Microbiological Evaluation of Diarrhea in Pediatric Kidney Transplant Recipients: A Retrospective Analysis

Diarrhea often occurs in pediatric kidney transplant recipients and can result from infectious or noninfectious causes. Identifying underlying issues can allow for proper management and prevent complications such as dehydration, graft dysfunction, and prolonged hospital stay.

We retrospectively evaluated stool samples of 204 pediatric kidney transplant recipients seen at the Başkent University Hospital with complaint of diarrhea. Direct microscoping evaluation, bacterial cultures, and viral antigen testing for rotavirus and adenovirus were performed. Presence of cytomegalovirus and Clostridium difficile were evaluated in selected patients. In 18 patients, a comprehensive viral panel was performed based on clinical suspicion.

One patient each showed Shigella species and enteropathogenic Escherichia coli. Candida species was isolated in 1 sample. Rotavirus was detected in 4 patients, adenovirus in 2 patients, and Clostridium difficile toxin in 0 patients. Among the 18 patients who underwent detailed panel testing, norovirus was detected in 2 patients and sapovirus in 1 patient. Forty -seven stool culture samples showed reduced or absent normal intestinal flora, suggesting possible intestinal dysbiosis. Entamoeba was detected in 7 patients. Cytomegalovirus was positive in 24 of 204 patients (11 % ). On direct microscopic examination, 19 patients showed minimal findings, and 24 patients had moderate findings. Fourteen patients had high numbers of leukocytes and erythrocytes in their stool. Because amebic colitis and Clostridium difficile infection could not be excluded, patients with moderate to severe findings were treated with metronidazole.

Among pediatric kidney transplant patients with diarrhea, the rate of intestinal pathogens was slow but reduced normal flora in stool cultures was common, indicating microbiota -related etiologies. The high rate of cytomegalovirus infection among patients suggested that cytomegalovirus infection should be considered as a potential etiological factor in pediatric transplant patients presenting with diarrhea. Noninfectious causes should also be considered in differential diagnosis of diarrhea in solid -organ transplant recipients.