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Kinetics of Enteric Pathogen Quantity During Acute Diarrhea in Children in Resource-Limited Settings
William J Lain1, Sarah E Elwood1, Jie Liu2
1Division of Infectious Diseases and International Health, University of Virginia School of Medicine, Charlottesville, Virginia, USA.
None:
Pathogen quantity kinetics during childhood diarrhea have implications for etiology ascertainment. Using a multisite cohort, we modeled quantitative PCR quantity by symptom duration. Rotavirus had the largest log reduction in quantity by day 7 (-1.98; 95% confidence interval: -2.88, -1.08), followed by Shigella (-0.87; -1.46, -.28) and heat-stable toxin-producing Escherichia coli (-0.78; -1.57, .02). While peak quantity was robust to host factors, kinetics were not. For example, malnourished children had a minimal decline in Cryptosporidium quantity over the first 7 days of illness. Pathogen quantity, etiology attribution, and non-PCR test sensitivity all peaked early in illness. Diarrheal studies should collect samples early to reduce bias in etiology identification.
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