Clinical interpretation of enteric molecular diagnostic tests

Tarr, Gillian A.M.; Tarr, Phillip I.; Freedman, Stephen B.

doi:10.1016/j.cmi.2019.08.018

Cited by 11 publications

(5 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Our study used both molecular techniques and traditional stool culture; however, detection by the former is not synonymous with infection. 40 It is becoming increasingly apparent that molecular diagnostic approaches detect enteropathogens in more patients than do conventional (i.e. culture) approaches.…”

Section: Discussionmentioning

confidence: 99%

Hematochezia in children with acute diarrhea seeking emergency department care – a prospective cohort study

Böhrer¹,

Fitzpatrick

Hurley

et al. 2022

Academic Emergency Medicine

View full text Add to dashboard Cite

Objectives: Although the passage of blood in stools in children represents a medical emergency, children seeking emergency department (ED) care remain poorly characterized. Our primary objective was to compare clinical characteristics and etiologic pathogens in children with acute diarrhea with and without caregiver-reported hematochezia. Secondary objectives were to characterize interventions and resource utilization. Methods:We conducted a secondary analysis of the Alberta Provincial Pediatric EnTeric Infection TEam (APPETITE) database. Children <18 years presenting to two pediatric EDs within a 24-hour period and <7 days of symptoms were consecutively recruited. Results: Of 1,061 participants, 115 (10.8%) reported hematochezia at the enrollment visit at which time those with hematochezia, compared to those without, had more HEMATOCHEZIA IN CHILDREN WITH ACUTE DIARRHEA SEEKING EMERGENCY DEPARTMENT CARE -A PROSPECTIVE COHORT STUDY INTRODUC TI ON Acute onset of blood in stools is a medical emergency 1 with etiologies varying with age. 2 Bacterial infections are a common consideration in children with hematochezia across all age groups 2 with Shigella spp., Campylobacter spp., Salmonella spp., Yersinia spp., Escherichia coli O157:H7, and other Shiga toxin-producing E. coli (STEC) being most often implicated. 1 However, viruses such as rotavirus, enteric adenovirus, and norovirus have also been detected in children in whom the diarrhea contains visible blood, but the pathogenesis remains unclear. 3,4 Furthermore, Clostridioides difficile infection must also be considered in the appropriate clinical scenario, with the most important risk factors being recent antibiotic use and hospitalization. 5,6 Pediatric bacterial enteric infections are associated with an acute onset of diarrhea, greater stool frequency in the 24 hours before emergency department (ED) presentation, abdominal tenderness, absence of vomiting, history of fever, 1,3,7-12 and spring/summer seasonality. 8,10,12-14 Although reports have described the etiologies of bloody stools associated with gastroenterology consultation and care, to the best of our knowledge, no publications have focused on the clinical features, infectious etiologies, and health care resource use of children with acute hematochezia seeking ED care. We sought to fill this knowledge gap by conducting a secondary analysis of the Alberta Provincial Pediatric EnTeric TEam (APPETITE) dataset. The latter was created through the conduct of a large, prospective cohort study of children with vomiting and diarrhea that conducted extensive stool testing using a broad, nucleic acid-based, enteropathogen detection strategy. 15-19 Our primary objective was to describe and compare the clinical characteristics and infectious etiologies of children with acute diarrhea and hematochezia presenting for ED care to those without hematochezia. Secondary objectives included a description and comparison of health care resource utilization by children with and without hematochezia. ME THODS Study design and p...

show abstract

Section: Discussionmentioning

confidence: 99%

Hematochezia in children with acute diarrhea seeking emergency department care – a prospective cohort study

Böhrer¹,

Fitzpatrick

Hurley

et al. 2022

Academic Emergency Medicine

View full text Add to dashboard Cite

show abstract

“…Despite the theoretical advantages of the diagnostic panels compared to standard techniques, their positive consequences on patient care and their economic impact have not been clearly objectified and are extremely variable depending on the populations studied (4)(5)(6)(25)(26)(27)(28). With a view of the putative implementation of the Novodiag Bacterial GEϩ kit at the Bordeaux University Hospital, this study allowed us to target the patient profile for which there would be a benefit.…”

