Diarrheagenic pathogens in polymicrobial infections

Abstract

During systematic active surveillance of the causes of diarrhea in patients admitted to the Infectious Diseases and Beliaghata General Hospital in Kolkata, India, we looked for 26 known gastrointestinal pathogens in fecal samples from 2,748 patients. Samples from about one-third (29%) of the patients contained multiple pathogens. Polymicrobial infections frequently contained Vibrio cholerae O1 and rotavirus. When these agents were present, some co-infecting agents were found significantly less often (p = 10 (-5) to 10 (-33), some were detected significantly more often (p = 10 (-5) to 10 (-26), and others were detected equally as often as when V. cholerae O1 or rotavirus was absent. When data were stratified by patient age and season, many nonrandom associations remained statistically significant. The causes and effects of these nonrandom associations remain unknown.

Figure

Odds ratios (ORs) showing odds of A) Vibrio cholerae or B) rotavirus co-occurring with various other pathogens relative to the odds of V. cholerae or rotavirus co-occurring independently with various other pathogens at the frequency with which each is present in the entire sample. This standard forest plot indicates the best estimate and the 95% confidence intervals (CIs) for each co-occurring organism. EAEC, enteroaggregative Escherichia coli; EPEC, enteropathogenic E. coli; ETEC, enterotoxigenic E. coli.