Acute infectious gastroenteritis in childhood: the role of rapid multiplex molecular syndromic panels in diagnosis and clinical management

Abstract

Acute infectious diarrhea is a major global health issue, especially in children, as gastrointestinal infections are the second most common infectious disease after respiratory infections. The implementation of rapid multiplex molecular syndromic panels (RMMSP) for the comprehensive detection and identification of enteric pathogens in stool samples has enhanced diagnostic precision, supplementing-or, in some cases, replacing-traditional methodologies. This narrative, non-systematic review synthesized the available evidence on the clinical performance of gastrointestinal RMMSP up to December 31, 2024. On May 27, 2024, specialists in Pediatrics and Microbiology met to assess the use of RMMSP in pediatric gastrointestinal infection diagnosis. This review focused on RMMSP applicable to urgent management of infectious acute gastroenteritis (AGE), excluding those panels unsuitable for immediate diagnosis. RMMSP facilitated rapid pathogen detection in pediatric infectious AGE and have shown potential advantages over traditional microbiological methods, including a reduction in time to appropriate treatment. Their use appeared particularly useful in emergency and inpatient settings for inflammatory AGE, prolonged traveler's diarrhea, or cases at risk for complications. They were also considered for outpatient diagnosis in moderate/severe cases, chronic diarrhea, or immunocompromised patients. Within a diagnostic stewardship framework, current evidence suggests that RMMSP can contribute to minimizing unnecessary testing and hospitalizations, improving outbreak control, and optimizing antimicrobial use. However, further research is necessary to refine diagnostic workflows and ensure timely result delivery. This document evaluated key aspects regarding the application of RMMSP in pediatric infectious AGE, aiming to establish standardized protocols, support clinical decision-making, and facilitate optimal patient management.

Keywords: Acute gastroenteritis; Culture-independent diagnostic test; Diarrhea; Gastrointestinal infection; Multiplex PCR panel; Rapid multiplex molecular syndromic panels.

Figure 1.. Proposed clinical roadmap for a child with infectious acute gastroenteritis.

Adapted from Menasalvas et al. [15 ]. DH: dehydration. *Infants <3 months with fever or suspected sepsis: Immediate evaluation and management are required. **Multiplex panel testing: If available, urgent testing is recommended in cases of severe acute gastroenteritis (AGE) requiring hospitalization, children with risk factors, diarrhea associated with an epidemic outbreak, or traveler’s diarrhea. In enteroinvasive AGE without admission criteria, consider multiplex testing upon presentation to the Emergency Department. ***Stool culture indications:Recommended in cases of prolonged symptoms, immunosuppression, or traveler’s diarrhea. ****Clostridioides difficile testing: Indicated in the presence of risk factors, including immunosuppression, recent antibiotic exposure, or pre-existing gastrointestinal conditions (e.g., Hirschsprung’s disease, inflammatory bowel disease). Routine testing is generally not recommended in infants <2 years, except in highly selected cases.