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Khales P, Razizadeh MH, Ghorbani S, Moattari A, Sarvari J, Saadati H, Sayyahfar S, Salavatiha Z, Hasanabad MH, Poortahmasebi V, Tavakoli A. Human adenoviruses in children with gastroenteritis: a systematic review and meta-analysis. BMC Infect Dis 2024; 24:478. [PMID: 38724898 PMCID: PMC11084101 DOI: 10.1186/s12879-024-09386-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 05/07/2024] [Indexed: 05/12/2024] Open
Abstract
PURPOSE Human adenoviruses (HAdVs) have always been suggested as one of the main causes of gastroenteritis in children. However, no comprehensive report on the global epidemiology of these viruses in pediatric gastroenteritis is available. METHODS A systematic search was conducted to obtain published papers from 2003 to 2023 in three main databases PubMed, Scopus, and Web of Science. RESULTS The estimated global pooled prevalence of HAdV infection in children with gastroenteritis was 10% (95% CI: 9-11%), with a growing trend after 2010. The highest prevalence was observed in Africa (20%, 95% CI: 14-26%). The prevalence was higher in inpatients (11%; 95% CI: 8-13%) and patients aged 5 years old and younger (9%; 95% CI: 7-10%). However, no significant difference was observed between male and female patients (P = 0.63). The most prevalent species was found to be the species F (57%; 95% CI: 41-72%). The most common HAdVs observed in children with gastroenteritis were types 40/41, 38, and 2. Analysis of case-control studies showed an association between HAdV and gastroenteritis in children (OR: 2.28, 95% CI; 1.51-3.44). CONCLUSION This study provided valuable insights into the importance of HAdVs in children with gastroenteritis, especially in hospitalized and younger children. The results can be used in future preventive measurements and the development of effective vaccines.
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Affiliation(s)
- Pegah Khales
- Department of Bacteriology and Virology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Hossein Razizadeh
- Department of Virology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
- Antimicrobial Resistance Research Center, Institute of Immunology and Infectious Diseases, Iran University of Medical Sciences, Tehran, Iran
| | - Saied Ghorbani
- Department of Bacteriology and Virology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Afagh Moattari
- Department of Bacteriology and Virology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Jamal Sarvari
- Department of Bacteriology and Virology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hassan Saadati
- Department of Epidemiology and Biostatistics, School of Health, North Khorasan University of Medical Sciences, Bojnurd, Iran
| | - Shirin Sayyahfar
- Research Center of Pediatric Infectious Diseases, Institute of Immunology and Infectious Diseases, Iran University of Medical Sciences, Tehran, Iran
| | - Zahra Salavatiha
- Department of Virology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Morteza Haghighi Hasanabad
- Antimicrobial Resistance Research Center, Institute of Immunology and Infectious Diseases, Iran University of Medical Sciences, Tehran, Iran
| | - Vahdat Poortahmasebi
- Department of Bacteriology and Virology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
- Infectious and Tropical Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ahmad Tavakoli
- Research Center of Pediatric Infectious Diseases, Institute of Immunology and Infectious Diseases, Iran University of Medical Sciences, Tehran, Iran.
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Fonseca-Romero P, Ahmed SM, Brintz BJ, Vierkant DM, Bard JD, Cohen DM, Festekjian A, Leber AL, Jackson JT, Kanwar N, Larsen C, Selvarangan R, Chapin KC, Pavia AT. Etiologies of bloody diarrhea in children presenting with acute gastroenteritis to US emergency departments. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.04.03.24305279. [PMID: 38633774 PMCID: PMC11023649 DOI: 10.1101/2024.04.03.24305279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
Among 111 children presenting with bloody diarrhea in a multicenter study of molecular testing in US emergency departments, we found viral pathogens in 18%, bacteria in 48%, protozoa in 2%, and no pathogens detected in 38%.
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Affiliation(s)
- Paola Fonseca-Romero
- Department of Pathology, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT, USA
- Department of Internal Medicine, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Sharia M Ahmed
- Department of Internal Medicine, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Ben J Brintz
- Department of Internal Medicine, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT, USA
| | - D Matthew Vierkant
- Department of Internal Medicine, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Jennifer Dien Bard
- Children's Hospital, Los Angeles; Keck School of Medicine, University of Southern California, Los Angeles, CA, US
| | - Daniel M Cohen
- Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH, USA
| | - Ara Festekjian
- Children's Hospital, Los Angeles; Keck School of Medicine, University of Southern California, Los Angeles, CA, US
| | - Amy L Leber
- Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH, USA
| | | | | | - Chari Larsen
- Department of Pediatrics, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT, USA
| | | | - Kimberle C Chapin
- Deepull, Barcelona, Spain
- Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Andrew T Pavia
- Department of Internal Medicine, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT, USA
- Department of Pediatrics, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT, USA
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Luo X, Deng J, Luo M, Yu N, Che X. Detection and Characterization of Bacterial and Viral Acute Gastroenteritis among Outpatient Children under 5 Years Old in Guangzhou, China. Am J Trop Med Hyg 2024; 110:809-814. [PMID: 38412529 PMCID: PMC10993840 DOI: 10.4269/ajtmh.23-0725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 12/16/2023] [Indexed: 02/29/2024] Open
Abstract
Acute gastroenteritis (AGE) in children can be attributed to a multitude of bacterial and viral pathogens. The objective of this study was to investigate the epidemiology of bacterial and viral AGE in children and to compare clinical characteristics between single and multiple enteric pathogen infections. A total of 456 stool samples were collected from outpatient children under 5 years old with AGE, which were subsequently analyzed for nine bacteria and three viruses using the Luminex xTAG® Gastrointestinal Pathogen Panel. The presence of at least one pathogen was detected in 260 cases (57.0%), with Salmonella being the predominant agent, followed by norovirus, Campylobacter, and rotavirus. A total of 69 cases (15.1%) exhibited positive results for two or more enteric pathogens. Although certain co-infections demonstrated significant differences in primary clinical features compared with mono-infections, no statistical variance was observed in terms of disease severity. In outpatient children from southern China, Salmonella emerged as the most prevalent causative agent of AGE, succeeded by norovirus and Campylobacter. This study underscores the burden posed by coinfections and highlights the clinical characteristics associated with AGE when accompanied by coinfections among children under 5 years old.
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Affiliation(s)
- Xin Luo
- Department of Laboratory Medicine, Guangdong Women and Children Hospital, Guangzhou, China
| | - Jiankai Deng
- Department of Laboratory Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Mingyong Luo
- Department of Laboratory Medicine, Guangdong Women and Children Hospital, Guangzhou, China
| | - Nan Yu
- Laboratory of Emerging Infectious Diseases and Division of Laboratory Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Xiaoyan Che
- Laboratory of Emerging Infectious Diseases and Division of Laboratory Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China
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Kang HM, Yoo IH, Jeong DC. The role of rapid syndromic diagnostic testing of gastrointestinal pathogens as a clinical decision support tool in a pediatric emergency department. Ann Clin Microbiol Antimicrob 2024; 23:3. [PMID: 38183046 PMCID: PMC10770992 DOI: 10.1186/s12941-023-00662-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 12/16/2023] [Indexed: 01/07/2024] Open
Abstract
PURPOSE This study aimed to investigate the role of rapid syndromic diagnostic testing of gastrointestinal pathogens as a clinical decision support tool in a pediatric emergency department (ED) by comparing clinical decision and patient outcome parameters pre- and post-implementation. METHODS This was a big data analytical study of children < 18 years old without any underlying diseases, that visited the ED with acute moderate to severe diarrhea during a 34-month period from 2018 to 2022 using Seoul St. Mary's hospital's healthcare corporate data warehouse to retrieve demographic, clinical, and laboratory parameters. Outcome measures pre- and post-implementation of a rapid syndromic multiplex gastrointestinal panel (GI panel) were compared. RESULTS A total of 4,184 patients' data were included in the analyses. Broad spectrum antibiotics were prescribed at a significantly lower rate to patients presenting with acute infectious diarrhea at discharge from the ED (9.9% vs 15.8%, P < 0.001) as well as upon admission (52.2% vs 66.0%, P < 0.001) during the post-implementation period compared to the pre-implementation period. Although the duration of ED stay was found to be significantly longer (6.5 vs 5.5 h, P < 0.0001), the rate of ED revisit due to persistent or aggravated symptoms was significantly lower (Δ in intercept, β = -0.027; SE = 0.013; P = 0.041), and the admission rate at follow up after being discharged from the ED shown to be significantly lower during the post-implementation period compared to the pre-implementation period (0.8% vs. 2.1%, P = 0.001, respectively). No significant difference in disease progression was observed (P = 1.000). CONCLUSION Using the GI panel in the ED was shown to decrease broad spectrum antibiotic prescribing practices and reduce revisits or admission at follow up by aiding clinical decisions and improving patient outcome.
