title: Gastrointestinal pathogens detected by multiplex nucleic acid amplification testing in stools of pediatric patients and patients returning from the tropics.
abstract: BACKGROUND
  Gastrointestinal infections are caused by a broad spectrum of pathogens. Conventional diagnostic procedures are resource and time consuming due to single pathogen testing, often in different laboratories.
  
  
  METHODS
  We analyzed 312 consecutive stool samples from pediatric patients (n = 127) with gastroenteritis or from adult travelers returning from the tropics with suspected parasite infestation (n = 185) using commercial multiplex nucleic acid amplification testing (NAT) (xTAG gastrointestinal pathogen panel, Luminex) covering 15 diarrhea-causing pathogens. The results of the positive samples and a representative number of negative samples were compared to standard methods, including NAT, direct antigen detection (DAD), bacterial culture and microscopy.
  
  
  RESULTS
  Of the 185 samples from adult travelers, 21 (11 %) were multiplexNAT-positive, with enterotoxigenic Escherichia coli (4 %) being the predominant pathogen. Microscopic examination revealed Blastocystis hominis in 23 % not covered by the panel. MultiplexNAT scored positive in 66 pediatric samples (52 %), with rotavirus (27 %) being the most prevalent. All adenovirus-, rotavirus-, Clostridium difficile- and Cryptosporidium-positive samples were confirmed in external laboratories, but only 40 % of norovirus- and 29 % of Giardia-positive samples. Analysis of frozen specimens by bacterial culture showed the highest discrepancies with the multiplexNAT.
  
  
  CONCLUSIONS
  Our study demonstrates broad detection of relevant gastroenteritis pathogens by multiplexNAT with a short turnaround time. This is important for diagnosis, infection control and empiric management of gastroenteritis patients, but may be selectively complemented by bacterial culture and resistance testing.
authors.forename: C
authors.initials: C
authors.lastname: Beckmann
authors.forename: U
authors.initials: U
authors.lastname: Heininger
authors.forename: H
authors.initials: H
authors.lastname: Marti
authors.forename: H H
authors.initials: HH
authors.lastname: Hirsch
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000818:Animals; D001419:Bacteria / Q000145:classification / Q000235:genetics / Q000302:isolation & purification; D002648:Child; D002675:Child, Preschool; D003967:Diarrhea / Q000382:microbiology / Q000469:parasitology; D005243:Feces / Q000382:microbiology*; D005260:Female; D005767:Gastrointestinal Diseases / Q000175:diagnosis / Q000382:microbiology* / Q000469:parasitology*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D060885:Multiplex Polymerase Chain Reaction / Q000379:methods*; D010271:Parasites / Q000145:classification / Q000235:genetics / Q000302:isolation & purification; D012680:Sensitivity and Specificity; D014195:Travel; D014780:Viruses / Q000145:classification / Q000235:genetics / Q000302:isolation & purification; D055815:Young Adult