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Wang S, Yang F, Li D, Qin J, Hou W, Jiang L, Kong M, Wu Y, Zhang Y, Zhao F, Fang Y, Miao Y, Xu L, Chen J, Bao Z, Olszewski MA, Zhao H, Zhang Y. Clinical application of a multiplex genetic pathogen detection system remaps the aetiology of diarrhoeal infections in Shanghai. Gut Pathog 2018; 10:37. [PMID: 30214488 PMCID: PMC6134694 DOI: 10.1186/s13099-018-0264-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 08/27/2018] [Indexed: 01/25/2023] Open
Abstract
Background Culture-based diagnostic methods cannot achieve rapid and precise diagnoses for the identification of multiple diarrhoeal pathogens (DPs). A high-throughput multiplex genetic detection system (HMGS) was adapted and evaluated for the simultaneous identification and differentiation of infectious DPs and a broad analysis of DP infection aetiology. Results DP-HMGS was highly sensitive and specific for DP detection compared with culture-based techniques and was similar to singleplex real-time PCR. The uniform level of sensitivity of DP-HMGS for all DPs allowed us to remap the aetiology of acute diarrhoeal infections in Shanghai, correcting incidences of massively underdiagnosed DP species with accuracy approaching that of sequencing-based methods. The most frequent DPs were enteropathogenic Escherichia coli, rotavirus and Campylobacter jejuni. DP-HMGS detected two additional causes of infectious diarrhoea that were previously missed by routine culture-based methods: enterohemorrhagic E. coli and Yersinia enterocolitica. We demonstrated the age dependence of specific DP distributions, especially the distributions of rotavirus, intestinal adenovirus and Clostridium difficile in paediatric patients as well as those of dominant bacterial infections in adults, with a distinct “top 3” pattern for each age group. Finally, the multiplexing capability and high sensitivity of DP-HMGS allowed the detection of infections co-induced by multiple pathogens (approximately 1/3 of the cases), with some DPs preferentially co-occurring as infectious agents. Conclusions DP-HMGS has been shown to be a rapid, specific, sensitive and appropriate method for the simultaneous screening/detection of polymicrobial DP infections in faecal specimens. Widespread use of DP-HMGS is likely to advance routine diagnostic and clinical studies on the aetiology of acute diarrhoea. Electronic supplementary material The online version of this article (10.1186/s13099-018-0264-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Shiwen Wang
- 1Department of Laboratory Medicine, Huadong Hospital, Affiliated with Fudan University, Shanghai, 200040 China.,Shanghai Key Laboratory of Clinical Geriatric Medicine, Shanghai, 200040 China.,3Research Center on Aging and Medicine, Fudan University, Shanghai, 200040 China
| | - Feng Yang
- 1Department of Laboratory Medicine, Huadong Hospital, Affiliated with Fudan University, Shanghai, 200040 China.,Shanghai Key Laboratory of Clinical Geriatric Medicine, Shanghai, 200040 China.,3Research Center on Aging and Medicine, Fudan University, Shanghai, 200040 China
| | - Dong Li
- 4Department of Clinical Laboratory, Shanghai Tongji Hospital, Tongji University School of Medicine, Shanghai, 200065 China
| | - Juanxiu Qin
- 5Department of Laboratory Medicine, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200135 China
| | - Weiwei Hou
- 4Department of Clinical Laboratory, Shanghai Tongji Hospital, Tongji University School of Medicine, Shanghai, 200065 China
| | - Lian Jiang
- 4Department of Clinical Laboratory, Shanghai Tongji Hospital, Tongji University School of Medicine, Shanghai, 200065 China
| | - Mimi Kong
- 6Ningbo HEALTH Gene Technologies Co., Ltd., Ningbo, China
| | - Yong Wu
- 6Ningbo HEALTH Gene Technologies Co., Ltd., Ningbo, China
| | - Yuchen Zhang
- 6Ningbo HEALTH Gene Technologies Co., Ltd., Ningbo, China
| | - Fuju Zhao
- 1Department of Laboratory Medicine, Huadong Hospital, Affiliated with Fudan University, Shanghai, 200040 China.,Shanghai Key Laboratory of Clinical Geriatric Medicine, Shanghai, 200040 China.,3Research Center on Aging and Medicine, Fudan University, Shanghai, 200040 China
| | - Yi Fang
- 1Department of Laboratory Medicine, Huadong Hospital, Affiliated with Fudan University, Shanghai, 200040 China.,Shanghai Key Laboratory of Clinical Geriatric Medicine, Shanghai, 200040 China.,3Research Center on Aging and Medicine, Fudan University, Shanghai, 200040 China
| | - Yingxin Miao
- 1Department of Laboratory Medicine, Huadong Hospital, Affiliated with Fudan University, Shanghai, 200040 China.,Shanghai Key Laboratory of Clinical Geriatric Medicine, Shanghai, 200040 China.,3Research Center on Aging and Medicine, Fudan University, Shanghai, 200040 China
| | - Lingli Xu
- Shanghai ABSciex Analytical Instrument Trading Co., Ltd., Shanghai, China
| | - Jie Chen
- Shanghai Key Laboratory of Clinical Geriatric Medicine, Shanghai, 200040 China.,3Research Center on Aging and Medicine, Fudan University, Shanghai, 200040 China.,8Department of Gastroenterology, Gerontology Institute of Shanghai, Affiliated with Huadong Hospital, Affiliated with Fudan University, Shanghai, 200040 China
| | - Zhijun Bao
- Shanghai Key Laboratory of Clinical Geriatric Medicine, Shanghai, 200040 China.,3Research Center on Aging and Medicine, Fudan University, Shanghai, 200040 China.,8Department of Gastroenterology, Gerontology Institute of Shanghai, Affiliated with Huadong Hospital, Affiliated with Fudan University, Shanghai, 200040 China
| | - Michal A Olszewski
- 9Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan Health System and Research Service, VA Ann Arbor Health Systems, Ann Arbor, MI USA
| | - Hu Zhao
- 1Department of Laboratory Medicine, Huadong Hospital, Affiliated with Fudan University, Shanghai, 200040 China.,Shanghai Key Laboratory of Clinical Geriatric Medicine, Shanghai, 200040 China.,3Research Center on Aging and Medicine, Fudan University, Shanghai, 200040 China
| | - Yanmei Zhang
- 1Department of Laboratory Medicine, Huadong Hospital, Affiliated with Fudan University, Shanghai, 200040 China.,Shanghai Key Laboratory of Clinical Geriatric Medicine, Shanghai, 200040 China.,3Research Center on Aging and Medicine, Fudan University, Shanghai, 200040 China
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