Detection of enteric pathogens in young children before and during acute gastroenteritis : results from a prospective German birth cohort study (LoewenKIDS)

Abstract

Purpose

To identify enteric pathogens in pediatric acute gastroenteritis (AGE) and assess their etiological relevance by comparison with samples during asymptomatic period. Methods

Children < 2 years of age (n = 89) were prospectively enrolled as part of the population-based birth cohort LoewenKIDS. Asymptomatic stool samples were collected regularly, and symptomatic samples were collected after the occurrence of > 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. Results

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. Conclusion

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 parasitic pathogens detection, partly due to constraints in their specific identification.