Detection of 23 Gastrointestinal Pathogens Among Children Who Present With Diarrhea

Abstract

Background: Diarrheal diseases are a major cause of ambulatory care visits and hospitalizations among children. Because of overlapping signs and symptoms and expensive and inefficient testing methods, the etiology of pediatric diarrhea is rarely established.

Methods: We identified children <18 years of age who were evaluated for diarrhea at Primary Children's Hospital in Salt Lake City, Utah, between October 2010 and September 2012. Stool specimens submitted for testing were evaluated by using the FilmArray gastrointestinal diagnostic system, which is a rapid multiplex polymerase chain reaction platform that can simultaneously detect 23 bacterial, viral, and protozoal agents.

Results: A pathogen was detected in 561 (52%) of 1089 diarrheal episodes. The most commonly detected pathogens included toxigenic Clostridium difficile (16%), diarrheagenic Escherichia coli (15%), norovirus GI/GII (11%), and adenovirus F 40/41 (7%). Shiga toxin-producing E coli were detected in 43 (4%) specimens. Multiple pathogens were identified in 160 (15%) specimens. Viral pathogens (norovirus, adenovirus, rotavirus, and sapovirus) were more common among children <5 years old than among those 5 to 17 years old (38% vs 16%, respectively; P < .001). Bacterial pathogens were identified most commonly in children 2 to 4 years of age. Children with 1 or more underlying chronic medical conditions were less likely to have a pathogen identified than those without a chronic medical condition (45% vs 60%, respectively; P < .01). Viral pathogens were detected more commonly in the winter, whereas bacterial pathogens were detected more commonly in the summer.

Conclusions: Toxigenic C difficile, diarrheagenic E coli, and norovirus were the leading organisms detected among these children with diarrhea. Viral pathogens are identified frequently among young children with acute gastroenteritis.

Keywords: FilmArray; acute gastroenteritis; children; gastrointestinal illness.

Figure 1.

Detection of 23 infectious diarrhea pathogens among children in Utah, 2010-2012. (A) Numbers and percentages of children with specific diarrheal pathogens detected in all age groups studied. There were 1089 children with a unique diarrheal episode, 561 (52%) of whom had at least 1 pathogen detected. Because the patients could have more than 1 pathogen detected, there were a total of 776 detections. Lighter and darker colors in the histogram indicate single and copathogen detections, respectively. (B) Proportions of detections (single and codetection) according to age group. Abbreviations: EAEC, enteroaggregative E coli; EPEC, enteropathogenic E coli; ETEC, enterotoxigenic E coli; STEC, shigatoxigenic E coli.

Figure 2.

Seasonality of pediatric diarrhea according to pathogen, 2010–2012. (A) Numbers of stool specimens tested according to month are presented as the overall height of the bars. Stacked within each of these bars are the numbers of bacterial, viral, protozoal, and mixed (bacterial + viral, bacterial + protozoal, or viral + protozoal) detections and negative test results (white). (B) Detection of enteric bacterial pathogens. (C) Detection of viral pathogens. (D) Detection of protozoal pathogens. The number of diarrheal episodes in which each pathogen was identified are presented as stacked bar graphs for each month of the 2-year study period. Abbreviations: EAEC, enteroaggregative E coli; EIEC, enteroinvasive E coli; EPEC, enteropathogenic E coli; ETEC, enterotoxigenic E coli; STEC, shigatoxigenic E coli.