Combined stool-based multiplex PCR and microscopy for enhanced pathogen detection in patients with persistent diarrhoea and asymptomatic controls from Côte d'Ivoire.
Infectious diarrhoea ranks among the leading causes of morbidity worldwide. Although most acute diarrhoeal episodes are self-limiting, the diagnosis and treatment of persistent diarrhoea (≥2 weeks) are cumbersome and require laboratory identification of the causative pathogen. Stool-based PCR assays have greatly improved the previously disappointing pathogen detection rates in high-income countries, but there is a paucity of quality data from tropical settings. We performed a case-control study to elucidate the spectrum of intestinal pathogens in patients with persistent diarrhoea and asymptomatic controls in southern Côte d'Ivoire. Stool samples from 68 patients and 68 controls were obtained and subjected to molecular multiplex testing with the Luminex(®) Gastrointestinal Pathogen Panel (GPP), microscopy and rapid antigen detection tests for the diagnosis of diarrhoeagenic pathogens. Overall, 20 different bacteria, parasites and viruses were detected by the suite of diagnostic methods employed. At least one pathogen was observed in 84% of the participants, and co-infections were observed in >50% of the participants. Enterotoxigenic Escherichia coli (32%), Giardia intestinalis (29%) and Shigella species (20%) were the predominant pathogens, and Strongyloides stercoralis (10%) was the most prevalent helminth. Pathogen frequencies and numbers of co-infections were similar in patients and controls. Although the Luminex(®) GPP detects a broad range of pathogens, microscopy for helminths and intestinal protozoa remains necessary to cover the full aetiological spectrum in tropical settings. We conclude that highly sensitive multiplex PCR assays constitute a useful screening tool, but that positive results might need to be confirmed by independent methods to discriminate active infection from asymptomatic faecal shedding of nucleic acids.
Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland; Institute of Medical Microbiology and Hygiene, Saarland University Medical Centre, Homburg/Saar, Germany.
S L
SL
Becker
Hôpital Méthodiste de Dabou, Dabou, Côte d'Ivoire.
J K
JK
Chatigre
Hôpital Méthodiste de Dabou, Dabou, Côte d'Ivoire.
J-P
JP
Gohou
Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland; Département Environnement et Santé, Centre Suisse de Recherches Scientifiques en Côte d'Ivoire, Abidjan, Côte d'Ivoire; Unité de Formation et de Recherche Biosciences, Université Félix Houphouët-Boigny, Abidjan, Côte d'Ivoire.
J T
JT
Coulibaly
Hôpital Méthodiste de Dabou, Dabou, Côte d'Ivoire; Ruedi Leuppi Foundation Côte d'Ivoire, Zug, Switzerland.
R
R
Leuppi
Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium.
K
K
Polman
Division of Tropical and Humanitarian Medicine, Geneva University Hospitals, Geneva, Switzerland.
F
F
Chappuis
Coris BioConcept, Gembloux, Belgium.
P
P
Mertens
Institute of Medical Microbiology and Hygiene, Saarland University Medical Centre, Homburg/Saar, Germany.
M
M
Herrmann
Département Environnement et Santé, Centre Suisse de Recherches Scientifiques en Côte d'Ivoire, Abidjan, Côte d'Ivoire; Unité de Formation et de Recherche Biosciences, Université Félix Houphouët-Boigny, Abidjan, Côte d'Ivoire.
E K
EK
N'Goran
Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland.
J
J
Utzinger
Institute of Medical Microbiology and Hygiene, Saarland University Medical Centre, Homburg/Saar, Germany. Electronic address: lutz.mueller@uks.eu.
L
L
von Müller
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000818:Animals; D001419:Bacteria / Q000302:isolation & purification; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D060085:Coinfection / Q000175:diagnosis / Q000453:epidemiology; D007560:Cote d'Ivoire / Q000453:epidemiology; D003955:Diagnostic Tests, Routine / Q000379:methods*; D003967:Diarrhea / Q000175:diagnosis* / Q000453:epidemiology; D005243:Feces / Q000382:microbiology* / Q000469:parasitology* / Q000821:virology; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008853:Microscopy / Q000379:methods*; D008875:Middle Aged; D060885:Multiplex Polymerase Chain Reaction / Q000379:methods*; D010271:Parasites / Q000302:isolation & purification; D015995:Prevalence; D014780:Viruses / Q000302:isolation & purification; D055815:Young Adult
Bacteria; Côte d’Ivoire; diagnosis; helminths; intestinal protozoa; microscopy; multiplex PCR; persistent diarrhoea; stool; viruses