title: Using Multiplex Molecular Testing to Determine the Etiology of Acute Gastroenteritis in Children.
abstract: To detect the etiologic agents of acute gastroenteritis (AGE) in children using broad molecular-based techniques, and compare clinical presentations among etiologies.
  
  
  
  This was a prospective population-based surveillance study of children aged <6 years with AGE conducted between 2008 and 2011 as part of the New Vaccine Surveillance Network. Stools from patients and healthy controls were tested for 21 gastrointestinal pathogens using the analyte-specific reagent Gastrointestinal Pathogen Panel and an additional reverse transcription real-time polymerase chain reaction assay for sapovirus and astrovirus.
  
  
  
  Of the 216 stool samples from patients with AGE, 152 (70.4%) tested positive for a pathogen, with norovirus genogroup II (n = 78; 36.1%) and Clostridium difficile (n = 35; 16.2%) the most common pathogens detected. Forty-nine patients (22.7%) tested positive for more than 1 pathogen, including 25 (71%) with a C difficile detection. There were no significant clinical differences among the patients with no pathogen detected, those with a single pathogen detected, and those with ≥2 pathogens detected.
  
  
  
  Using a broad molecular testing approach, high rates of enteropathogens were detected in children with AGE, dominated by norovirus genogroup II and C difficile. Coinfections were common but had no identifiable impact on clinical manifestations. As routine diagnostics of AGE progressively evolve toward nucleic acid-based pathogen detection, ongoing systematic studies are needed to better analyze the clinical significance of results.
authors.affiliation: Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Vanderbilt University School of Medicine, Nashville, TN. Electronic address: maribeth.r.nicholson@vanderbilt.edu.
authors.forename: Maribeth R
authors.initials: MR
authors.lastname: Nicholson
authors.affiliation: Department of Microbiology, American Esoteric Laboratories, Memphis, TN.
authors.forename: Gerald T
authors.initials: GT
authors.lastname: Van Horn
authors.affiliation: Department of Laboratory Medicine, Memorial Sloan-Kettering Cancer Center, Department of Pathology and Laboratory Medicine, Weill Medical College of Cornell University, New York, NY.
authors.forename: Yi-Wei
authors.initials: YW
authors.lastname: Tang
authors.affiliation: Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA.
authors.forename: Jan
authors.initials: J
authors.lastname: Vinjé
authors.affiliation: Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA.
authors.forename: Daniel C
authors.initials: DC
authors.lastname: Payne
authors.affiliation: Vanderbilt Vaccine Research Program, Division of Pediatric Infectious Disease, Vanderbilt University School of Medicine, Nashville, TN.
authors.forename: Kathryn M
authors.initials: KM
authors.lastname: Edwards
authors.affiliation: Department of Pathology, Microbiology, and Immunology, Vanderbilt University School of Medicine, Nashville, TN.
authors.forename: James D
authors.initials: JD
authors.lastname: Chappell
mesh_terms: D000208:Acute Disease; D002675:Child, Preschool; D005260:Female; D005759:Gastroenteritis / Q000175:diagnosis* / Q000209:etiology* / Q000382:microbiology / Q000469:parasitology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D025202:Molecular Diagnostic Techniques / Q000379:methods; D060885:Multiplex Polymerase Chain Reaction; D011159:Population Surveillance; D011446:Prospective Studies
keywords: Clostridium difficile; coinfections; colonization; diarrhea; norovirus