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Potentially Pathogenic Organisms in Stools and Their Association With Acute Diarrheal Illness in Children Aged <2
Gabor Mihala1, Robert S Ware1, Stephen B Lambert2
1Menzies Health Institute Queensland and School of Medicine and Dentistry, Griffith University, Gold Coast, Queensland, Australia.
Insights
Certain pathogens like rotavirus and Salmonella are linked to acute diarrheal illness (ADI) in young Australian children. However, asymptomatic shedding of these organisms can complicate diagnosis.
Area of Science:
- Pediatric infectious diseases
- Microbiology
- Public health
Background:
- Acute diarrheal illness (ADI) presents a significant health burden in high-income nations.
- Understanding the causative agents of ADI in infants is crucial for effective management and prevention.
Purpose of the Study:
- To investigate the association between specific pathogenic organisms detected in stool samples and the occurrence of ADI in children under two years old.
- To determine the incidence rates of pathogen detection and their correlation with diarrheal episodes.
Main Methods:
- A community-based birth cohort study involved daily symptom recording and weekly stool sample collection from children up to age two.
- Polymerase chain reaction (PCR) assays were used to detect 11 viruses, 5 bacteria, and 4 protozoa.
- New organism detections or repeat detections after negative results were linked to ADI episodes to calculate incidence and relative risks.
Main Results:
- Over 11,000 stool samples were analyzed from 154 children, with 228 ADI episodes identified.
- Fifty-five percent of samples tested positive for at least one target organism.
- New detections of adenovirus, enterovirus, norovirus GII, parechovirus A, wild-type rotavirus, sapovirus, Salmonella, Blastocystis, and Cryptosporidium were associated with a 1.5-6.4 times greater risk of ADI.
Conclusions:
- Wild-type rotavirus, norovirus GII, sapovirus, adenovirus 40/41, and Salmonella were significantly associated with ADI in Australian children under two.
- High rates of asymptomatic pathogen shedding in stools can lead to diagnostic challenges during ADI episodes.
Background:
Acute diarrheal illness (ADI) causes a substantial disease burden in high-income countries. We investigated associations between potentially pathogenic organisms in stools and ADI by polymerase chain reaction (PCR) in Australian children aged <2 years.
Methods:
Children in a community-based birth cohort had gastrointestinal symptoms recorded daily and stool samples collected weekly until their second birthday. Diarrhea was defined as ≥3 liquid or looser than normal stools within a 24-hour period. PCR assays tested for 11 viruses, 5 bacteria, and 4 protozoa. Detections of a new organism or of the same following at least 2 negative tests were linked to ADIs, and incidence rates and estimates of association with ADI were calculated.
Results:
One hundred fifty-four children provided 11 111 stool samples during 240 child-years of observation, and 228 ADIs were linked to samples. Overall, 6105 (55%) samples tested positive for a target organism. The incidence rate of 2967 new detections was 11.9 (95% confidence interval 11.4-12.3) per child-year, with 2561 (92%) new detections unrelated to an ADI. The relative risk of an ADI was 1.5-6.4 times greater for new detections of adenovirus, enterovirus, norovirus GII, parechovirus A, wild-type rotavirus, sapovirus GI/II/IV/V, Salmonella, Blastocystis, and Cryptosporidium, compared to when these were absent.
Conclusions:
Wild-type rotavirus, norovirus GII, sapovirus GI/II/IV/V, adenovirus 40/41, and Salmonella were associated with ADI in this age group and setting. However, high levels of asymptomatic shedding of potential pathogens in stools from children may contribute to diagnostic confusion when children present with an episode of ADI.
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