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Affiliation(s)
- Hyun Mi Kang
- Department of Pediatrics, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- College of Medicine, Vaccine Bio Research Institute, The Catholic University of Korea, Seoul, Korea
| | - In Hyuk Yoo
- Department of Pediatrics, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
| | - Dae Chul Jeong
- Department of Pediatrics, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Mallier C, Creuzet E, Lambert C, Delmas J, Mirand A, Rochette E, Valot S, Moniot M, Dalle F, Henquell C, Merlin E, Poirier P, Verdan M, Nourrisson C. Summer diarrhea in children: a monocentric French epidemiological observational study. Sci Rep 2023; 13:15078. [PMID: 37700075 PMCID: PMC10497495 DOI: 10.1038/s41598-023-42098-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 09/05/2023] [Indexed: 09/14/2023] Open
Abstract
Pediatric diarrhea is a major public health problem worldwide. In France, continuous surveillance shows a winter epidemic peak and a more modest summer recrudescence. Few studies describe the infectious agents responsible for pediatric summer diarrhea in France. The objectives were to estimate the prevalence of infectious diarrhea and describe the pathogens responsible for summer diarrhea in children; and to describe common factors that can be used as guidance on the etiology of these diarrheas. A cross-sectional, single-center, epidemiological observational study was conducted in the pediatric emergency department of a French hospital between June and September in 2019 and 2020. Multiplex gastrointestinal pathogen panels were used for diagnostics. A multiple correspondence analysis was used to determine profiles of patients. A total of 95 children were included, of whom 82.1% (78/95) were under five years old. The prevalence of infectious summer diarrhea was 81.1% (77/95, 95%CI 71.7-88.4%). A total of 126 infectious agents were detected (50.0% bacteria, 38.1% viruses, 11.9% parasites). The main enteric pathogens were enteropathogen Escherichia coli (24/126), rotavirus (17/126) and Salmonella (16/126). A co-detection was found in 51.9% (40/77) of cases. Four patient profiles, considering the severity and the pathogen involved, were highlighted.
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Affiliation(s)
- Camille Mallier
- Service de Pédiatrie, CHU Clermont-Ferrand, 63000, Clermont-Ferrand, France
| | - Elisa Creuzet
- Service de Parasitologie-Mycologie, CHU Clermont-Ferrand, 63000, Clermont-Ferrand, France
| | - Céline Lambert
- DRCI, Unité de Biostatistiques, CHU Clermont-Ferrand, 63000, Clermont-Ferrand, France
| | - Julien Delmas
- Service de Bactériologie, 3IHP, INSERM, CHU Clermont-Ferrand, Université Clermont Auvergne, 63000, Clermont-Ferrand, France
| | - Audrey Mirand
- Service de Virologie, CNR des Entérovirus et Parechovirus, 3IHP, CHU Clermont-Ferrand, 63000, Clermont-Ferrand, France
- LMGE UMR CNRS 6023, Equipe EPIE - Epidémiologie et Physiopathologie des Infections à Entérovirus, Faculté de Médecine, Université Clermont Auvergne, 63001, Clermont-Ferrand, France
| | - Emmanuelle Rochette
- Service de Pédiatrie, CHU Clermont-Ferrand, 63000, Clermont-Ferrand, France
- Unité CRECHE (INSERM CIC1405), Université Clermont Auvergne, 63000, Clermont-Ferrand, France
| | - Stéphane Valot
- Laboratoire de Parasitologie-Mycologie, Plateforme de Biologie Hospitalo-Universitaire Gérard Mack, 21000, Dijon, France
- Laboratoire associé du Centre National de Référence "Cryptosporidioses, microsporidies et autres protozooses digestives", 21000, Dijon, France
| | - Maxime Moniot
- Service de Parasitologie-Mycologie, CHU Clermont-Ferrand, 63000, Clermont-Ferrand, France
- Laboratoire associé du Centre National de Référence "Cryptosporidioses, microsporidies et autres protozooses digestives", 63000, Clermont-Ferrand, France
| | - Frédéric Dalle
- Laboratoire de Parasitologie-Mycologie, Plateforme de Biologie Hospitalo-Universitaire Gérard Mack, 21000, Dijon, France
- Laboratoire associé du Centre National de Référence "Cryptosporidioses, microsporidies et autres protozooses digestives", 21000, Dijon, France
- AgroSup Dijon, Equipe Vin, Aliment, Microbiologie, Stress, UMR PAM L'Université de Bourgogne Franche-Comté (UBFC), 21000, Dijon, France
| | - Cécile Henquell
- Service de Virologie, CNR des Entérovirus et Parechovirus, 3IHP, CHU Clermont-Ferrand, 63000, Clermont-Ferrand, France
- LMGE UMR CNRS 6023, Equipe EPIE - Epidémiologie et Physiopathologie des Infections à Entérovirus, Faculté de Médecine, Université Clermont Auvergne, 63001, Clermont-Ferrand, France
| | - Etienne Merlin
- Service de Pédiatrie, CHU Clermont-Ferrand, 63000, Clermont-Ferrand, France
- Unité CRECHE (INSERM CIC1405), Université Clermont Auvergne, 63000, Clermont-Ferrand, France
| | - Philippe Poirier
- Service de Bactériologie, 3IHP, INSERM, CHU Clermont-Ferrand, Université Clermont Auvergne, 63000, Clermont-Ferrand, France
- Laboratoire associé du Centre National de Référence "Cryptosporidioses, microsporidies et autres protozooses digestives", 63000, Clermont-Ferrand, France
- Service de Parasitologie-Mycologie, 3IHP, INSERM, CHU Clermont-Ferrand, Université Clermont Auvergne, 63000, Clermont-Ferrand, France
| | - Matthieu Verdan
- Service de Pédiatrie, CHU Clermont-Ferrand, 63000, Clermont-Ferrand, France
| | - Céline Nourrisson
- Service de Bactériologie, 3IHP, INSERM, CHU Clermont-Ferrand, Université Clermont Auvergne, 63000, Clermont-Ferrand, France.
- Laboratoire associé du Centre National de Référence "Cryptosporidioses, microsporidies et autres protozooses digestives", 63000, Clermont-Ferrand, France.
- Service de Parasitologie-Mycologie, 3IHP, INSERM, CHU Clermont-Ferrand, Université Clermont Auvergne, 63000, Clermont-Ferrand, France.
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Pavia AT, Cohen DM, Leber AL, Daly JA, Jackson JT, Selvarangan R, Kanwar N, Bender JM, Bard JD, Festekjian A, Duffy S, Larsen C, Holmberg KM, Bardsley T, Haaland B, Bourzac KM, Stockmann C, Chapin KC, Leung DT. Clinical Impact of Multiplex Molecular Diagnostic Testing in Children with Acute Gastroenteritis Presenting to An Emergency Department: A Multicenter Prospective Study. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.07.27.23293208. [PMID: 37577483 PMCID: PMC10418295 DOI: 10.1101/2023.07.27.23293208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/15/2023]
Abstract
Background Multiplex molecular diagnostic panels have greatly enhanced detection of gastrointestinal pathogens. However, data on the impact of these tests on clinical and patient-centered outcomes are limited. Methods We conducted a prospective, multicenter, stepped-wedge trial to determine the impact of multiplex molecular testing at five academic children's hospitals in children presenting to the ED with acute gastroenteritis. Caregivers were interviewed on enrollment and again 7-10 days after enrollment to determine symptoms, risk factors, subsequent medical visits, and impact on family members. During the pre-intervention period, diagnostic testing was performed at the discretion of clinicians. During the intervention period, multiplex molecular testing was performed on all children with results available to clinicians. Primary outcome was return visits to a health care provider within 10 days of enrollment. Results Potential pathogens were identified by clinician ordered tests in 19/571 (3.3%) in the pre-intervention period compared to 434/586 (74%) in the intervention period; clinically relevant pathogens were detected in 2.1% and 15% respectively. In the multivariate model adjusting for potential confounders, the intervention was associated with a 21% reduction in the odds of any return visit (OR 0.79; 95% CI 0.70-0.90). Appropriate treatment was prescribed in 11.3% compared to 19.6% during the intervention period(P=0.22). Conclusions Routine molecular multiplex testing for all children presenting to the ED with AGE detected more clinically relevant pathogens and led to a 21% decrease in return visits. Additional research is needed to define patients most likely to benefit from testing.
