Narrowing of the Diagnostic Gap of Acute Gastroenteritis in Children 0-6 Years of Age Using a Combination of Classical and Molecular Techniques, Delivers Challenges in Syndromic Approach Diagnostics.
Twenty-five percent to 50% of acute gastroenteritis (AGE) cases remain etiologically undiagnosed. Our main aim was to determine the most appropriate list of enteric pathogens to be included in the daily diagnostics scheme of AGE, ensuring the lowest possible diagnostic gap.



Two hundred ninety seven children ≤6 years of age, admitted to hospital in Slovenia, October 2011 to October 2012, with AGE, and 88 ≤6 years old healthy children were included in the study. A broad spectrum of enteric pathogens was targeted with molecular methods, including 8 viruses, 6 bacteria and 2 parasites.



At least one enteric pathogen was detected in 91.2% of cases with AGE and 27.3% of controls. Viruses were the most prevalent (82.5% and 15.9%), followed by bacteria (27.3% and 10.2%) and parasites (3.0% and 1.1%) in cases and controls, respectively. A high proportion (41.8%) of mixed infections was observed in the cases. For cases with undetermined etiology (8.8%), stool samples were analyzed with next generation sequencing, and a potential viral pathogen was detected in 17 additional samples (5.8%).



Our study suggests that tests for rotaviruses, noroviruses genogroup II, adenoviruses 40/41, astroviruses, Campylobacter spp. and Salmonella sp. should be included in the initial diagnostic algorithm, which revealed the etiology in 83.5% of children tested. The use of molecular methods in diagnostics of gastroenteritis is preferable because of their high sensitivity, specificity, fast performance and the possibility of establishing the concentration of the target. The latter may be valuable for assessing the clinical significance of the detected enteric, particularly viral pathogens.
*Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia; †Department of Infectious Diseases, University Medical Centre Ljubljana, Ljubljana, Slovenia; ‡Department of Pediatric Surgery and Intensive Care, University Medical Centre Ljubljana, Ljubljana, Slovenia; §Department for Public Health Microbiology, Centre for Medical Microbiology, National Laboratory of Health, Environment and Food, Ljubljana, Slovenia; ¶Faculty of Organizational Sciences, University of Maribor, Kranj, Slovenia; ‖Center for Infection and Immunity, Mailman School of Public Health, Columbia University, New York, NY; and **The Research Institute at Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio.
Andrej
A
Steyer
Monika
M
Jevšnik
Miroslav
M
Petrovec
Marko
M
Pokorn
Štefan
Š
Grosek
Adela
A
Fratnik Steyer
Barbara
B
Šoba
Tina
T
Uršič
Tjaša
T
Cerar Kišek
Marko
M
Kolenc
Marija
M
Trkov
Petra
P
Šparl
Raja
R
Duraisamy
W Ian
WI
Lipkin
Sara
S
Terzić
Mojca
M
Kolnik
Tatjana
T
Mrvič
Amit
A
Kapoor
Franc
F
Strle
D000208:Acute Disease; D000818:Animals; D001419:Bacteria / Q000235:genetics; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D005243:Feces / Q000382:microbiology / Q000469:parasitology / Q000821:virology; D005759:Gastroenteritis / Q000175:diagnosis* / Q000382:microbiology / Q000469:parasitology / Q000821:virology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D025202:Molecular Diagnostic Techniques; D058889:Molecular Typing; D010271:Parasites / Q000235:genetics; D017422:Sequence Analysis, DNA; D014780:Viruses / Q000235:genetics