Narrowing of the Diagnostic Gap of Acute Gastroenteritis in Children 0–6 Years of Age Using a Combination of Classical and Molecular Techniques, Delivers Challenges in Syndromic Approach Diagnostics

Abstract

Background 25%-50% of acute gastroenteritis (AGE) cases remain etiologically undiagnosed. Our main aim was to determine the most appropriate list of enteric pathogens to be included in the daily diagnostics scheme of AGE, ensuring the lowest possible diagnostic gap. Methods 297 children ≤6 years of age, admitted to hospital in Slovenia, October 2011 – October 2012, with AGE, and 88 ≤6 year old healthy children, were included in the study. A broad spectrum of enteric pathogens was targeted with molecular methods, including 8 viruses, 6 bacteria and 2 parasites. Results At least one enteric pathogen was detected in 91.2% of cases with AGE and 27.3% of controls. Viruses were the most prevalent (82.5% and 15.9%), followed by bacteria (27.3% and 10.2%) and parasites (3.0% and 1.1%) in cases and controls, respectively. A high proportion (41.8%) of mixed infections was observed in the cases. For cases with undetermined etiology (8.8%), stool samples were analyzed with next generation sequencing and a potential viral pathogen was detected in 17 additional samples (5.8%). Conclusions Our study suggests that tests for rotaviruses, noroviruses genogroup II, adenoviruses 40/41, astroviruses, Campylobacter spp. and Salmonella sp. should be included in the initial diagnostic algorithm, which revealed the etiology in 83.5% of children tested. The use of molecular methods in diagnostics of gastroenteritis is preferable because of their high sensitivity, specificity, fast performance and the possibility of establishing the concentration of the target. The latter may be valuable for assessing the clinical significance of the detected enteric, particularly viral pathogens.

Group A Rotavirus Detection and Genotype Distribution before and after Introduction of a National Immunisation Programme in Ireland: 2015–2019

“…Depending on the year, we report that 51–65% had no detectable viral pathogen. This apparent diagnostic gap highlights a further limitation of this study, in that it is quite possible that parallel samples were sent for the investigation of bacterial or parasitic pathogens, which are common causes of gastroenteritis [ 42 , 43 ]. Unfortunately, we did not have access to these results.…”

Approach to Neonates and Young Infants with Fever without a Source Who Are at Risk for Severe Bacterial Infection

“…Recently, new syndromic molecular methods have been developed for rapid etiologic diagnosis of localized or systemic infections. These multiplex real-time polymerase chain reaction tests are able to detect, directly in a single clinical specimen, the most important viral, bacterial, or fungal pathogens responsible for gastrointestinal infections [73], respiratory infections [74], sepsis [75, 76], or meningitis [77] and are characterized by a good diagnostic accuracy. However, their clinical impact and the possibility to include them in the diagnostic algorithms for infants with FWS have not been thoroughly evaluated yet.…”

Advances in Diagnostic Approaches for Viral Etiologies of Diarrhea: From the Lab to the Field

“…Owing to high specificity and sensitivity of molecular methods, most laboratories employ these methods for accurate diagnosis of viruses (Steyer et al, 2016). These methods largely involve the amplification of DNA or RNA by various nucleic acid amplification techniques.…”