High Burden of Co-Infection with Multiple Enteric Pathogens in Children Suffering with Diarrhoea from Rural and Peri-Urban Communities in South Africa

Abstract

Infectious diarrhoea contributes to high morbidity and mortality in young children from sub-Saharan Africa. The aim of this study was to assess the prevalence of single and multiple diarrhoeal-causing pathogen combinations in children suffering from diarrhoea from rural and peri-urban communities in South Africa. A total of 275 diarrhoea stool specimens were collected between 2014 and 2016 from Hospitals and Primary Health Care clinics. The BioFire® FilmArray® Gastrointestinal panel was used to simultaneously detect 22 diarrhoea pathogens (viruses, bacteria, parasites) known to cause diarrhoea. A total of 82% (226/275) enteric pathogens were detected in the stool specimens. The two most detected bacterial, viral and parasitic pathogens each included: EAEC (42%), EPEC (32%), Adenovirus F40/41 (19%), Norovirus (15%), Giardia (8%) and Cryptosporidium (6%), respectively. Single enteric pathogen infections were recorded in 24% (65/275) specimens with EAEC, and Norovirus was found in 26% (17/65) and 14% (9/65) of the specimens, respectively. Multiple enteric pathogen combinations were recorded in 59% (161/275) of the stool specimens with 53% (85/161) containing two pathogens, 22% (35/161) containing three pathogens and 25% (41/161) containing four or more pathogens. The results from this study demonstrated the complex nature of pathogen co-infections in diarrhoeal episodes which could have an impact on treatment effectiveness.

Occurrence of Diarrheagenic Pathogens and Their Coinfection Profiles in Diarrheic Under Five Children and Tracked Human Contacts in Urban and Rural Settings of Eastern Ethiopia

“… 80 Likewise, in the present study, 2 or 3 enteric bacterial pathogens (co-infection, co-occurrence) were found in 8.53% diarrheic UFC and 6.02% of their human contacts. The enteric bacterial coinfection rates is higher than the reports of Cho et al, 6 and lower than the finding of Potgieter et al 81 who recently reported, 1.43% and 29% from Gyeongju, Korea, and South Africa, respectively. In agreement to the present study, Andersson et al 82 and Zhang et al 80 also reported enteric bacterial coinfection in diarrheic and nondiarrheic individuals with higher occurrence rates in diarrheal cases.…”

“…Children in LICs might be exposed simultaneously to multiple enteric pathogens due to poor sanitary conditions in the environment, and poor quality of food and drinking water contributing to the widespread of microorganisms. 80,81,83,84 The study result also showed the overall occurrence rate of the diarrheagenic FBPs was linearly increasing from December 2021 to February 2022 (winter) and June to August (summer) with peaks of 73.91% and 45.45%, in February and July, respectively (Figure 2A). Pediatric diarrheal disease is caused by a wide variety of pathogens and various studies have found that some pathogens are seasonal, peaking at different times of the year.…”

“…Children in LICs might be exposed simultaneously to multiple enteric pathogens due to poor sanitary conditions in the environment, and poor quality of food and drinking water contributing to the widespread of microorganisms. 80 , 81 , 83 , 84 …”

Screening for viral pathogens in the gastrointestinal tract from cases of sudden unexpected death in infancy at the Tygerberg Medico-legal Mortuary

“…Co-detection between bacteria and viruses was confirmed in 47% of cases. Similarly, a study conducted in South Africa to determine the prevalence of individual and multiple diarrhoea-causing pathogen combinations among children suffering from diarrhoea in rural and peri urban communities reported a 47% prevalence of bacterial and viral co-infection [ 77 ]. The prevalence of co-detection between NoV (GI/GII) and DEC as well as RV-A and DEC in this study was higher than that in Southwest China (25.3% versus 1.1% and 25.3% versus 2.3%, respectively) [ 78 ].…”

Evaluating the AllplexTM GI-Bacteria (I) Assay Efficiency to Assess the Diversity of Bacterial Pathogens among Young Children with Diarrhea in Burundi

“…In Burundi, after malaria and pneumonia, diarrhea was the third leading cause of mortality among children under 5 years old with an estimated mortality of seven deaths per 1,000 live births (8). Up to 55% coinfection with multiple gastrointestinal bacteria including diarrheagenic E. coli and Shigella isolates was reported in children under the age of ve years suffering from diarrhea in South Africa (9).…”