Diarrhea Etiology in a Pediatric Emergency Department: A Case Control Study

Abstract

Background. The etiology of childhood diarrhea is frequently unknown. Methods. We sought Aeromonas, Campylobacter, Escherichia coli O157:H7, Pleisiomonas shigelloides, Salmonella, Shigella, Vibrio, and Yersinia (by culture), adenoviruses, astroviruses, noroviruses, rotavirus, and Shiga toxin-producing E. coli (STEC; by enzyme immunoassay), Clostridium difficile (by cytotoxicity), parasites (by microscopy), and enteroaggregative E. coli (EAEC; by polymerase chain reaction [PCR] analysis) in the stools of 254 children with diarrhea presenting to a pediatric emergency facility. Age-and geographic-matched community controls without diarrhea (n = 452) were similarly studied, except bacterial cultures of the stool were limited only to cases.Results. Twenty-nine (11.4%) case stools contained 13 Salmonella, 10 STEC (6 O157:H7 and 4 non-O157:H7 serotypes), 5 Campylobacter, and 2 Shigella. PCR-defined EAEC were present more often in case (3.2%) specimens than in control (0.9%) specimens (adjusted odds ratio [OR], 3.9; 95% confidence interval [CI], 1.1-13.7), and their adherence phenotypes were variable. Rotavirus, astrovirus, and adenovirus were more common among cases than controls, but both groups contained noroviruses and C. difficile at similar rates. PCR evidence of hypervirulent C. difficile was found in case and control stools; parasites were much more common in control specimens.Conclusions. EAEC are associated with childhood diarrhea in Seattle, but the optimal way to identify these agents warrants determination. Children without diarrhea harbor diarrheagenic pathogens, including hypervirulent C. difficile. Our data support the importance of taking into account host susceptibility, microbial density, and organism virulence traits in future case-control studies, not merely categorizing candidate pathogens as being present or absent.

Clostridium difficile Infections in Children: Impact of the Diagnostic Method on Infection Rates

“…In a case-control study that looked for causes of diarrhea in children, the proportion of C. difficile positives was higher in controls compared with cases. 33 Our study's objective was not to document carriage rate.…”

Shiga Toxin/Verocytotoxin-Producing Escherichia coli Infections: Practical Clinical Perspectives

“…Hence, the presence of a colorless colony on sorbitolMacConkey agar that agglutinates with an appropriate serologic reagent enables the microbiologist to make a confident and timely presumptive diagnosis. For inexplicable reasons, E. coli O157:H7 is more easily detected by sorbitol-MacConkey agar plating than by toxin testing of broth cultures of stool (1,16,(52)(53)(54)(55)(56). Because of the greater sensitivity of agar plating, the critical importance of making a diagnosis of E. coli O157:H7 infection as rapidly as possible, and the recognition that a small subset of non-O157:H7 STEC/VTEC infections can be severe, we agree with the guidance of the Centers for Disease Control and Prevention that advises the simultaneous testing for E. coli O157:H7 (on agar plates) and non-O157:H7 STEC/VTEC (using, in most cases, a toxin enzyme immunoassay [EIA]) (57).…”

“…Shiga toxin (Stx)-producing Escherichia coli (STEC) cause illness with a spectrum of severity ranging from mild (even asymptomatic) carriage to life-threatening disease (1)(2)(3). STEC infections are relatively uncommon; in the United States, extrapolation of data from FoodNet (4) to a nationwide population that exceeds 300,000,000 indicates there are fewer than 4,000 diagnosed cases of E. coli O157:H7 infection per annum.…”

Acute Gastroenteritis Agents Among 0–5 Years-Old Turkish Children

“…Additionally, Clostridium difficile, another bacterial diarrheal agent, is a big threat for children in both community and hospitals 8,9 . Clostridium difficile infection has more recently been implicated as dramatically increased prevalent diarrheal pathogen in children [10][11][12] . Moreover, evidence suggests that a large proportion of pediatric Clostridium difficile cases are community-acquired infections 13,14 .…”