title: Multiple etiologies of infectious diarrhea and concurrent infections in a pediatric outpatient-based screening study in Odisha, India.
abstract: BACKGROUND
  There are multiple etiologies responsible for infectious gastroenteritis causing acute diarrhea which are often under diagnosed. Also acute diarrhea is one of the major causes of morbidity and mortality among children less than 5 years of age.
  
  
  METHODS
  In our study, fecal samples (n=130) were collected from children (<5 years) presenting with symptoms of acute diarrhea. Samples were screened for viral, bacterial, and parasitic etiologies. Rotavirus and Adenovirus were screened by immunochromatographic tests. DiarrheagenicEscherichia coli(EPEC, EHEC, STEC, EAEC, O157, O111),Shigellaspp.,Salmonellaspp.,Vibrio cholera,Cryptosporidiumspp., andGiardiaspp. were detected by gene-specific polymerase chain reaction.
  
  
  RESULTS
  Escherichia coliwas detected to be the major etiological agent (30.07%) followed by Rotavirus (26.15%),Shigella(23.84%), Adenovirus (4.61%),Cryptosporidium(3.07%), andGiardia(0.77%). Concurrent infections with two or more pathogens were observed in 44 of 130 (33.84%) cases with a predominant incidence particularly in <2-year-old children (65.90%) compared to children of 2-5 years age group (34.09%). An overall result showed significantly higher detection rates among children with diarrhea in both combinations of two as well as three infections concurrently (p= 0.004915 and 0.03917, respectively).
  
  
  CONCLUSIONS
  Suspecting possible multiple infectious etiologies and diagnosis of the right causative agent(s) can aid in a better pharmacological management of acute childhood diarrhea. It is hypothesized that in cases with concurrent infections the etiological agents might be complementing each other's strategies of pathogenesis resulting in severe diarrhea that could be studied better in experimental infections.
authors.affiliation: Infection Biology Laboratory, School of Biotechnology, KIIT University, Bhubaneswar, Odisha 751024 India.
authors.forename: Arpit Kumar
authors.initials: AK
authors.lastname: Shrivastava
authors.affiliation: Infection Biology Laboratory, School of Biotechnology, KIIT University, Bhubaneswar, Odisha 751024 India.
authors.forename: Subrat
authors.initials: S
authors.lastname: Kumar
authors.affiliation: Kalinga Institute of Medical Sciences, KIIT University, Bhubaneswar, Odisha 751024 India.
authors.forename: Nirmal Kumar
authors.initials: NK
authors.lastname: Mohakud
authors.affiliation: Infection Biology Laboratory, School of Biotechnology, KIIT University, Bhubaneswar, Odisha 751024 India.
authors.forename: Mrutyunjay
authors.initials: M
authors.lastname: Suar
authors.affiliation: Infection Biology Laboratory, School of Biotechnology, KIIT University, Bhubaneswar, Odisha 751024 India.|Kalinga Institute of Medical Sciences, KIIT University, Bhubaneswar, Odisha 751024 India.|Divisions of Pathology, School of Medicine, International Medical University, 57000 Kuala Lumpur, Malaysia.
authors.forename: Priyadarshi Soumyaranjan
authors.initials: PS
authors.lastname: Sahu
keywords: Children; Co-infection; Concurrent infection; Diarrhea; Infectious diarrhea; Odisha