Detection of enteric pathogens in young children before and during acute gastroenteritis: results from a prospective German birth cohort study (LoewenKIDS)
Abstract
To identify enteric pathogens in pediatric acute gastroenteritis (AGE) and assess their etiological relevance by comparison with samples during asymptomatic period. Children 3 loose stools and/or one vomiting in 24 h. Intraindividual pairs of symptomatic and preceding asymptomatic samples for each child were analyzed for 25 enteric pathogens via multiplex real-time RT-PCR. Enteric viruses were detected in 64% (57/89) of symptomatic samples and significantly associated with gastrointestinal symptoms (Odds Ratio [OR] 3.9; 95% Confidence Interval [CI] 2.1–7.3). The most common viruses in AGE were norovirus (Genogroups GI and GII) (36%, 32/89) and adenovirus (27%, 24/89). Bacteria were detected in 46% (41/89) of symptomatic samples and 43% (38/89) of asymptomatic ones, with no association to symptoms (OR 1.1; 95% CI 0.6-2). The most common bacteria in AGE were Enteropathogenic Escherichia coli (28%, 25/89) and Clostridium difficile (16%, 14/89). Dientamoeba fragilis was the only detected parasite in AGE (7%, 6/89), and was not associated with symptoms (OR 1.4; 95% CI 0.4–5.5). Pathogen loads in symptomatic and asymptomatic pairs correlated with symptoms for norovirus GII, astrovirus and sapovirus (each p < 0.01), but not for other pathogens. This study supports the clinical significance of detection of viral pathogens in young children with acute gastroenteritis and without relevant comorbidities in high-income countries, but limits the significance of enteric bacterial and…
How strong is the evidence?
Evidence Hub reads this as a cohort study, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence. Reported size: 89 participants or records.
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