title: Detection of 23 Gastrointestinal Pathogens Among Children Who Present With Diarrhea.
abstract: BACKGROUND
  Diarrheal diseases are a major cause of ambulatory care visits and hospitalizations among children. Because of overlapping signs and symptoms and expensive and inefficient testing methods, the etiology of pediatric diarrhea is rarely established.
  
  
  METHODS
  We identified children <18 years of age who were evaluated for diarrhea at Primary Children's Hospital in Salt Lake City, Utah, between October 2010 and September 2012. Stool specimens submitted for testing were evaluated by using the FilmArray gastrointestinal diagnostic system, which is a rapid multiplex polymerase chain reaction platform that can simultaneously detect 23 bacterial, viral, and protozoal agents.
  
  
  RESULTS
  A pathogen was detected in 561 (52%) of 1089 diarrheal episodes. The most commonly detected pathogens included toxigenic Clostridium difficile (16%), diarrheagenic Escherichia coli (15%), norovirus GI/GII (11%), and adenovirus F 40/41 (7%). Shiga toxin-producing E coli were detected in 43 (4%) specimens. Multiple pathogens were identified in 160 (15%) specimens. Viral pathogens (norovirus, adenovirus, rotavirus, and sapovirus) were more common among children <5 years old than among those 5 to 17 years old (38% vs 16%, respectively; P < .001). Bacterial pathogens were identified most commonly in children 2 to 4 years of age. Children with 1 or more underlying chronic medical conditions were less likely to have a pathogen identified than those without a chronic medical condition (45% vs 60%, respectively; P < .01). Viral pathogens were detected more commonly in the winter, whereas bacterial pathogens were detected more commonly in the summer.
  
  
  CONCLUSIONS
  Toxigenic C difficile, diarrheagenic E coli, and norovirus were the leading organisms detected among these children with diarrhea. Viral pathogens are identified frequently among young children with acute gastroenteritis.
authors.affiliation: Departments of Pediatrics.
authors.forename: Chris
authors.initials: C
authors.lastname: Stockmann
authors.affiliation: Departments of Pediatrics.
authors.forename: Andrew T
authors.initials: AT
authors.lastname: Pavia
authors.affiliation: BioFire Diagnostics, Inc.
authors.forename: Brad
authors.initials: B
authors.lastname: Graham
authors.affiliation: BioFire Diagnostics, Inc.
authors.forename: Mike
authors.initials: M
authors.lastname: Vaughn
authors.affiliation: BioFire Diagnostics, Inc.
authors.forename: Rob
authors.initials: R
authors.lastname: Crisp
authors.affiliation: BioFire Diagnostics, Inc.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Poritz
authors.affiliation: BioFire Diagnostics, Inc.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Thatcher
authors.affiliation: Primary Children's Hospital, Intermountain Healthcare.
authors.forename: E Kent
authors.initials: EK
authors.lastname: Korgenski
authors.affiliation: Primary Children's Hospital, Intermountain Healthcare.
authors.forename: Trenda
authors.initials: T
authors.lastname: Barney
authors.affiliation: Primary Children's Hospital, Intermountain Healthcare.|Pathology, University of Utah Health Sciences Center, Salt Lake City.
authors.forename: Judy
authors.initials: J
authors.lastname: Daly
authors.affiliation: BioFire Diagnostics, Inc.
authors.forename: Margarita
authors.initials: M
authors.lastname: Rogatcheva
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003967:Diarrhea / Q000382:microbiology* / Q000469:parasitology / Q000821:virology; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D060885:Multiplex Polymerase Chain Reaction; D012621:Seasons; D014589:Utah / Q000453:epidemiology
keywords: FilmArray; acute gastroenteritis; children; gastrointestinal illness