Summer diarrhea in children: a monocentric French epidemiological observational study

Abstract

Pediatric diarrhea is a major public health problem worldwide. In France, continuous surveillance shows a winter epidemic peak and a more modest summer recrudescence. Few studies describe the infectious agents responsible for pediatric summer diarrhea in France. The objectives were to estimate the prevalence of infectious diarrhea and describe the pathogens responsible for summer diarrhea in children; and to describe common factors that can be used as guidance on the etiology of these diarrheas. A cross-sectional, single-center, epidemiological observational study was conducted in the pediatric emergency department of a French hospital between June and September in 2019 and 2020. Multiplex gastrointestinal pathogen panels were used for diagnostics. A multiple correspondence analysis was used to determine profiles of patients. A total of 95 children were included, of whom 82.1% (78/95) were under five years old. The prevalence of infectious summer diarrhea was 81.1% (77/95, 95%CI 71.7-88.4%). A total of 126 infectious agents were detected (50.0% bacteria, 38.1% viruses, 11.9% parasites). The main enteric pathogens were enteropathogen Escherichia coli (24/126), rotavirus (17/126) and Salmonella (16/126). A co-detection was found in 51.9% (40/77) of cases. Four patient profiles, considering the severity and the pathogen involved, were highlighted.

Figure 1

Flowchart of the study.

Figure 2

Prevalence of each enteropathogen and co-detection. The most frequently detected infectious agents were EPEC followed by rotavirus and then Salmonella. No Yersinia enterocolitica, Giardia duodenalis, Entamoeba histolytica, Enterocytozoon bieneusi nor Encephalitozoon sp. were detected. A co-detection was identified in more than half of the infectious stools. EHEC enterohemorrhagic Escherichia coli, EIEC enteroinvasive Escherichia coli, EPEC enteropathogen Escherichia coli, STEC Shiga toxin-producing Escherichia coli.

Figure 3

Monthly distribution of the different infectious agents detected (a): bacteria (b), viruses (c) and parasites (d). EHEC enterohemorrhagic Escherichia coli, EIEC enteroinvasive Escherichia coli, EPEC enteropathogen Escherichia coli, STEC Shiga toxin-producing Escherichia coli.