title: Epidemiology of Diarrheal Illness in Pediatric Oncology Patients.
abstract: BACKGROUND
  Diarrhea is common in children with cancer, but this has not been systematically studied to date.
  
  
  METHODS
  Remnant stool samples collected between January 2010 and June 2011 from pediatric oncology patients with diarrhea were tested for bacterial, viral, and parasitic enteropathogens using a combination of standard-of-care (SOC) diagnostic tests, including broad-range, real-time polymerase chain reaction (PCR) assays for adenoviruses, astroviruses, and sapoviruses and 2 commercially available multiplexed PCR assays. Corresponding demographic and clinical data were abstracted from patients' medical records.
  
  
  RESULTS
  One hundred fourteen episodes of diarrhea in 93 patients (median age, 3.7 years; range, 0.2-18.8) were included in the study. No patients died, but morbidity was significant. A total of 158 potential pathogens were detected in 114 diarrhea episodes, with >1 organism in one third of these; the most common were Clostridium difficile, noroviruses, adenoviruses, and astroviruses. Clostridium difficile, in combination with norovirus or adenovirus, was most common when >1 pathogen was detected. When both studies were obtained, SOC and broadly multiplexed PCR tests were concordant in 64 episodes (56%). Forty-five pathogens (28%) were identified retrospectively by broadly multiplexed PCR assays only. A total of 19 (13%) were detected by SOC real-time PCR assays but not by either commercially available multiplexed PCR assay.
  
  
  CONCLUSIONS
  Most pediatric oncology patients in this study had 1 or more potential infectious causes for their diarrhea. Additional studies are warranted to understand the natural history of gastroenteritis in this patient population. Although broadly multiplexed PCR assays offer some advantages over conventional testing, there may be disadvantages to their use for the diagnosis of infectious gastroenteritis that are unique to pediatric oncology patients.
authors: Department of Infectious Diseases.
authors: Mohammad N
authors: MN
authors: Mhaissen
authors: Department of Pathology.
authors: Alicia
authors: A
authors: Rodriguez
authors: Department of Pathology.
authors: Zhengming
authors: Z
authors: Gu
authors: Department of Pathology.
authors: Haiqing
authors: H
authors: Zhu
authors: Biostatistics, St. Jude Children's Research Hospital.
authors: Li
authors: L
authors: Tang
authors: Biostatistics, St. Jude Children's Research Hospital.
authors: Yilun
authors: Y
authors: Sun
authors: Department of Infectious Diseases.|Department of Microbiology, Immunology and Biochemistry.
authors: Stacey T
authors: ST
authors: Schultz-Cherry
authors: Department of Pathology.
authors: Randall T
authors: RT
authors: Hayden
authors: Department of Infectious Diseases.|Department of Pediatrics, University of Tennessee Health Sciences Center, Memphis.
authors: Elisabeth E
authors: EE
authors: Adderson
mesh_terms: D000258:Adenovirus Infections, Human / Q000453:epidemiology / Q000209:etiology; D000293:Adolescent; D019350:Astroviridae Infections / Q000453:epidemiology / Q000209:etiology; D017250:Caliciviridae Infections / Q000453:epidemiology / Q000209:etiology; D002648:Child; D002675:Child, Preschool; D003015:Clostridium Infections / Q000453:epidemiology / Q000209:etiology; D003967:Diarrhea / Q000453:epidemiology* / Q000209:etiology / Q000382:microbiology / Q000821:virology; D006801:Humans; D007223:Infant; D008297:Male; D009369:Neoplasms / Q000150:complications*; D060888:Real-Time Polymerase Chain Reaction
keywords: american Lebanese Syrian Associated Charities; diarrhea; gastroenteritis; oncology; pediatric