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An Evaluation of Enteropathogen-Specific Disease Severity and Duration in Children With Acute Gastroenteritis
Cindy G Roskind1, David Schnadower2,3, Alexander J Rogers4
1Department of Emergency Medicine, Columbia University, Vagelos College of Physicians & Surgeons, New York, NY.
Insights
In children with acute gastroenteritis (AGE), viral and bacterial pathogens caused varied symptom durations and severities. However, symptom differences were not clinically significant enough to distinguish between pathogen types alone.
Area of Science:
- Pediatric Infectious Diseases
- Gastroenterology
- Clinical Microbiology
Background:
- Acute gastroenteritis (AGE) is a common childhood illness.
- Understanding pathogen-specific clinical presentations is crucial for diagnosis and management.
- Previous studies have varied in pathogen identification and outcome assessment.
Purpose of the Study:
- To describe pathogen-specific symptom severity and duration in children with AGE.
- To quantify health care resource utilization associated with AGE.
- To identify associations between pathogen type and clinical outcomes in pediatric AGE.
Main Methods:
- Secondary analysis of 2 trials involving children aged 3 to 48 months with AGE.
- Disease severity assessed by vomiting/diarrhea frequency/duration and Modified Vesikari Scale (MVS) score.
- Descriptive statistics and regression models used to analyze pathogen-type associations with outcomes.
Main Results:
- Viral pathogens identified in 47.9%, bacterial in 5.9%; Norovirus was most common (20.6%).
- Salmonella infection showed the longest diarrhea duration (median 160h).
- Viruses were associated with more frequent vomiting and higher MVS scores than bacteria, but shorter diarrhea duration.
Conclusions:
- Viral and bacterial pathogens present with distinct, though not always clinically distinct, symptom profiles in children with AGE.
- Symptom patterns alone are insufficient to reliably differentiate between specific viral and bacterial causes of AGE.
- Further research could explore specific pathogen-host interactions and refine diagnostic criteria.
Objectives:
Our primary objectives were to describe pathogen-specific symptom severity and duration in a prospective cohort study of children with acute gastroenteritis (AGE). Our secondary objective was to quantify health care resource utilization.
Methods:
This secondary analysis of 2 trials included children aged 3 to 48 months with AGE. Children were eligible if they had ≥3 watery stools in the preceding 24 hours and were brought to the Emergency Department. Disease severity was quantified by frequency and duration of vomiting and diarrhea, and the Modified Vesikari Scale score. We used descriptive statistics to summarize severity and regression models to identify associations between pathogen type and outcomes.
Results:
In total, 1565 trial participants had pathogen testing performed and completed follow-up. Viral pathogens were identified in 47.9% (749/1565) and bacterial pathogens in 5.9% (92/1565). Norovirus (322/1565; 20.6%) was the most frequently identified pathogen. Diarrhea duration was greatest (median 160h, IQR: 98, 216) for children with Salmonella . Vomiting (aOR: 11.02; 95% CI: 7.47, 16.26) occurred more commonly in children with viruses compared with bacteria. The mean duration of diarrhea was shorter for viruses compared with bacteria (aIRR: 0.81, 95% CI: 0.68, 0.96). Mean MVS scores were higher in children with viruses compared with those with bacteria (coefficient: 1.64, 95% CI: 0.46, 2.82).
Conclusions:
We describe the clinical course of viral and bacterial pathogens. Although statistically significant, differences in symptom severity across pathogens were not clinically meaningful for distinguishing between them based on symptoms alone.
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