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Ndjangangoye NK, Lekana-Douki SE, Oyegue-Liabagui SL, Kouna LC, Ndong Ndong KA, Onanga R, Lekana-Douki JB. Molecular Prevalence of Diarrheal Pathogens in Children with Acute Diarrhea in Southeastern Gabon. Am J Trop Med Hyg 2023; 108:829-836. [PMID: 36848891 PMCID: PMC10077015 DOI: 10.4269/ajtmh.22-0378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 09/12/2022] [Indexed: 03/01/2023] Open
Abstract
Diarrheal diseases are a major cause of morbidity and mortality in infants and young children, particularly in sub-Saharan countries. In Gabon, there are few data on the prevalence of diarrheal pathogens in children. The aim of this study was to assess the prevalence of diarrheal pathogens in children with diarrhea in southeastern Gabon. Stool samples (n = 284) from Gabonese children 0 to 15 years of age with acute diarrhea were analyzed using polymerase chain reaction targeting 17 diarrheal pathogens. At least one pathogen was detected in 75.7% of samples (n = 215). Coinfection with multiple pathogens was observed in 44.7% of patients (n = 127). Diarrheagenic Escherichia coli was the most commonly detected pathogen (30.6%, n = 87), followed by adenovirus (26.4%, n = 75), rotavirus (16.9%, n = 48), Shigella sp. (16.5%, n = 47), Giardia duodenalis (14.4%, n = 41), norovirus GII (7.0%, n = 20), sapovirus (5.6%, n = 16), Salmonella enterica (4.9%, n = 14), astrovirus (4.6%, n = 13), Campylobacter jejuni/coli (4.6%, n = 13), bocavirus (2.8%, n = 8), and norovirus GI (2.8%, n = 8). Our study provides useful information on the possible causes of diarrheal diseases affecting children in southeastern Gabon. A similar study with a control group of healthy children is needed to assess the burden of the disease attributed to each pathogen.
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Affiliation(s)
- Nal Kennedy Ndjangangoye
- Unité d’Evolution, Epidémiologie et Résistances Parasitaires, Centre Interdisciplinaire de Recherches Médicales de Franceville, Franceville, Gabon
- Unité Émergence des Maladies Virales, Centre Interdisciplinaire de Recherches Médicales de Franceville, Franceville, Gabon
- Ecole Doctorale Régionale d’Afrique Centrale en Infectiologie Tropicale, Université des Sciences et Techniques de Masuku, Franceville, Gabon
| | - Sonia Etenna Lekana-Douki
- Unité Émergence des Maladies Virales, Centre Interdisciplinaire de Recherches Médicales de Franceville, Franceville, Gabon
| | - Sandrine Lydie Oyegue-Liabagui
- Unité d’Evolution, Epidémiologie et Résistances Parasitaires, Centre Interdisciplinaire de Recherches Médicales de Franceville, Franceville, Gabon
- Ecole Doctorale Régionale d’Afrique Centrale en Infectiologie Tropicale, Université des Sciences et Techniques de Masuku, Franceville, Gabon
- Département de Biologie, Faculté des Sciences, Université des Sciences et Techniques de Masuku, Franceville, Gabon
| | - Lady Charlene Kouna
- Unité d’Evolution, Epidémiologie et Résistances Parasitaires, Centre Interdisciplinaire de Recherches Médicales de Franceville, Franceville, Gabon
| | - Kerry Ance Ndong Ndong
- Unité d’Evolution, Epidémiologie et Résistances Parasitaires, Centre Interdisciplinaire de Recherches Médicales de Franceville, Franceville, Gabon
| | - Richard Onanga
- Unité de Recherche et d’Analyses Médicales, Laboratoire de Bactériologie, Centre Interdisciplinaire de Recherches Médicales de Franceville, Franceville, Gabon
| | - Jean Bernard Lekana-Douki
- Unité d’Evolution, Epidémiologie et Résistances Parasitaires, Centre Interdisciplinaire de Recherches Médicales de Franceville, Franceville, Gabon
- Département de Parasitologie-Mycologie Médecine Tropicale, Faculté de Médecine, Université des Sciences de la Santé, Libreville, Gabon
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Sever A, Ben Zvi H, Melamed SB, Sachs N, Krause I, Bilavsky E. Clinical impact of biofire gastrointestinal panel testing for hospitalised children with acute gastroenteritis. Acta Paediatr 2023; 112:505-509. [PMID: 36447381 DOI: 10.1111/apa.16610] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 10/30/2022] [Accepted: 11/28/2022] [Indexed: 12/05/2022]
Abstract
AIM To investigate the clinical impact of BioFire FilmArray Gastrointestinal Panel (FGP) testing in real-life diarrhoeal episodes of hospitalised paediatric patients. METHODS Children hospitalised between October 2018 and September 2020 for whom stool specimens for FGP were submitted at the clinician's discretion were retrospectively observed. For each episode, demographics, clinical information and stool tests were collected. RESULTS The clinical impact for each case was evaluated by changing the antibiotic prescription, following the result of the FGP testing. Out of 140 diarrhoeal episodes, 25 pathogens were found in 24 cases using conventional methods, whereas, FGP testing identified 75 pathogens in 56 cases (p < 0.05). The pathogens more frequently identified by FGP testing were Campylobacter, Shigella, Rotavirus, Giardia lamblia and Cryptosporidium. The clinical impact of FGP testing was observed in 17/140 (12%) diarrhoeal episodes, and higher rates in previously healthy (19%) and solid organ-transplanted children (15%). CONCLUSION We found that using FGP testing for hospitalised children with diarrhoeal episodes could increase pathogen identification and impact clinical decisions, especially in healthy and transplant patients.
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Affiliation(s)
- Aviv Sever
- Department of Pediatrics C, Schneider Children's Medical Center, Petach Tikva, Israel
| | - Haim Ben Zvi
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Microbiology Laboratory, Beilinson Hospital, Rabin Medical Center, Petach Tikva, Israel
| | - Shirel Barnea Melamed
- Department of Pediatrics C, Schneider Children's Medical Center, Petach Tikva, Israel
| | - Nimrod Sachs
- Department of Pediatrics C, Schneider Children's Medical Center, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Irit Krause
- Department of Pediatrics C, Schneider Children's Medical Center, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Efraim Bilavsky
- Department of Pediatrics C, Schneider Children's Medical Center, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Evaluation of the BioFire Gastrointestinal Panel to Detect Diarrheal Pathogens in Pediatric Patients. Diagnostics (Basel) 2021; 12:diagnostics12010034. [PMID: 35054200 PMCID: PMC8774520 DOI: 10.3390/diagnostics12010034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 12/17/2021] [Accepted: 12/20/2021] [Indexed: 12/04/2022] Open
Abstract
Infectious diarrhea is a global pediatric health concern; therefore, rapid and accurate detection of enteropathogens is vital. We evaluated the BioFire® FilmArray® Gastrointestinal (GI) Panel with that of comparator laboratory tests. Stool samples of pediatric patients with diarrhea were prospectively collected and tested. As a comparator method for bacteria, culture, conventional PCR for diarrheagenic E. coli, and Allplex GI-Bacteria(I) Assay were tested. For discrepancy analysis, BD MAX Enteric Bacterial Panel was used. As a comparator method for virus, BD MAX Enteric Virus Panel and immunochromatography was used and Allplex GI-Virus Assay was used for discrepancy analysis. The “true positive” was defined as culture-positive and/or positive results from more than two molecular tests. Of the 184 stool samples tested, 93 (50.5%) were true positive for 128 pathogens, and 31 (16.9%) were positive for multiple pathogens. The BioFire GI Panel detected 123 pathogens in 90 of samples. The BioFire GI Panel demonstrated a sensitivity of 100% for 12 targets and a specificity of >95% for 16 targets. The overall positive rate and multiple pathogen rate among patients in the group without underlying diseases were significantly higher than those in the group with hematologic disease (57.0% vs. 28.6% (p = 0.001) and 20.4% vs. 4.8% (p = 0.02), respectively). The BioFire GI Panel provides comprehensive results within 2 h and may be useful for the rapid identification of enteropathogens.
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10
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Harrison CJ, Hassan F, Lee B, Boom J, Sahni LC, Johnson C, Dunn J, Payne DC, Wikswo ME, Parashar U, Selvarangan R. Multiplex PCR Pathogen Detection in Acute Gastroenteritis Among Hospitalized US Children Compared With Healthy Controls During 2011-2016 in the Post-Rotavirus Vaccine Era. Open Forum Infect Dis 2021; 8:ofab592. [PMID: 34988246 PMCID: PMC8694200 DOI: 10.1093/ofid/ofab592] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 11/18/2021] [Indexed: 12/02/2022] Open
Abstract
Background Despite vaccine-induced decreases in US rotavirus (RV) disease, acute gastroenteritis (AGE) remains relatively common. We evaluated AGE pathogen distribution in hospitalized US children in the post–RV vaccine era. Methods From December 2011 to June 2016, the New Vaccine Surveillance Network (NVSN) conducted prospective, active, population-based surveillance in hospitalized children with AGE. We tested stools from 2 NVSN sites (Kansas City, Houston) with Luminex x-TAG Gastrointestinal Pathogen Panels (Luminex GPP) and analyzed selected signs and symptoms. Results For 660 pediatric AGE inpatients and 624 age-matched healthy controls (HCs), overall organism detection was 51.2% and 20.6%, respectively (P < .001). Among AGE subjects, GPP polymerase chain reaction detected >1 virus in 39% and >1 bacterium in 14% of specimens. Detection frequencies for AGE subjects vs HCs were norovirus (NoV) 18.5% vs 6.6%, RV 16.1% vs 9.8%, adenovirus 7.7% vs 1.4%, Shigella 4.8% vs 1.0%, Salmonella 3.1% vs 0.1%, and Clostridioides difficile in ≥2-year-olds 4.4% vs 2.4%. More co-detections occurred among AGE patients (37/660, 5.6%) than HCs (14/624, 2.2%; P = .0024). Per logistic regression analysis, ill contacts increased risk for NoV, RV, and Shigella (P < .001). More vomiting episodes occurred with NoV and RV, and more diarrheal episodes with Shigella and Salmonella. Modified Vesikari scores were highest for Shigella and lowest for C. difficile. Conclusions NoV detection was most frequent; however, RV remained important in hospitalized AGE in the post–RV vaccine era. Continued active surveillance is important to document ongoing vaccine effects, pathogen emergence, and baseline disease burden for new vaccines.
