915 and 0.03917, respectively).
Conclusion:
Suspecting possible multiple infectious etiologies and diagnosis of the right causative agent(s) can aid in a better pharmacological management of acute childhood diarrhea. It is hypothesized that in cases with concurrent infections the etiological agents might be complementing each other's strategies of pathogenesis resulting in severe diarrhea that could be studied better in experimental infections.