title: Etiology of diarrhea in young children in Denmark: a case-control study.
abstract: Infectious gastroenteritis is one of the most common diseases in young children. To clarify the infectious etiology of diarrhea in Danish children less than 5 years of age, we conducted a 2-year prospective case-control study. Stools from 424 children with diarrhea and 870 asymptomatic age-matched controls were examined, and their parents were interviewed concerning symptoms. Rotavirus, adenovirus, and astrovirus were detected by enzyme-linked immunosorbent assay, and norovirus and sapovirus were detected by PCR. Salmonella, thermotolerant Campylobacter, Yersinia, Shigella, and Vibrio spp. were detected by standard methods. Shiga toxin-producing (STEC), attaching-and-effacing (A/EEC), enteropathogenic (EPEC), enterotoxigenic, enteroinvasive, and enteroaggregative Escherichia coli were detected by using colony hybridization with virulence gene probes and serotyping. Parasites were detected by microscopy. Overall, a potential pathogen was found in 54% of cases. More cases than controls were infected with rotavirus, Salmonella, norovirus, adenovirus, Campylobacter, sapovirus, STEC, classical EPEC, Yersinia, and Cryptosporidium strains, whereas A/EEC, although common, was not associated with illness. The single most important cause of diarrhea was rotavirus, which points toward the need for a childhood vaccine for this pathogen, but norovirus, adenovirus, and sapovirus were also major etiologies. Salmonella sp. was the most common bacterial pathogen, followed by Campylobacter, STEC, Yersinia, and classical EPEC strains. A/EEC not belonging to the classical EPEC serotypes was not associated with diarrhea, underscoring the importance of serotyping for the definition of EPEC.
authors.affiliation: Department of Bacteriology, Mycology and Parasitology, Statens Serum Institut, Artillerivej 5, DK-2300 Copenhagen S, Denmark. benol@fa.dk
authors.forename: Bente
authors.initials: B
authors.lastname: Olesen
authors.forename: Jacob
authors.initials: J
authors.lastname: Neimann
authors.forename: Blenda
authors.initials: B
authors.lastname: Böttiger
authors.forename: Steen
authors.initials: S
authors.lastname: Ethelberg
authors.forename: Peter
authors.initials: P
authors.lastname: Schiellerup
authors.forename: Charlotte
authors.initials: C
authors.lastname: Jensen
authors.forename: Morten
authors.initials: M
authors.lastname: Helms
authors.forename: Flemming
authors.initials: F
authors.lastname: Scheutz
authors.forename: Katharina E P
authors.initials: KE
authors.lastname: Olsen
authors.forename: Karen
authors.initials: K
authors.lastname: Krogfelt
authors.forename: Eskild
authors.initials: E
authors.lastname: Petersen
authors.forename: Kåre
authors.initials: K
authors.lastname: Mølbak
authors.forename: Peter
authors.initials: P
authors.lastname: Gerner-Smidt
mesh_terms: D016022:Case-Control Studies; D002675:Child, Preschool; D003967:Diarrhea / Q000209:etiology* / Q000382:microbiology / Q000469:parasitology; D004926:Escherichia coli / Q000302:isolation & purification; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D011446:Prospective Studies; D012401:Rotavirus / Q000302:isolation & purification