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Affiliation(s)
- Christopher J Harrison
- Children's Mercy Kansas City and University of Missouri Kansas City-School of Medicine, Missouri, USA
| | - Ferdaus Hassan
- Children's Mercy Kansas City and University of Missouri Kansas City-School of Medicine, Missouri, USA
| | - Brian Lee
- Children's Mercy Kansas City and University of Missouri Kansas City-School of Medicine, Missouri, USA
| | - Julie Boom
- Texas Children's Hospital, Houston, Texas, USA
| | | | | | - James Dunn
- Texas Children's Hospital, Houston, Texas, USA
| | - Daniel C Payne
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Mary E Wikswo
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Umesh Parashar
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Rangaraj Selvarangan
- Department of Pathology and Laboratory Medicine, Children's Mercy Kansas City and University of Missouri-Kansas City, School of Medicine, Kansas City, Missouri, USA
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11
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Prevalence of Diarrheagenic E. Coli Among Hospitalized Children in a Clinical Centre. ACTA MEDICA BULGARICA 2021. [DOI: 10.2478/amb-2021-0041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Abstract
Introduction. Escherichia coli is a common cause of acute diarrhea mainly in young children and, less frequently, in elderly or immunosuppressed patients. Many types of E. coli are part of the normal enteric flora, but can cause urinary tract or nervous system infections.
Objective. To study the prevalence of the main types and serogroups of diarrheagenic E. coli among hospitalized children with enteric infections.
Material and methods. Over a period of 5 years, 1,160 hospitalized children with acute diarrhea syndrome were studied. Fecal samples underwent culturing, biochemical and phenotypic identification.
Results. Among the studied patients, 112/1,160 children (9.7%) had diarrhea caused by E. coli, and only 4 of the isolates were lactose-negative. The most common was diarrhea caused by ETEC – 65/112 (58.0%), followed by EPEC – 38/112 (33.9%), and in third place – EHES 9/112 (8.0%). We did not isolate EIEC types. Depending on the group of E. coli, we observed some differences in the clinical presentation and specifics in the distribution of patients by age.
Conclusion. The study shows that this causative agent is common among Bulgarian children with diarrhea. Unfortunately, in Bulgaria the microbiological network is still not able to adequately respond to the challenges of the extended serodiagnosis for detection of diarrheagenic E. coli, which is performed in Western Europe and North America.
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12
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Manouana GP, Byrne N, Mbong Ngwese M, Nguema Moure A, Hofmann P, Bingoulou Matsougou G, Lotola Mougeni F, Nnoh Dansou E, Agbanrin MD, Mapikou Gouleu CS, Ategbo S, Zinsou JF, Adegbite BR, Edoa JR, Kremsner PG, Mordmüller B, Eibach D, McCall M, Abraham A, Borrmann S, Adegnika AA. Prevalence of Pathogens in Young Children Presenting to Hospital with Diarrhea from Lambaréné, Gabon. Am J Trop Med Hyg 2021; 105:254-260. [PMID: 34232911 DOI: 10.4269/ajtmh.20-1290] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 02/08/2021] [Indexed: 11/07/2022] Open
Abstract
Diarrheal disease is the second most frequent cause of mortality in children younger than 5 years worldwide, causing more than half a million deaths each year. Our knowledge of the epidemiology of potentially pathogenic agents found in children suffering from diarrhea in sub-Saharan African countries is still patchy, and thereby hinders implementation of effective preventative interventions. The lack of cheap, easy-to-use diagnostic tools leads to mostly symptomatic and empirical case management. An observational study with a total of 241 participants was conducted from February 2017 to August 2018 among children younger than 5 years with diarrhea in Lambaréné, Gabon. Clinical and demographic data were recorded, and a stool sample was collected. The samples were examined using a commercial rapid immunoassay to detect Rotavirus/adenovirus, conventional bacterial culture for Salmonella spp., and multiplex real-time PCR for Cryptosporidium spp., Giardia lamblia, Cyclospora cayetanensis, enterotoxigenic Escherichia coli (ETEC), and enteroinvasive Escherichia coli (EIEC)/Shigella. At least one infectious agent was present in 121 of 241 (50%) samples. The most frequently isolated pathogens were EIEC/Shigella and ETEC (54/179; 30.2% and 44/179; 24.6%, respectively), followed by G. lamblia (33/241; 13.7%), Cryptosporidium spp. (31/241; 12.9%), and Rotavirus (23/241; 9.5%). Coinfection with multiple pathogens was observed in 33% (40/121) of the positive cases with EIEC/Shigella, ETEC, and Cryptosporidium spp. most frequently identified. Our results provide new insight into the possible causes of diarrheal disease in the Moyen-Ogooué region of Gabon and motivate further research on possible modes of infection and targeted preventive measures.
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Affiliation(s)
- Gédéon Prince Manouana
- 1Centre de Recherche Médicales de Lambaréné, Lambaréné, Gabon.,2Institut für Tropenmedizin, Eberhad Karls Universität Tübingen, Tübingen, Germany
| | - Natalie Byrne
- 2Institut für Tropenmedizin, Eberhad Karls Universität Tübingen, Tübingen, Germany
| | | | | | - Philipp Hofmann
- 3German Center for Infection Research (DZIF), Hamburg-Borstel-Lübeck-Riems, Greifswald - Insel Riems, Germany
| | - Gedeon Bingoulou Matsougou
- 1Centre de Recherche Médicales de Lambaréné, Lambaréné, Gabon.,4Département de Pédiatrie, Faculté de Médecine, Université des Sciences de la Santé (USS), Libreville, Gabon
| | | | | | | | | | - Simon Ategbo
- 4Département de Pédiatrie, Faculté de Médecine, Université des Sciences de la Santé (USS), Libreville, Gabon
| | | | - Bayode Romeo Adegbite
- 1Centre de Recherche Médicales de Lambaréné, Lambaréné, Gabon.,5Department of Infectious Diseases, Center of Tropical Medicine and Travel Medicine, Amsterdam University Medical Centers, Location Amsterdam, Amsterdam, The Netherlands.,6Amsterdam Infection and Immunity, Amsterdam Public Health, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Peter Gottfried Kremsner
- 1Centre de Recherche Médicales de Lambaréné, Lambaréné, Gabon.,2Institut für Tropenmedizin, Eberhad Karls Universität Tübingen, Tübingen, Germany.,7German Center for Infection Research (DZIF), Tübingen, Germany
| | - Benjamin Mordmüller
- 1Centre de Recherche Médicales de Lambaréné, Lambaréné, Gabon.,2Institut für Tropenmedizin, Eberhad Karls Universität Tübingen, Tübingen, Germany.,7German Center for Infection Research (DZIF), Tübingen, Germany
| | - Daniel Eibach
- 3German Center for Infection Research (DZIF), Hamburg-Borstel-Lübeck-Riems, Greifswald - Insel Riems, Germany.,8Infectious Disease Epidemiology, Bernhard Nocht Insitute for Tropical Medicine, Hamburg, Germany
| | - Matthew McCall
- 1Centre de Recherche Médicales de Lambaréné, Lambaréné, Gabon.,2Institut für Tropenmedizin, Eberhad Karls Universität Tübingen, Tübingen, Germany.,9Department of Medical Microbiology, Radboudumc, Nijmegen, The Netherlands
| | - Alabi Abraham
- 1Centre de Recherche Médicales de Lambaréné, Lambaréné, Gabon
| | - Steffen Borrmann
- 1Centre de Recherche Médicales de Lambaréné, Lambaréné, Gabon.,2Institut für Tropenmedizin, Eberhad Karls Universität Tübingen, Tübingen, Germany.,7German Center for Infection Research (DZIF), Tübingen, Germany
| | - Ayola Akim Adegnika
- 1Centre de Recherche Médicales de Lambaréné, Lambaréné, Gabon.,2Institut für Tropenmedizin, Eberhad Karls Universität Tübingen, Tübingen, Germany.,7German Center for Infection Research (DZIF), Tübingen, Germany
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13
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Castany-Feixas M, Simo S, Garcia-Garcia S, Fernandez de Sevilla M, Launes C, Kalkgruber M, Gene A, Muñoz-Almagro C, Brotons P. Rapid molecular syndromic testing for aetiological diagnosis of gastrointestinal infections and targeted antimicrobial prescription: experience from a reference paediatric hospital in Spain. Eur J Clin Microbiol Infect Dis 2021; 40:2153-2160. [PMID: 33963926 PMCID: PMC8449766 DOI: 10.1007/s10096-021-04266-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 04/28/2021] [Indexed: 11/30/2022]
Abstract
Aetiological diagnosis of gastrointestinal infections is challenging since a wide range of bacteria, parasites and viruses can be causal agents and derived clinical manifestations appear quite similar. Our aim was to evaluate contribution of the novel QIAstat-DxGastrointestinal Panel (GIP) to aetiological diagnosis of gastrointestinal infections and rational antimicrobial prescription in a reference paediatric hospital. Evaluation included comparison of diagnostic yield and agreement of results of QIAstat-Dx GIP and conventional microbiological methods. Parallel testing was performed on stool samples collected prospectively from children admitted to Sant Joan de Deu Barcelona Hospital (Spain) during the period February-March 2019. Influence of the panel test use on antimicrobial prescription was assessed using a pre-post study design. Eighty-six (68.8%) out of 125 specimens were positive by QIAstat-Dx GIP versus 44 (35.2%) positive by a composite of conventional methods (p<0.001). Global agreement of panel test results with rotavirus-adenovirus antigen detection (92.8%) and a two-step antigen/toxin and PCR-based algorithm for toxigenic Clostridioides difficile detection (87.5%) was greater than that with bacterial culture (76.0%) and parasite microscopic identification (64.3%). Panel test results orientated antimicrobial prescription changes in 18 (14.4%) patients, including antimicrobial start in 11 cases initially untreated, targeted antimicrobial prescription in 5 and discontinuation in 2 cases empirically treated. Results showed that QIAstat-Dx GIP significantly expanded aetiological diagnosis of gastrointestinal infections compared to conventional microbiological methods while orientating a more judicious use of antimicrobial drugs in hospitalised children.
