title: Presence of infectious agents and co-infections in diarrheic dogs determined with a real-time polymerase chain reaction-based panel.
abstract: BACKGROUND
  Infectious diarrhea can be caused by bacteria, viruses, or protozoan organisms, or a combination of these. The identification of co-infections in dogs is important to determine the prognosis and to plan strategies for their treatment and prophylaxis. Although many pathogens have been individually detected with real-time polymerase chain reaction (PCR), a comprehensive panel of agents that cause diarrhea in privately owned dogs has not yet been established. The objective of this study was to use a real-time PCR diarrhea panel to survey the frequencies of pathogens and co-infections in owned dogs attended in a veterinary hospital with and without diarrhea, as well the frequency in different countries. Feces samples were tested for canine distemper virus, canine coronavirus, canine parvovirus type 2 (CPV-2), Clostridium perfringens alpha toxin (CPA), Cryptosporidium spp., Giardia spp., and Salmonella spp. using molecular techniques.
  
  
  RESULTS
  In total, 104 diarrheic and 43 control dogs that were presented consecutively at a major private veterinary hospital were included in the study. Overall, 71/104 (68.3%) dogs with diarrhea were positive for at least one pathogen: a single infection in 39/71 dogs (54.9%) and co-infections in 32/71 dogs (45.1%), including 21/32 dogs (65.6%) with dual, 5/32 (15.6%) with triple, and 6/32 (18.8%) with quadruple infections. In the control group, 13/43 (30.2%) dogs were positive, all with single infections only. The most prevalent pathogens in the diarrheic dogs were CPA (40/104 dogs, 38.5%), CPV-2 (36/104 dogs, 34.6%), and Giardia spp. (14/104 dogs, 13.5%). CPV-2 was the most prevalent pathogen in the dual co-infections, associated with CPA, Cryptosporidium spp., or Giardia spp. No statistical difference (P = 0.8374) was observed in the duration of diarrhea or the number of deaths (P = 0.5722) in the presence or absence of single or co-infections.
  
  
  CONCLUSIONS
  Diarrheic dogs showed a higher prevalence of pathogen infections than the controls. Whereas the healthy dogs had only single infections, about half the diarrheic dogs had co-infections. Therefore, multiple pathogens should be investigated in dogs presenting with diarrhea. The effects of multiple pathogens on the disease outcomes remain unclear because the rate of death and the duration of diarrhea did not seem to be affected by these factors.
authors.affiliation: Department of Veterinary Medicine, Federal University of Parana, 1540 R dos Funcionários, Curitiba, PR 80035-050, Brazil. alinebrgizzi@gmail.com.
authors.forename: Aline Baumann da Rocha
authors.initials: AB
authors.lastname: Gizzi
authors.forename: Simone Tostes
authors.initials: ST
authors.lastname: Oliveira
authors.forename: Christian M
authors.initials: CM
authors.lastname: Leutenegger
authors.forename: Marko
authors.initials: M
authors.lastname: Estrada
authors.forename: Denise Adamczyk
authors.initials: DA
authors.lastname: Kozemjakin
authors.forename: Rafael
authors.initials: R
authors.lastname: Stedile
authors.forename: Mary
authors.initials: M
authors.lastname: Marcondes
authors.forename: Alexander Welker
authors.initials: AW
authors.lastname: Biondo
mesh_terms: D000375:Aging; D000818:Animals; D001424:Bacterial Infections / Q000150:complications / Q000175:diagnosis / Q000662:veterinary*; D060085:Coinfection / Q000382:microbiology / Q000469:parasitology / Q000662:veterinary*; D003967:Diarrhea / Q000382:microbiology / Q000469:parasitology / Q000662:veterinary*; D004283:Dog Diseases / Q000209:etiology / Q000382:microbiology*; D004285:Dogs; D005243:Feces / Q000382:microbiology / Q000469:parasitology; D005260:Female; D005767:Gastrointestinal Diseases / Q000209:etiology / Q000662:veterinary*; D008297:Male; D010273:Parasitic Diseases, Animal / Q000175:diagnosis* / Q000469:parasitology; D060888:Real-Time Polymerase Chain Reaction / Q000379:methods / Q000662:veterinary*