title: Microbiological diagnosis of severe diarrhea in kidney transplant recipients by use of multiplex PCR assays.
abstract: Diarrhea is a frequent complication after kidney transplantation, ascribed to adverse effects of the immunosuppressive therapy in case of negative microbiological examination of the stools. The aim of this study was to improve the microbiological diagnosis by implementing molecular tests. Fifty-four severe diarrhea events that occurred in 49 adult kidney transplant recipients from September 2010 to November 2011 were investigated. One or several enteric pathogens were detected in 13 (23%) stool samples using classical microbiological methods versus 39 (72%) for the seven commercially available multiplex PCR assays used retrospectively (P = 0.006). Interestingly, molecular diagnosis identified 15 multiple infections compared to none using classical techniques. The primary pathogens detected were enteropathogenic Escherichia coli (EPEC) (n = 15; 38%), Campylobacter spp. (n = 15; 38%), and Norovirus (n = 14; 36%). Specificities for Campylobacter and Norovirus infection diagnosis were 75 and 100%, respectively, by comparison to reference methods. Based on molecular findings, a cyclosporine-mycophenolate mofetil combination was identified as a risk factor for developing Norovirus-induced diarrhea. Norovirus infections were also responsible for higher weight loss than all the other causes of diarrhea. In samples from asymptomatic immunocompromised and immunocompetent patients, EPEC but not Norovirus and Campylobacter infections were detected at a frequency similar to that observed in symptomatic kidney transplant recipients. In conclusion, molecular tools significantly improved the detection of single and multiple enteric infections by comparison to classical techniques and could quickly become the key element in the management of severe acute diarrhea in transplant recipients.
authors.affiliation: Clinical and Molecular Virology Unit, Faculty of Medicine, University Hospital and EA-4684 Cardiovir SFR-CAP sante, Reims, France.
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Coste
authors.forename: Vincent
authors.initials: V
authors.lastname: Vuiblet
authors.forename: Betoul
authors.initials: B
authors.lastname: Moustapha
authors.forename: Alexis
authors.initials: A
authors.lastname: Bouin
authors.forename: Sylvie
authors.initials: S
authors.lastname: Lavaud
authors.forename: Olivier
authors.initials: O
authors.lastname: Toupance
authors.forename: Alexis
authors.initials: A
authors.lastname: de Rougemont
authors.forename: Lucie
authors.initials: L
authors.lastname: Benejat
authors.forename: Francis
authors.initials: F
authors.lastname: Megraud
authors.forename: Aurore
authors.initials: A
authors.lastname: Wolak-Thierry
authors.forename: Isabelle
authors.initials: I
authors.lastname: Villena
authors.forename: Cathy
authors.initials: C
authors.lastname: Chemla
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Le Magrex
authors.forename: Christophe
authors.initials: C
authors.lastname: de Champs
authors.forename: Laurent
authors.initials: L
authors.lastname: Andreoletti
authors.forename: Philippe
authors.initials: P
authors.lastname: Rieu
authors.forename: Nicolas
authors.initials: N
authors.lastname: Leveque
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001424:Bacterial Infections / Q000175:diagnosis / Q000382:microbiology; D060085:Coinfection / Q000175:diagnosis / Q000382:microbiology / Q000821:virology; D003967:Diarrhea / Q000175:diagnosis* / Q000382:microbiology / Q000821:virology; D005243:Feces / Q000382:microbiology* / Q000821:virology*; D005260:Female; D006801:Humans; D016867:Immunocompromised Host; D016030:Kidney Transplantation; D008297:Male; D008828:Microbiological Techniques / Q000379:methods*; D008875:Middle Aged; D025202:Molecular Diagnostic Techniques / Q000379:methods*; D008969:Molecular Sequence Data; D060885:Multiplex Polymerase Chain Reaction / Q000379:methods*; D017422:Sequence Analysis, DNA; D014180:Transplantation; D014777:Virus Diseases / Q000175:diagnosis / Q000821:virology; D055815:Young Adult
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