Section: Resultsmentioning

confidence: 99%

Performance Evaluation of the Novodiag Bacterial GE+ Multiplex PCR Assay

Roy

Damien²,

Bénéjat

et al. 2020

J Clin Microbiol

View full text Add to dashboard Cite

The bacteriological diagnosis of intestinal bacterial infections has historically been based on culture on agar plates. However, culture may lack sensitivity and some enteropathogens such as pathovars of Escherichia coli may escape routine diagnosis. Our goal was to evaluate the analytical performance of the Novodiag® Bacterial GE+ kit, for the detection of enteropathogenic bacteria in acute community diarrhea. 251 stools were included in this study (198 retrospective and 53 prospective). The analytical performance was calculated using a composite reference standard (CRS) in absence of a perfect gold standard (lack of sensitivity of culture). The CRS was defined as positive if culture was positive or, in case of a negative culture if the BD MAX™ Extended Enteric Bacterial Panel and/or other RT-PCRs were positive. Of the 251 samples, 200 were positive and 51 were negative. Overall sensitivities of the Novodiag® Bacterial GE + kit for Campylobacter sp, Salmonella sp, Shigella sp/EIEC, Yersinia enterocolitica, EHEC and ETEC ranged from 98.98 to 100%, and specificities from 98.08 to 100%, PPV from 88.24 to 100% and NVP from 99.36 to 100%. The analytical performance of the Novodiag® Bacterial GE+ kit is excellent. It can be used as a routine tool in the rapid diagnosis of bacterial gastroenteritis. Despite the eNAT tube dilution of the primary sample, the detection of Salmonella sp and EHEC was perfect. The kit has the advantage of only detecting pathogenic Y. enterocolitica. Its performance for Campylobacters is very satisfactory.

show abstract

“…While molecular detection of pathogens is increasingly used to understand exposure to pathogens and the health consequences, the clinical relevance of such detection remains unclear (60,61,62). Detection of enteric pathogens by molecular or other means does not always mean an individual has or will experience acute disease.…”

Section: Discussionmentioning

confidence: 99%

Enteric pathogen detection among children discharged from outpatient treatment for severe acute malnutrition and associations with subsequent relapse in South Sudan

Knee,

D'Mello-Guyett,

Grignard

et al. 2024

Preprint

View full text Add to dashboard Cite

Severe acute malnutrition (SAM) affects millions of children each year, putting them at increased risk of death and disease. Many children relapse to acute malnutrition (AM) or SAM following community-based management of acute malnutrition (CMAM) programmes. Enteric infection is hypothesized to be a risk factor for relapse. We collected rectal swabs from children recently recovered from uncomplicated SAM in South Sudan and tested them for a suite of enteric pathogens using a TaqMan Array Card. We estimated enteric pathogen prevalence and examined associations between pathogen detection and risk of relapse to AM and SAM within three and six months of recovery. One or more enteric pathogen was detected in 82% of children (389/476). Bacterial and protozoan pathogens were the most frequently detected pathogen types, with each detected in 57% of children, followed by enteric viruses (10%) and helminths (4.4%). Detection of one or more enteric pathogen, protozoan pathogen, or viral pathogen was not associated with relapse to AM or SAM at either time point. Detection ≥1 helminth was associated with increased risk of relapse to SAM, and ≥1 bacterial pathogen was associated with decreased risk of relapse to AM. Both enterotoxigenic E. coli and enteroaggregative E. coli were associated with decreased risk of relapse to SAM and/or AM at three- or six-months post-recovery. Shigella was the only individual pathogen associated with increased risk of relapse to AM and SAM. In this setting, most children suffering from SAM were exposed to enteric pathogens during treatment. However, we found no consistent relationship between pathogen detection at treatment discharge and risk of relapse to AM or SAM within three or six months of recovery. Despite this, limiting pathogen exposures during this vulnerable period remains important given the high risk of serious adverse health effects. These results highlight the lack of access to safe water, sanitation, and hygiene and reinforce the potential importance of anthelmintics as part of CMAM.

show abstract

Clinical interpretation of enteric molecular diagnostic tests

Cited by 11 publications

References 17 publications

Hematochezia in children with acute diarrhea seeking emergency department care – a prospective cohort study

Hematochezia in children with acute diarrhea seeking emergency department care – a prospective cohort study

Performance Evaluation of the Novodiag Bacterial GE+ Multiplex PCR Assay

Enteric pathogen detection among children discharged from outpatient treatment for severe acute malnutrition and associations with subsequent relapse in South Sudan

Contact Info

Product

Resources

About