title: Association between stool enteropathogen quantity and disease in Tanzanian children using TaqMan array cards: a nested case-control study.
abstract: Etiologic studies of diarrhea are limited by uneven diagnostic methods and frequent asymptomatic detection of enteropathogens. Polymerase chain reaction-based stool pathogen quantification may help distinguish clinically significant infections. We performed a nested case-control study of diarrhea in infants from a community-based birth cohort in Tanzania. We tested 71 diarrheal samples and pre-diarrheal matched controls with a laboratory-developed TaqMan Array Card for 19 enteropathogens. With qualitative detection, no pathogens were significantly associated with diarrhea. When pathogen quantity was considered, rotavirus (odds ratio [OR] = 2.70 per log10 increase, P < 0.001), astrovirus (OR = 1.49, P = 0.01), and Shigella/enteroinvasive Escherichia coli (OR = 1.47, P = 0.04) were associated with diarrhea. Enterotoxigenic E. coli (0.15 SD decline in length-for-age z score after 3 months per log10 increase, P < 0.001) and Campylobacter jejuni/C. coli (0.11 SD decline, P = 0.003) in pre-diarrheal stools were associated with poor linear growth. Quantitative analysis can help refine the association between enteropathogens and disease in endemic settings.
authors.affiliation: Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia, Charlottesville, Virginia; Haydom Lutheran Hospital, Haydom, Tanzania; Kilimanjaro Clinical Research Institute, Moshi, Tanzania; Fogarty International Center, National Institutes of Health, Bethesda, Maryland.
authors.forename: James A
authors.initials: JA
authors.lastname: Platts-Mills
authors.forename: Jean
authors.initials: J
authors.lastname: Gratz
authors.forename: Esto
authors.initials: E
authors.lastname: Mduma
authors.forename: Erling
authors.initials: E
authors.lastname: Svensen
authors.forename: Caroline
authors.initials: C
authors.lastname: Amour
authors.forename: Jie
authors.initials: J
authors.lastname: Liu
authors.forename: Athanasia
authors.initials: A
authors.lastname: Maro
authors.forename: Queen
authors.initials: Q
authors.lastname: Saidi
authors.forename: Ndealilia
authors.initials: N
authors.lastname: Swai
authors.forename: Happiness
authors.initials: H
authors.lastname: Kumburu
authors.forename: Benjamin J J
authors.initials: BJ
authors.lastname: McCormick
authors.forename: Gibson
authors.initials: G
authors.lastname: Kibiki
authors.forename: Eric R
authors.initials: ER
authors.lastname: Houpt
mesh_terms: D019350:Astroviridae Infections / Q000453:epidemiology / Q000821:virology*; D016022:Case-Control Studies; D019353:Endemic Diseases; D005243:Feces / Q000382:microbiology*; D005260:Female; D005767:Gastrointestinal Diseases / Q000453:epidemiology / Q000382:microbiology*; D006801:Humans; D007223:Infant; D008297:Male; D001257:Mamastrovirus / Q000302:isolation & purification*; D016017:Odds Ratio; D012307:Risk Factors; D012401:Rotavirus / Q000302:isolation & purification*; D012400:Rotavirus Infections / Q000453:epidemiology / Q000821:virology; D013636:Tanzania / Q000453:epidemiology