title: Diarrhoeagenic microbes by real-time PCR in Rwandan children under 5 years of age with acute gastroenteritis.
abstract: Acute gastroenteritis is a main cause of disease and death among children in low-income countries. The causality rates and pathogenic characteristics of putative aetiological agents remain insufficiently known. We used real-time PCR targeting 16 diarrhoeagenic agents to analyse stool samples from children ≤5.0 years old with acute diarrhoea in Rwanda. Among the 880 children (median age 14.2 months; 41% female) at least one pathogen was detected in 92% and two or more agents in 63% of cases. Rotavirus was detected in 36.9%, adenovirus in 39.7%, enterotoxigenic Escherichia coli (ETEC) with genes for labile (eltB) or stable (estA) toxin in 31.3% and 19.0%, E. coli with eae or bfpA genes in 25.2% and 14.2%, Shigella in 17.5% and Cryptosporidium in 7.8%. Rotavirus and ETEC-estA were associated with more severe dehydration than diarrhoea due to other causes. Shigella was associated with bloody stools and higher CRP. Microbial loads (Ct values) of rotavirus, ETEC-estA and Shigella were associated with severity of symptoms. Rotavirus, ETEC-estA and E. coli with bfpA were associated with younger age, Shigella with older age. Antibiotic treatment was given to 42% and was associated with dehydration, fever and CRP, but not with pathogen. We conclude that rotavirus and ETEC-estA were the most important causes of diarrhoea with dehydration, that Shigella caused bloody diarrhoea but less severe dehydration, that microbial loads of rotavirus, ETEC-estA and Shigella were associated with severity of symptoms, and that antibiotic use was frequent and in poor agreement with microbiological findings.
authors.affiliation: Department of Infectious Diseases, University of Gothenburg, Gothenburg, Sweden; Department of Paediatrics, National University of Rwanda, Kigali, Rwanda.
authors.forename: J-C
authors.initials: JC
authors.lastname: Kabayiza
authors.forename: M E
authors.initials: ME
authors.lastname: Andersson
authors.forename: S
authors.initials: S
authors.lastname: Nilsson
authors.forename: C
authors.initials: C
authors.lastname: Baribwira
authors.forename: G
authors.initials: G
authors.lastname: Muhirwa
authors.forename: T
authors.initials: T
authors.lastname: Bergström
authors.forename: M
authors.initials: M
authors.lastname: Lindh
mesh_terms: D000256:Adenoviridae / Q000302:isolation & purification; D002675:Child, Preschool; D003458:Cryptosporidium / Q000302:isolation & purification; D003967:Diarrhea / Q000453:epidemiology* / Q000382:microbiology / Q000469:parasitology / Q000821:virology; D004926:Escherichia coli / Q000302:isolation & purification; D005243:Feces / Q000382:microbiology / Q000469:parasitology / Q000821:virology; D005260:Female; D005759:Gastroenteritis / Q000453:epidemiology* / Q000382:microbiology / Q000469:parasitology / Q000821:virology; D006801:Humans; D007223:Infant; D008297:Male; D015995:Prevalence; D060888:Real-Time Polymerase Chain Reaction; D012401:Rotavirus / Q000302:isolation & purification; D012432:Rwanda / Q000453:epidemiology; D012760:Shigella / Q000302:isolation & purification
keywords: Diarrhoea; epidemiology; faeces; gastroenteritis; real-time PCR