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Affiliation(s)
| | - Silvia Simo
- Institut de Recerca Sant Joan de Deu, Barcelona, Spain.,CIBER de Epidemiología y Salud Pública CIBERESP, Madrid, Spain
| | - Selene Garcia-Garcia
- Institut de Recerca Sant Joan de Deu, Barcelona, Spain.,Universitat Internacional de Catalunya, Barcelona, Spain
| | - Mariona Fernandez de Sevilla
- Institut de Recerca Sant Joan de Deu, Barcelona, Spain.,CIBER de Epidemiología y Salud Pública CIBERESP, Madrid, Spain.,University Hospital Sant Joan de Deu, P° Sant Joan de Déu, n° 2 08950 Esplugues, Barcelona, Spain.,Universitat de Barcelona, Barcelona, Spain
| | - Cristian Launes
- Institut de Recerca Sant Joan de Deu, Barcelona, Spain.,CIBER de Epidemiología y Salud Pública CIBERESP, Madrid, Spain.,University Hospital Sant Joan de Deu, P° Sant Joan de Déu, n° 2 08950 Esplugues, Barcelona, Spain.,Universitat de Barcelona, Barcelona, Spain
| | | | - Amadeu Gene
- University Hospital Sant Joan de Deu, P° Sant Joan de Déu, n° 2 08950 Esplugues, Barcelona, Spain
| | - Carmen Muñoz-Almagro
- Institut de Recerca Sant Joan de Deu, Barcelona, Spain. .,CIBER de Epidemiología y Salud Pública CIBERESP, Madrid, Spain. .,Universitat Internacional de Catalunya, Barcelona, Spain. .,University Hospital Sant Joan de Deu, P° Sant Joan de Déu, n° 2 08950 Esplugues, Barcelona, Spain.
| | - Pedro Brotons
- Institut de Recerca Sant Joan de Deu, Barcelona, Spain.,CIBER de Epidemiología y Salud Pública CIBERESP, Madrid, Spain.,Universitat Internacional de Catalunya, Barcelona, Spain
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14
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Chang H, Guo J, Wei Z, Huang Z, Wang C, Qiu Y, Xu X, Zeng M. Aetiology of acute diarrhoea in children in Shanghai, 2015-2018. PLoS One 2021; 16:e0249888. [PMID: 33831124 PMCID: PMC8031434 DOI: 10.1371/journal.pone.0249888] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 03/28/2021] [Indexed: 01/22/2023] Open
Abstract
Diarrhoea remains a major cause of childhood morbidity and mortality worldwide. This study aimed to monitor the aetiology of acute diarrhoea in children in Shanghai. Paediatric outpatients with acute diarrhoea were enrolled in the study from Jan 2015 to Dec 2018. Faecal samples were collected for testing. Enteric bacteria were identified and typed by culture and serotyping, respectively. Enteric viruses were identified by real-time PCR. Enteric pathogens were identified in 1572 (58.4%) of the 2692 enrolled children with acute diarrhoea. Viruses were detected more frequently than bacteria (41.3% versus 25.0%). Nontyphoidal Salmonella spp. (NTS) was the most common (10.3%) bacteria isolated, followed by enteropathogenic Escherichia coli (EPEC) (6.5%), enteroaggregative Escherichia coli (EAEC) (6.2%), Campylobacter spp. (3.6%), enterotoxigenic Escherichia coli (ETEC) (1.1%), Shigella spp. (0.2%), and enterohemorrhagic Escherichia coli (EHEC) (0.1%). Rotavirus was the most common (16.0%) virus detected, followed by norovirus (15.5%), adenovirus (7.2%), sapovirus (3.0%) and astrovirus (2.7%). Rotavirus, norovirus and NTS were the major pathogens responsible for diarrhoea in Shanghainese children. Improving uptake of the rotavirus vaccine and strengthening foodborne-pathogen prevention will aid in reducing the burden of diarrhoeal disease in children in Shanghai.
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Affiliation(s)
- Hailing Chang
- Department of Infectious Diseases, Children’s Hospital of Fudan University, Shanghai, China
| | - Jiayin Guo
- Department of Microbiology, Changning District Center for Disease Control and Prevention, Shanghai, China
| | - Zhongqiu Wei
- Department of Infectious Diseases, Children’s Hospital of Fudan University, Shanghai, China
| | - Zheng Huang
- Department of Microbiology, Changning District Center for Disease Control and Prevention, Shanghai, China
| | - Chuning Wang
- Department of Infectious Diseases, Children’s Hospital of Fudan University, Shanghai, China
| | - Yue Qiu
- Department of Infectious Diseases, Children’s Hospital of Fudan University, Shanghai, China
| | - Xuebin Xu
- Department of Microbiology, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
- * E-mail: (XX); (MZ)
| | - Mei Zeng
- Department of Infectious Diseases, Children’s Hospital of Fudan University, Shanghai, China
- * E-mail: (XX); (MZ)
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15
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Li Y, Xia S, Jiang X, Feng C, Gong S, Ma J, Fang Z, Yin J, Yin Y. Gut Microbiota and Diarrhea: An Updated Review. Front Cell Infect Microbiol 2021; 11:625210. [PMID: 33937093 PMCID: PMC8082445 DOI: 10.3389/fcimb.2021.625210] [Citation(s) in RCA: 79] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 03/26/2021] [Indexed: 12/15/2022] Open
Abstract
Diarrhea is a common problem to the whole world and the occurrence of diarrhea is highly associated with gut microbiota, such as bacteria, fungi, and viruses. Generally, diarrheal patients or animals are characterized by gut microbiota dysbiosis and pathogen infections may lead to diarrheal phenotypes. Of relevance, reprograming gut microbiota communities by dietary probiotics or fecal bacteria transplantation are widely introduced to treat or prevent diarrhea. In this review, we discussed the influence of the gut microbiota in the infection of diarrhea pathogens, and updated the research of reshaping the gut microbiota to prevent or treat diarrhea for the past few years. Together, gut microbiota manipulation is of great significance to the prevention and treatment of diarrhea, and further insight into the function of the gut microbiota will help to discover more anti-diarrhea probiotics.
