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. 2023 Sep;42(9):1091-1101.
doi: 10.1007/s10096-023-04642-5. Epub 2023 Jul 19.

Epidemiology of gastrointestinal infections: lessons learned from syndromic testing, Region Zealand, Denmark

Rikke Lykke Johansen  1 , Christian Højte Schouw  1 , Tina Vasehus Madsen  1 , Xiaohui Chen Nielsen  1 , Jørgen Engberg  2
Affiliations

Epidemiology of gastrointestinal infections: lessons learned from syndromic testing, Region Zealand, Denmark

Rikke Lykke Johansen et al. Eur J Clin Microbiol Infect Dis. 2023 Sep.

Abstract

The aim of this study was to investigate the value of syndromic diagnostic testing for a better understanding of the epidemiology of gastrointestinal infections in Denmark. Here we evaluated the QIAstat-Dx® Gastrointestinal (GI) Panel 1 assay on 18,610 fecal samples requested for analysis for enteric pathogens in Region Zealand, Denmark, in 1 year (October 1, 2021, to September 30, 2022). In total, 6905 (37%) samples were detected positive for one or more diarrhoeal bacteria, viruses, and protozoa. The most common bacterial, viral, and parasitic pathogens detected with the QIAstat-Dx® Gastrointestinal Panel 1 were EPEC (in patients ≥ 2 years of age) (n = 1420 (20.6%)), rotavirus (n = 948 (13.7%)), and Cryptosporidium spp. (n = 196 (2.84%)). We identified a large diversity in infections likely reflecting substantial differences in the epidemiology including origin of infections, mode of transmission, seasonality, age-dependent susceptibility to disease, severity, and travel history. All pathogens were detected as both single and coinfections. Viral infections peaked in March with a positive rate of 31.6%, and bacterial infections peaked in August with a positive rate of 35.3%. ETEC, Shigella/EIEC, EAEC, and P. shigelloides were most related to travel activity, and coinfections were frequent. The distribution of Ct values varied significantly between the pathogens, with the lowest Ct values (median 17-18) observed in astrovirus, adenovirus, and rotavirus. Our results highlight the value of providing extensive diagnostic testing on fecal samples for sufficient detection of relevant diarrhoeal pathogens for optimal clinical care.

Keywords: Diarrhea; Evaluation; Experience; Gastrointestinal infections; Multiplex PCR; QIAstat-Dx; Syndromic testing.

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Conflict of interest statement

Rikke Lykke Johansen, Christian Højte Schouw, Tina Vasehus Madsen, and Xiaohui Chen Nielsen declare they have no financial interests. Jørgen Engberg has received a speaker honorarium from QIAGEN.

Figures

Fig. 1
Fig. 1
Positive fecal samples by the enteric pathogen, October 2021 to October 2022
Fig. 2
Fig. 2
The median and quartiles of age by an enteric pathogen. Pathogens detected < 10 times are not presented
Fig. 3
Fig. 3
A Distribution of single versus coinfections by an enteric pathogen. Pathogens detected < 10 times are not presented. B Number of pathogens detected simultaneously by age group
Fig. 4
Fig. 4
Origin of infections by travel. Pathogens detected < 10 times are not presented
Fig. 5
Fig. 5
Origin of infections by the healthcare system. Pathogens detected < 10 times are not presented
Fig. 6
Fig. 6
A Enteric pathogen group by season. The mean daily temperature per month in Denmark is presented for comparison. In Denmark, placed in the Northern Hemisphere, the annual seasons are winter (December–February), spring (March–May), summer (June–August), and fall (September–October) [9]. B Enteric pathogens by month. The colors are based on normalized values for each pathogen and indicate increasing frequency by warmer colors. Numbers in boxes are positive rate (%) of the detected pathogen by the number of tested fecal samples. Rarely detected pathogens (< 25 detections) are not presented. * denotes part of identified and investigated general outbreaks [10, 11]
Fig. 7
Fig. 7
The median and quartiles of PCR Ct values. Pathogens detected < 10 times are not presented
See this image and copyright information in PMC

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