Clinical relevance of enteropathogen co-infections in preschool children-a population-based repeated cross-sectional
R Pijnacker1, W van Pelt1, H Vennema1
1Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands.
Insights
Young children, especially those in daycare, are more prone to multiple enteropathogen infections. However, these co-infections do not increase the risk of gastroenteritis in preschool children.
Area of Science:
- Pediatric Infectious Diseases
- Microbiology
- Epidemiology
Background:
- Enteropathogen infections are common in young children.
- Understanding co-infections is crucial for managing pediatric gastroenteritis.
Purpose of the Study:
- Identify risk factors for enteropathogen co-infections in preschool children.
- Assess the impact of co-infections on gastroenteritis risk.
- Determine if co-infections occur randomly.
Main Methods:
- Cross-sectional survey of 981 Dutch children aged 0-48 months.
- Monthly stool sample collection and testing for 19 enteropathogens via real-time multiplex PCR.
- Logistic regression analysis to evaluate risk factors and associations.
Main Results:
- 72.7% of samples had at least one enteropathogen; 48.5% had two or more.
- Younger age, daycare attendance, and larger households were risk factors for co-infection.
- Specific pathogen pairs co-occurred more frequently than expected by chance.
- No association found between co-infection and increased gastroenteritis risk.
Conclusions:
- Risk factors for enteropathogen co-infections in young children have been identified.
- Certain enteropathogens co-occur more often than random chance would predict.
- Enteropathogen co-infections do not appear to increase gastroenteritis risk in this age group, questioning their clinical significance.
Objectives:
This study aimed to (i) determine risk factors for enteropathogen co-infections, (ii) determine whether enteropathogen co-infections influence gastroenteritis risk, and (iii) determine whether enteropathogen co-infection occurred randomly in preschool children.
Methods:
A monthly-repeated cross-sectional survey in Dutch children aged 0-48 months was conducted during October 2012 to October 2014. A total of 981 stool samples were collected along with questionnaires collecting data on gastrointestinal symptoms and potential risk factors; 822 samples were successfully tested for 19 enteropathogens using real-time multiplex PCRs. Logistic regression analysis assessed co-infections in relation to gastroenteritis and potential risk factors.
Results:
In all, 598/822 (72.7%) stool samples tested positive for at least one enteropathogen, of which 290 (48.5%) were positive for two or more enteropathogens. Risk factors for two or more enteropathogen co-infections were young age (<12 months, OR 1.9, 95% CI 1.1-3.3; 13-36 months, OR 1.7, 95% CI 1.1-2.5, versus 37-48 months), day-care attendance (OR 1.8, 95% CI 1.3-2.5), households with three or more children versus those with one child (OR 1.7, 95% CI 1.1-2.8). Stool samples collected in spring less often had two or more enteropathogens versus summer (OR 0.4, 95% CI 0.2-0.7). Food allergy was a risk factor for three or more enteropathogen co-infections (OR 3.2, 95% CI 1.1-8.9). The frequency of co-infection was higher than expected for norovirus GI/norovirus GII, Clostridium difficile/norovirus GI, C. difficile/rotavirus, astrovirus/Dientamoeba fragilis, atypical enteropathogenic Escherichia coli/adenovirus, typical enteropathogenic E. coli/adenovirus, and enteroaggregative E. coli/astrovirus. No co-infection was associated with increased gastroenteritis risk.
Conclusions:
Risk factors for enteropathogen co-infections were identified and specific enteropathogens co-occurred significantly more often than expected by chance. Enteropathogen co-infections were not associated with increased gastroenteritis risk, calling into question their clinical relevance in preschool children.
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