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Affiliation(s)
- Yunxia Li
- Animal Nutritional Genome and Germplasm Innovation Research Center, College of Animal Science and Technology, Hunan Agricultural University, Changsha, China
| | - Siting Xia
- Animal Nutritional Genome and Germplasm Innovation Research Center, College of Animal Science and Technology, Hunan Agricultural University, Changsha, China
| | - Xiaohan Jiang
- Animal Nutritional Genome and Germplasm Innovation Research Center, College of Animal Science and Technology, Hunan Agricultural University, Changsha, China
| | - Can Feng
- Animal Nutritional Genome and Germplasm Innovation Research Center, College of Animal Science and Technology, Hunan Agricultural University, Changsha, China
| | - Saiming Gong
- Animal Nutritional Genome and Germplasm Innovation Research Center, College of Animal Science and Technology, Hunan Agricultural University, Changsha, China
| | - Jie Ma
- Animal Nutritional Genome and Germplasm Innovation Research Center, College of Animal Science and Technology, Hunan Agricultural University, Changsha, China
| | - Zhengfeng Fang
- Animal Nutrition Institute, Sichuan Agricultural University, Chengdu, China
- *Correspondence: Jie Yin, ; Zhengfeng Fang,
| | - Jie Yin
- Animal Nutritional Genome and Germplasm Innovation Research Center, College of Animal Science and Technology, Hunan Agricultural University, Changsha, China
- *Correspondence: Jie Yin, ; Zhengfeng Fang,
| | - Yulong Yin
- Animal Nutritional Genome and Germplasm Innovation Research Center, College of Animal Science and Technology, Hunan Agricultural University, Changsha, China
- Institute of Subtropical Agriculture, Chinese Academy of Sciences, Changsha, China
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16
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An Overview of the Molecular Methods in the Diagnosis of Gastrointestinal Infectious Diseases. Int J Microbiol 2020; 2020:8135724. [PMID: 32280346 PMCID: PMC7128059 DOI: 10.1155/2020/8135724] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 01/24/2020] [Accepted: 03/02/2020] [Indexed: 12/14/2022] Open
Abstract
Gastrointestinal infectious diseases are very common worldwide and an important cause of morbidity and mortality, particularly in infants in developing countries. Diarrhea and other intestinal infections are caused by a wide range of bacteria, viruses, protozoa, and parasites. Conventional diagnosis of these infections is performed by culture, microscopy, and antigen detection immunoassays. The traditional culture and microscopy procedures are time-consuming, lack sensitivity, and require special laboratory setup and well-trained staff. However, based on the advancement in the molecular diagnostics and with the introduction of commercially available tests, traditional diagnostic techniques have been continuously replaced by these newer rapid antigen detection and molecular-based methods. This review summarizes and discusses the availability, advantages, and disadvantages of molecular methods in the detection and identification of human gastrointestinal pathogens.
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17
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Hannet I, Engsbro AL, Pareja J, Schneider UV, Lisby JG, Pružinec-Popović B, Hoerauf A, Parčina M. Multicenter evaluation of the new QIAstat Gastrointestinal Panel for the rapid syndromic testing of acute gastroenteritis. Eur J Clin Microbiol Infect Dis 2019; 38:2103-2112. [DOI: 10.1007/s10096-019-03646-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 07/15/2019] [Indexed: 12/17/2022]
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Tatte VS, Gopalkrishna V. Detection of different enteric viruses in children with diarrheal disease: evidence of the high frequency of mixed infections. Access Microbiol 2019; 1:e000010. [PMID: 32974508 PMCID: PMC7470349 DOI: 10.1099/acmi.0.000010] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 02/08/2019] [Indexed: 01/19/2023] Open
Abstract
Enteric viruses play a major role in causing diarrhea in children. Early identification of the causative pathogen is still a challenge in the clinical laboratory. A multiplex PCR assay is a useful tool to screen a large number of clinical samples especially in an outbreak situation. In this study, a multiplex reverse transcription (RT)-PCR assay was developed to detect nine enteric viruses such as group A rotavirus, norovirus GGII, sapovirus, adenovirus, astrovirus, aichivirus, parechovirus, bocavirus and enterovirus in clinical samples of diarrheal cases. Stool samples (n=185) collected from infants and children with acute gastroenteritis cases in Pune, western India were analysed for nine different enteric viruses by currently developed multiplex RT- PCR. Predominance of group A rotavirus (76%) followed by enterovirus (11.5%), astrovirus (4.5%), adenovirus (2.7%) and norovirus GII (1.6%) was observed. A total of 44.8 % (82/185) samples analysed by this method showed high frequency of mixed infections. These results highlighted high prevalence and diversity of different enteric viruses in children. The multiplex PCR showed good concordance with monoplex RT-PCR for detection of these enteric viruses in clinical samples. This is the first report on the development of a multiplex RT-PCR assay for detection of multiple enteric viruses in diarrheal diseases from India.
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Affiliation(s)
- Vaishali S Tatte
- Enteric Viruses Group, National Institute of Virology, Pune, India
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19
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Diagnostic Interpretation Guidance for Pediatric Enteric Pathogens: A Modified Delphi Consensus Process. CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY 2018; 2018:2589826. [PMID: 30363711 PMCID: PMC6180965 DOI: 10.1155/2018/2589826] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 08/07/2018] [Indexed: 02/04/2023]
Abstract
Background We sought to develop diagnostic test guidance definitions for pediatric enteric infections to facilitate the interpretation of positive test results in the era of multianalyte molecular diagnostic test platforms. Methods We employed a systematic, two-phase, modified Delphi consensus process consisting of three web-based surveys and an expert panel face-to-face meeting. In phase 1, we surveyed an advisory panel of North American experts to select pathogens requiring diagnostic test guidance definition development. In phase 2, we convened a 14-member expert panel to develop, refine, and select the final definitions through two web-based questionnaires interspersed with a face-to-face meeting. Both questionnaires asked panelists to rate the degree to which they agreed that if the definition is met the pathogen is likely to be causative of clinical illness. Results The advisory panel survey identified 19 pathogens requiring definitions. In the expert panel premeeting survey, 13 of the 19 definitions evaluated were rated as being highly likely (“agree” or “strongly agree”) to be responsible for acute gastroenteritis symptoms by ≥67% of respondent panel members. The definitions for the remaining six pathogens (Aeromonas, Clostridium difficile, Edwardsiella, nonenteric adenovirus, astrovirus, and Entamoeba histolytica) were indeterminate. After the expert panel meeting, only two of the modified definitions, C. difficile and E. histolytica/dispar, failed to achieve the a priori specified threshold of ≥67% agreement. Conclusions We developed diagnostic test guidance definitions to assist healthcare providers for 17 enteric pathogens. We identified two pathogens that require further research and definition development.
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McKee RS, Tarr PI, Dietzen DJ, Chawla R, Schnadower D. Clinical and Laboratory Predictors of Shiga Toxin-Producing Escherichia coli Infection in Children With Bloody Diarrhea. J Pediatric Infect Dis Soc 2018; 7:e116-e122. [PMID: 29617871 PMCID: PMC6097574 DOI: 10.1093/jpids/piy025] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 02/12/2018] [Indexed: 12/25/2022]
Abstract
OBJECTIVES Children with acute bloody diarrhea are at risk of being infected with Shiga toxin-producing Escherichia coli (STEC) and of progression to hemolytic uremic syndrome. Our objective was to identify clinical and laboratory factors associated with STEC infection in children who present with acute bloody diarrhea. METHODS We performed a prospective cohort study of consecutive children younger than 18 years who presented with acute (<2-week duration) bloody diarrhea between August 1, 2013, and August 1, 2014. We excluded patients with a chronic gastrointestinal illness and/or an obvious noninfectious source of bloody stool. We obtained a standardized history and study laboratory tests, performed physical examinations, and recorded patient outcomes. RESULTS Of the 135 eligible patients, 108 were enrolled; 27 declined consent. The median patient age was 3 years, and 56% were male. Ten (9%) patients tested positive for STEC (E coli O157:H7, n = 8; E coli O111, n = 1; E coli O103, n = 1), and 62 had negative stool culture results. Children infected with STEC were older (8.5 vs 3 years, respectively) (P < .001) and more likely to have abdominal tenderness (83% vs 17%, respectively) than those in the other groups. D-Dimer concentrations had a 70% sensitivity and 55% specificity for differentiating children with STEC from those with another cause of bloody diarrhea and 75% sensitivity and 70% specificity in differentiating children with a bacterial etiology from those with negative stool culture results. CONCLUSION Clinical assessment and laboratory data cannot reliably exclude the possibility that children with bloody diarrhea have an STEC infection and are at consequent risk of developing hemolytic uremic syndrome. Abnormal D-dimer concentrations (>0.5 μg/mL) were insufficiently sensitive and specific for distinguishing patients with STEC from those with another bacterial cause of bloody diarrhea. However, this marker might be useful in identifying children whose bloody diarrhea is caused by a bacterial enteric pathogen.
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Affiliation(s)
- Ryan S McKee
- Washington University School of Medicine, St. Louis, Missouri
| | - Phillip I Tarr
- Washington University School of Medicine, St. Louis, Missouri
| | | | - Rachit Chawla
- Washington University School of Medicine, St. Louis, Missouri
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Kronman MP, Banerjee R, Duchon J, Gerber JS, Green MD, Hersh AL, Hyun D, Maples H, Nash CB, Parker S, Patel SJ, Saiman L, Tamma PD, Newland JG. Expanding Existing Antimicrobial Stewardship Programs in Pediatrics: What Comes Next. J Pediatric Infect Dis Soc 2018; 7:241-248. [PMID: 29267871 PMCID: PMC7107461 DOI: 10.1093/jpids/pix104] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Accepted: 09/08/2017] [Indexed: 02/06/2023]
Abstract
The prevalence of pediatric antimicrobial stewardship programs (ASPs) is increasing in acute care facilities across the United States. Over the past several years, the evidence base used to inform effective stewardship practices has expanded, and regulatory interest in stewardship programs has increased. Here, we review approaches for established, hospital-based pediatric ASPs to adapt and report standardized metrics, broaden their reach to specialized populations, expand to undertake novel stewardship initiatives, and implement rapid diagnostics to continue their evolution in improving antimicrobial use and patient outcomes.
