Coinfection in acute gastroenteritis predicts a more severe clinical course in children

Abstract

The objectives of this study were to determine the incidence of enteric pathogens causing acute gastroenteritis (AGE) among hospitalized children in a large Italian hospital, to measure the incidence of coinfections, and to compare the clinical characteristics of those infected with one versus multiple agents. A prospective study was conducted from March 2010 to April 2011 at the Bambino Gesù Pediatric Hospital in Rome, Italy. All patients between 1 month and 16 years of age admitted to the Pediatric Department with a diagnosis of AGE were eligible for enrollment. Two stool samples for each patient were tested for gastrointestinal pathogens. We summarized the clinical severity of episodes, describing the duration of diarrhea, duration and frequency of vomiting, fever, and severity of dehydration. All the patients underwent medical evaluation with estimation of dehydration. One or more etiological agents were detected in 151 out of 232 patients (65.1%), while we did not detect any etiological agent in 81 (34.9%). Rotavirus was detected in 96 (63.6%), adenovirus in 17 (11.2%), norovirus in 7 (4.6%), toxin-producing Clostridium difficile in 23 (15.2%), Salmonella spp. in 15 (9.9%, B group in 12/15 and D group in 3/15), C. perfringens in 12 (7.9%), Campylobacter spp. in 6 (4%), and verotoxigenic Escherichia coli (VTEC) in 2 (1.3%). In 27 children out of 151 (17.9%), we found evidence of coinfection. Coinfection with rotavirus and toxin-producing C. difficile was the most common (63%). Children with coinfection had a more severe clinical presentation and had a higher probability to be severely dehydrated, independently of age and living community type.

Clostridium difficile Infection Among Children Across Diverse US Geographic Locations

“…Although a singlecenter study reported a 11% rate of C difficile coinfection among pediatric cases, most of the coinfected cases were ,1 year of age. 33 The distribution of NAP types in our study was consistent with recent US findings among adults with CA CDI, in whom NAP1 was the most common strain type. 26 The predominance of the NAP1 strain among CA pediatric cases is notable, because 1 factor postulated to have contributed to its emergence is high-level resistance to fluoroquinolones.…”

Co-infection as a confounder for the role of Clostridium difficile infection in children with diarrhoea: a summary of the literature

“…Studies included children aged 0-2 years (n=4), 0-5 years (n=2), 0-12 years (n=3) and 0-18 years (n= 22). The majority of studies were from North America (n=12; 6,184 cases) [13][14][15][16][17][18][19][20][21][22][23][24] and Europe (n=12; 2,467 cases) [8,[25][26][27][28][29][30][31][32][33][34][35], with other studies from Asia (n=4; 1,762 cases) [36][37][38][39], Australia (n=2; 148 cases) [40,41] and South America (n = 1; 210 cases) [42]. Ten studies included only community-onset patients [13,14,25,27,28,31,32,34,35,38], three included only hospital patients [20,30,40], 12 included both hospital and community [8, 15, 16, 19, 21-24, 26, 29, 33, 42] and six studies did not report the place of onset [17,…”

“…Albert et al analysed stool samples from 814 children with diarrhoea (aged 0-5 years), noting a coinfection in 53.8 % (7/13) of those with a positive C. difficile test (rotavirus, n=2; C. jejuni, n=1, enteropathogenic E. coli, n=1, enterotoxigenic E. coli, n=1, Aeromonas spp., n=1; Shigella spp., n=1) [37]. Twenty studies tested for bacterial co-infection in all samples [13,18,19,23,24,[27][28][29][30][31][32][33][34][35][36][37][38][39][40][41], 13 tested for viral pathogens (of which five tested for rotavirus only) [16, 18, 19, 23, 27-31, 33-35, 37] and six tested for parasites [23,30,32,33,37,40]. In ten studies, not all samples were tested for co-infection or no data were reported on the number of tested samples [8, 14, 15, 17, 20-22, 25, 26, 42].…”

Absence of Genetic Differences among G10P[11] Rotaviruses Associated with Asymptomatic and Symptomatic Neonatal Infections in Vellore, India

“…These viruses commonly infect young children, often without signs of clinical disease (67)(68)(69)(70)(71). Coinfections involving RV and other enteric viral or bacterial pathogens have been frequently reported, and there have been a few studies suggesting that coinfections with certain pathogens can alter GI disease severity (63,(72)(73)(74)(75)(76). However, little information is available concerning whether coinfection of young children, and particularly neonates, with RV and Aichi virus, astrovirus, or salivirus/klassevirus has an impact on disease symptoms.…”