TY - JOUR
T1 - Diarrhea etiology in a pediatric emergency department
T2 - A case control study
AU - Denno, Donna M.
AU - Shaikh, Nurmohammad
AU - Stapp, Jenny R.
AU - Qin, Xuan
AU - Hutter, Carolyn M.
AU - Hoffman, Valerie
AU - Mooney, Jody C.
AU - Wood, Kelly M.
AU - Stevens, Harold J.
AU - Jones, Robert
AU - Tarr, Phillip I.
AU - Klein, Eileen J.
N1 - Funding Information:
Financial support. This study was supported by US Department of Agriculture (NRI grant 0202238 to P. I. T.) and the Morphology and Biobank Cores of the Washington University School of Medicine Digestive Diseases Research Core Center (P30DK052574). Virus enzyme immunoassay kits were kindly provided at reduced cost by Dako, but Dako had no role in study design or manuscript preparation. Potential conflicts of interest. All authors: No reported conflicts.
PY - 2012/10/1
Y1 - 2012/10/1
N2 - Background.The etiology of childhood diarrhea is frequently unknown.Methods.We sought Aeromonas, Campylobacter, Escherichia coli O157:H7, Pleisiomonas shigelloides, Salmonella, Shigella, Vibrio, and Yersinia (by culture), adenoviruses, astroviruses, noroviruses, rotavirus, and Shiga toxin-producing E. coli (STEC; by enzyme immunoassay), Clostridium difficile (by cytotoxicity), parasites (by microscopy), and enteroaggregative E. coli (EAEC; by polymerase chain reaction [PCR] analysis) in the stools of 254 children with diarrhea presenting to a pediatric emergency facility. Age- and geographic-matched community controls without diarrhea (n = 452) were similarly studied, except bacterial cultures of the stool were limited only to cases.Results.Twenty-nine (11.4) case stools contained 13 Salmonella, 10 STEC (6 O157:H7 and 4 non-O157:H7 serotypes), 5 Campylobacter, and 2 Shigella. PCR-defined EAEC were present more often in case (3.2) specimens than in control (0.9) specimens (adjusted odds ratio [OR], 3.9; 95 confidence interval [CI], 1.1-13.7), and their adherence phenotypes were variable. Rotavirus, astrovirus, and adenovirus were more common among cases than controls, but both groups contained noroviruses and C. difficile at similar rates. PCR evidence of hypervirulent C. difficile was found in case and control stools; parasites were much more common in control specimens.Conclusions.EAEC are associated with childhood diarrhea in Seattle, but the optimal way to identify these agents warrants determination. Children without diarrhea harbor diarrheagenic pathogens, including hypervirulent C. difficile. Our data support the importance of taking into account host susceptibility, microbial density, and organism virulence traits in future case-control studies, not merely categorizing candidate pathogens as being present or absent.
AB - Background.The etiology of childhood diarrhea is frequently unknown.Methods.We sought Aeromonas, Campylobacter, Escherichia coli O157:H7, Pleisiomonas shigelloides, Salmonella, Shigella, Vibrio, and Yersinia (by culture), adenoviruses, astroviruses, noroviruses, rotavirus, and Shiga toxin-producing E. coli (STEC; by enzyme immunoassay), Clostridium difficile (by cytotoxicity), parasites (by microscopy), and enteroaggregative E. coli (EAEC; by polymerase chain reaction [PCR] analysis) in the stools of 254 children with diarrhea presenting to a pediatric emergency facility. Age- and geographic-matched community controls without diarrhea (n = 452) were similarly studied, except bacterial cultures of the stool were limited only to cases.Results.Twenty-nine (11.4) case stools contained 13 Salmonella, 10 STEC (6 O157:H7 and 4 non-O157:H7 serotypes), 5 Campylobacter, and 2 Shigella. PCR-defined EAEC were present more often in case (3.2) specimens than in control (0.9) specimens (adjusted odds ratio [OR], 3.9; 95 confidence interval [CI], 1.1-13.7), and their adherence phenotypes were variable. Rotavirus, astrovirus, and adenovirus were more common among cases than controls, but both groups contained noroviruses and C. difficile at similar rates. PCR evidence of hypervirulent C. difficile was found in case and control stools; parasites were much more common in control specimens.Conclusions.EAEC are associated with childhood diarrhea in Seattle, but the optimal way to identify these agents warrants determination. Children without diarrhea harbor diarrheagenic pathogens, including hypervirulent C. difficile. Our data support the importance of taking into account host susceptibility, microbial density, and organism virulence traits in future case-control studies, not merely categorizing candidate pathogens as being present or absent.
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U2 - 10.1093/cid/cis553
DO - 10.1093/cid/cis553
M3 - Article
C2 - 22700832
AN - SCOPUS:84866139410
SN - 1058-4838
VL - 55
SP - 897
EP - 904
JO - Clinical Infectious Diseases
JF - Clinical Infectious Diseases
IS - 7
ER -