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Affiliation(s)
- Matthew P Kronman
- Division of Infectious Diseases, Department of Pediatrics, University of Washington, Seattle, Washington
| | - Ritu Banerjee
- Division of Infectious Diseases, Department of Pediatrics, Vanderbilt University, Nashville, Tennessee
| | - Jennifer Duchon
- Division of Infectious Diseases, Department of Pediatrics, Columbia University Medical Center, New York, New York
| | - Jeffrey S Gerber
- Division of Infectious Diseases, Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Michael D Green
- Division of Infectious Diseases, Department of Pediatrics, University of Pittsburgh, Pennsylvania
| | - Adam L Hersh
- Division of Infectious Diseases, Department of Pediatrics, University of Utah, Salt Lake City, Utah
| | | | - Holly Maples
- Department of Pharmacy, University of Arkansas, Little Rock, Arkansas
| | - Colleen B Nash
- Division of Infectious Diseases, Department of Pediatrics, University of Chicago, Illinois
| | - Sarah Parker
- Division of Infectious Diseases, Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado
| | - Sameer J Patel
- Division of Infectious Diseases, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Lisa Saiman
- Division of Infectious Diseases, Department of Pediatrics, Columbia University Medical Center, New York, New York
| | - Pranita D Tamma
- Division of Infectious Diseases, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jason G Newland
- Division of Infectious Diseases, Department of Pediatrics, Washington University, St. Louis, Missouri
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Calderaro A, Martinelli M, Buttrini M, Montecchini S, Covan S, Rossi S, Ferraglia F, Montagna P, Pinardi F, Larini S, Arcangeletti MC, Medici MC, Chezzi C, De Conto F. Contribution of the FilmArray ® Gastrointestinal Panel in the laboratory diagnosis of gastroenteritis in a cohort of children: a two-year prospective study. Int J Med Microbiol 2018; 308:514-521. [PMID: 29748124 DOI: 10.1016/j.ijmm.2018.04.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 04/20/2018] [Accepted: 04/30/2018] [Indexed: 02/08/2023] Open
Abstract
This study represents a 2-year picture of the epidemiology of enteric pathogens in children suffering from gastroenteritis using the FilmArray® Gastrointestinal Panel (FA-GP), a multiplex molecular assay that allows to simultaneously detect a large panel of pathogens independently of the etiological suspicion and to evaluate its potential contribution to the diagnosis compared to the conventional methods. A total of 1716 stool samples, collected from children with clinical suspicion of bacterial and/or viral gastroenteritis attending the University Hospital of Parma, was submitted to the FA-GP and, when an adequate aliquot was available, to electron microscopy (n = 1163) for virus detection and to an enterovirus-targeting real-time PCR (n = 1703). Specimens with positive results for Salmonella, Yersinia enterocolitica, Vibrio, diarrheagenic Escherichia coli/Shigella, Campylobacter, Plesiomonas shigelloides and/or parasites by the FA-GP were also submitted to conventional diagnostic methods. The FA-GP gave positive results in 958 (55.8%) cases, 64.8% from inpatients: 647 (67.5%) contained a single agent and 311 (32.5%) multiple agents, for a total of 1374 pathogens. Enteropathogenic E. coli, rotavirus, norovirus, toxigenic Clostridioides difficile, and sapovirus were the most commonly detected pathogens. A total of 812 additional agents (344 of which as single pathogen) was detected by the FA-GP and not included in the clinical suspicion. The overall recovery rate of the conventional methods from stools that resulted positive by the FA-GP was 38.6% for bacteria, 50% and 84.2% for Giardia intestinalis and Cryptosporidium, respectively, and ranged from 3.7% to 64.6% for viruses, if excluding all electron microscopy-negative astroviruses. Enterovirus, an agent not targeted by the FA-GP, was revealed in 9.6% (164/1703) of the examined samples, and in 52 cases it was the only agent detected. The results of this study allowed to extend the range of detectable pathogens independently of the clinical suspicion, to detect co-infections in almost one third of children positive for at least one agent and to show that conventional methods would have missed more than half of the enteric agents detected by the FA-GP.
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Affiliation(s)
- Adriana Calderaro
- Department of Medicine and Surgery, University of Parma, Parma, Italy.
| | - Monica Martinelli
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Mirko Buttrini
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Sara Montecchini
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Silvia Covan
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Sabina Rossi
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | | | - Paolo Montagna
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Federica Pinardi
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Sandra Larini
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | | | | | - Carlo Chezzi
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Flora De Conto
- Department of Medicine and Surgery, University of Parma, Parma, Italy
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23
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Freeman K, Mistry H, Tsertsvadze A, Royle P, McCarthy N, Taylor-Phillips S, Manuel R, Mason J. Multiplex tests to identify gastrointestinal bacteria, viruses and parasites in people with suspected infectious gastroenteritis: a systematic review and economic analysis. Health Technol Assess 2018; 21:1-188. [PMID: 28619124 DOI: 10.3310/hta21230] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Gastroenteritis is a common, transient disorder usually caused by infection and characterised by the acute onset of diarrhoea. Multiplex gastrointestinal pathogen panel (GPP) tests simultaneously identify common bacterial, viral and parasitic pathogens using molecular testing. By providing test results more rapidly than conventional testing methods, GPP tests might positively influence the treatment and management of patients presenting in hospital or in the community. OBJECTIVE To systematically review the evidence for GPP tests [xTAG® (Luminex, Toronto, ON, Canada), FilmArray (BioFire Diagnostics, Salt Lake City, UT, USA) and Faecal Pathogens B (AusDiagnostics, Beaconsfield, NSW, Australia)] and to develop a de novo economic model to compare the cost-effectiveness of GPP tests with conventional testing in England and Wales. DATA SOURCES Multiple electronic databases including MEDLINE, EMBASE, Web of Science and the Cochrane Database were searched from inception to January 2016 (with supplementary searches of other online resources). REVIEW METHODS Eligible studies included patients with acute diarrhoea; comparing GPP tests with standard microbiology techniques; and patient, management, test accuracy or cost-effectiveness outcomes. Quality assessment of eligible studies used tailored Quality Assessment of Diagnostic Accuracy Studies-2, Consolidated Health Economic Evaluation Reporting Standards and Philips checklists. The meta-analysis included positive and negative agreement estimated for each pathogen. A de novo decision tree model compared patients managed with GPP testing or comparable coverage with patients managed using conventional tests, within the Public Health England pathway. Economic models included hospital and community management of patients with suspected gastroenteritis. The model estimated costs (in 2014/15 prices) and quality-adjusted life-year losses from a NHS and Personal Social Services perspective. RESULTS Twenty-three studies informed the review of clinical evidence (17 xTAG, four FilmArray, two xTAG and FilmArray, 0 Faecal Pathogens B). No study provided an adequate reference standard with which to compare the test accuracy of GPP with conventional tests. A meta-analysis (of 10 studies) found considerable heterogeneity; however, GPP testing produces a greater number of pathogen-positive findings than conventional testing. It is unclear whether or not these additional 'positives' are clinically important. The review identified no robust evidence to inform consequent clinical management of patients. There is considerable uncertainty about the cost-effectiveness of GPP panels used to test for suspected infectious gastroenteritis in hospital and community settings. Uncertainties in the model include length of stay, assumptions about false-positive findings and the costs of tests. Although there is potential for cost-effectiveness in both settings, key modelling assumptions need to be verified and model findings remain tentative. LIMITATIONS No test-treat trials were retrieved. The economic model reflects one pattern of care, which will vary across the NHS. CONCLUSIONS The systematic review and cost-effectiveness model identify uncertainties about the adoption of GPP tests within the NHS. GPP testing will generally correctly identify pathogens identified by conventional testing; however, these tests also generate considerable additional positive results of uncertain clinical importance. FUTURE WORK An independent reference standard may not exist to evaluate alternative approaches to testing. A test-treat trial might ascertain whether or not additional GPP 'positives' are clinically important or result in overdiagnoses, whether or not earlier diagnosis leads to earlier discharge in patients and what the health consequences of earlier intervention are. Future work might also consider the public health impact of different testing treatments, as test results form the basis for public health surveillance. STUDY REGISTRATION This study is registered as PROSPERO CRD2016033320. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- Karoline Freeman
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Hema Mistry
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Alexander Tsertsvadze
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Pam Royle
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Noel McCarthy
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Sian Taylor-Phillips
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | | | - James Mason
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
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24
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A Gastrointestinal PCR Panel Improves Clinical Management and Lowers Health Care Costs. J Clin Microbiol 2017; 56:JCM.01457-17. [PMID: 29093106 DOI: 10.1128/jcm.01457-17] [Citation(s) in RCA: 82] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 10/26/2017] [Indexed: 11/20/2022] Open
Abstract
Conventional methods for the identification of gastrointestinal pathogens are time-consuming and expensive and have limited sensitivity. The aim of this study was to determine the clinical impact of a comprehensive molecular test, the BioFire FilmArray gastrointestinal (GI) panel, which tests for many of the most common agents of infectious diarrhea in approximately 1 h. Patients with stool cultures submitted were tested on the GI panel (n = 241) and were compared with control patients (n = 594) from the year prior. The most common organisms detected by the GI panel were enteropathogenic Escherichia coli (EPEC, n = 21), norovirus (n = 21), rotavirus (n = 15), sapovirus (n = 9), and Salmonella (n = 8). Patients tested on the GI panel had an average of 0.58 other infectious stool tests compared with 3.02 in the control group (P = 0.0001). The numbers of days on antibiotic(s) per patient were 1.73 in the cases and 2.12 in the controls (P = 0.06). Patients with the GI panel had 0.18 abdomen and/or pelvic imaging studies per patient compared with 0.39 (P = 0.0002) in the controls. The average length of time from stool culture collection to discharge was 3.4 days in the GI panel group versus 3.9 days in the controls (P = 0.04). The overall health care cost could have decreased by $293.61 per patient tested. The GI panel improved patient care by rapidly identifying a broad range of pathogens which may not have otherwise been detected, reducing the need for other diagnostic tests, reducing unnecessary use of antibiotics, and leading to a reduction in hospital length of stay.
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25
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Chung N, Wang SM, Shen CF, Kuo FC, Ho TS, Hsiung CA, Mu JJ, Wu FT, Huang LM, Huang YC, Huang YC, Chi H, Lin HC, Liu CC. Clinical and epidemiological characteristics in hospitalized young children with acute gastroenteritis in southern Taiwan: According to major pathogens. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2017; 50:915-922. [DOI: 10.1016/j.jmii.2017.07.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Revised: 06/30/2017] [Accepted: 07/12/2017] [Indexed: 02/04/2023]
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Abstract
Solid-organ transplantation in pediatrics can be a life-saving procedure, but it cannot be accomplished without risk of infection-related morbidity and mortality. Evaluation of the recipient during candidacy and donor during evaluation can assist with identification of risk. Further, risk of infection from the surgical procedure can be mitigated through careful planning and attention to infection prevention processes. Finally, early recognition of infection posttransplant can limit the impact of these events.
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Affiliation(s)
- Elizabeth Doby Knackstedt
- Division of Pediatric Infectious Disease, University of Utah, Salt Lake City, Utah; Division of Transplant/Immunocompromised Infectious Diseases, Primary Children's Hospital, Salt Lake City, Utah
| | - Lara Danziger-Isakov
- Division of Pediatric Infectious Diseases, University of Cincinnati, Immunocompromised Host Infectious Disease, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
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27
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Piralla A, Lunghi G, Ardissino G, Girello A, Premoli M, Bava E, Arghittu M, Colombo MR, Cognetto A, Bono P, Campanini G, Marone P, Baldanti F. FilmArray™ GI panel performance for the diagnosis of acute gastroenteritis or hemorragic diarrhea. BMC Microbiol 2017; 17:111. [PMID: 28494766 PMCID: PMC5427568 DOI: 10.1186/s12866-017-1018-2] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2017] [Accepted: 04/28/2017] [Indexed: 12/16/2022] Open
Abstract
Background Acute gastroenteritis is a common cause of morbidity and mortality in humans worldwide. The rapid and specific identification of infectious agents is crucial for correct patient management. However, diagnosis of acute gastroenteritis is usually performed with diagnostic panels that include only a few pathogens. In the present bicentric study, the diagnostic value of FilmArray™ GI panels was assessed in unformed stool samples of patients with acute gastroenteritis and in a series of samples collected from pediatric patients with heamorragic diarrhea. The clinical performance of the FilmArray™ gastrointestinal (GI) panel was assessed in 168 stool samples collected from patients with either acute gastroenteritis or hemorragic diarrhea. Samples showing discordant results between FilmArray and routine methods were further analyzed with an additional assay. Results Overall, the FilmArray™ GI panel detected at least one potential pathogen in 92/168 (54.8%) specimens. In 66/92 (71.8%) samples, only one pathogen was detected, while in 26/92 (28.2%) multiple pathogens were detected. The most frequent pathogens were rotavirus 13.9% (22/168), Campylobacter 10.7% (18/168), Clostridium difficile 9.5% (16/168), and norovirus 8.9% (15/168). Clostridium difficile was identified only in patients with acute gastroenteritis (p < 0.01), while STEC was detected exclusively in patients with hemorragic diarrhea (p < 0.01). In addition, Campylobacter spp., Salmonella spp., EPEC and E. coli producing Shiga-like toxin were more frequently detected in patients with hemorragic diarrhea (p < 0.05). The overall percent agreement calculated in samples was 73.8% and 65.5%, while 34.5% were discordant. After additional confirmatory analyses, the proportion of discordant samples decreased to 7.7%. Rotavirus and astrovirus were the most frequently unconfirmed pathogens. Conclusion In conclusion, the FilmArray™ GI panel has proved to be a valuable new diagnostic tool for improving the diagnostic efficiency of GI pathogens.
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Affiliation(s)
- Antonio Piralla
- Microbiology and Virology Department, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Giovanna Lunghi
- Microbiology and Virology Unit, Fondazione Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Gianluigi Ardissino
- Center of HUS Control, Prevention and Management, Fondazione Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Alessia Girello
- Microbiology and Virology Department, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Marta Premoli
- Microbiology and Virology Department, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Erika Bava
- Microbiology and Virology Department, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Milena Arghittu
- Microbiology and Virology Unit, Fondazione Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Maria Rosaria Colombo
- Microbiology and Virology Unit, Fondazione Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Alessandra Cognetto
- Microbiology and Virology Unit, Fondazione Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Patrizia Bono
- Microbiology and Virology Unit, Fondazione Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giulia Campanini
- Microbiology and Virology Department, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Piero Marone
- Microbiology and Virology Department, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Fausto Baldanti
- Microbiology and Virology Department, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy. .,Section of Microbiology, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy.
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28
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Kim Y, Kim HJ, Lim S, Bae KS, Han SB, Jeong DC, Kang JH, Shin GJ, Lee GD, Park YJ. Community-acquired Escherichia coli Enteritis in Korean Children: The Clinical Application of a Stool Polymerase Chain Reaction Assay. Infect Chemother 2017; 49:275-281. [PMID: 29299895 PMCID: PMC5754338 DOI: 10.3947/ic.2017.49.4.275] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Accepted: 11/28/2017] [Indexed: 01/31/2023] Open
Abstract
Background Although Escherichia coli is a common cause of bacterial enteritis in Korea, reports on community-acquired E. coli enteritis in Korean children are scarce. This study aimed to determine the clinical characteristics and pathotype distribution of community-acquired E. coli enteritis diagnosed by a multiplex polymerase chain reaction (PCR) assay in Korean children. Materials and Methods The medical records of children aged 18 years or less who were diagnosed with acute gastroenteritis by the attending physician between 2013 and 2016 were retrospectively reviewed. The clinical characteristics of children diagnosed with E. coli enteritis were investigated and compared with those diagnosed with Salmonella enteritis. E. coli and Salmonella infections were diagnosed by a stool PCR assay. Results Among 279 children, in whom PCR assays for E. coli and Salmonella spp. were performed, Salmonella enteritis and E. coli enteritis were diagnosed in 43 (15.4%) and 39 (14.0%) children, respectively. Among the 39 children with E. coli enteritis, enteropathogenic E. coli (n=21, 53.8%) and enteroaggregative E. coli (n=15, 38.4%) were the most common causative agents. Empirical antibiotics were administered to 33 (84.6%) children. A total of 31 (79.5%) children developed fever, and 25 (80.6%) of them had the fever for 3 days or less, which resolved a median of 1 day (range 0-3 days) after hospitalization. The most frequent gastrointestinal symptom was diarrhea (n=36, 92.3%). Significantly more children with E. coli enteritis were aged 2 years or less as compared with those with Salmonella enteritis (41.0% vs. 21.9%, P = 0.021). Children with Salmonella enteritis more frequently complained of fever (97.7% vs. 79.5%, P = 0.012), abdominal pain (90.7% vs. 64.1%, P = 0.004), and hematochezia (46.5% vs. 10.3%, P <0.001) than those with E. coli enteritis. Erythrocyte sedimentation rate and C-reactive protein levels were significantly higher in children with Salmonella enteritis than those with E. coli enteritis (P <0.001). Conclusion Enteropathogenic E. coli was the most frequent pathotype in Korean children with E. coli enteritis that caused mild clinical symptoms. A stool PCR assay for E. coli may be useful for epidemiological purpose and for an early diagnosis of E. coli enteritis.
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Affiliation(s)
- Youie Kim
- Department of Pediatrics, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyo Jin Kim
- Department of Pediatrics, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sooyeon Lim
- Department of Pediatrics, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kil Seong Bae
- Department of Pediatrics, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.,The Vaccine Bio Research Institute, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seung Beom Han
- Department of Pediatrics, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.,The Vaccine Bio Research Institute, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
| | - Dae Chul Jeong
- Department of Pediatrics, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.,The Vaccine Bio Research Institute, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jin Han Kang
- Department of Pediatrics, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.,The Vaccine Bio Research Institute, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Gook Jae Shin
- Department of Laboratory Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Gun Dong Lee
- Department of Laboratory Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yeon Joon Park
- Department of Laboratory Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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