Identification of Enteropathogens by Multiplex PCR among Rural and Urban Guatemalan Children with Acute Diarrhea.
| Title: | Identification of Enteropathogens by Multiplex PCR among Rural and Urban Guatemalan Children with Acute Diarrhea. |
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| Authors: | Gaensbauer JT; Department of Pediatrics, Denver Health Hospital Authority, Denver, Colorado.; Center for Global Health and Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado.; Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado.; Lamb M; Center for Global Health and Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado.; Calvimontes DM; Hospital Roosevelt, Guatemala City, Guatemala.; Asturias EJ; Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado.; Center for Global Health and Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado.; Kamidani S; Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado.; Contreras-Roldan IL; Centro de Estudios en Salud, Universidad de Valle de Guatemala, Guatemala, Guatemala.; Dominguez SR; Department of Pathology and Laboratory Medicine, Children's Hospital Colorado, Aurora, Colorado.; Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado.; Robinson CC; Department of Pathology and Laboratory Medicine, Children's Hospital Colorado, Aurora, Colorado.; Zacarias A; Center for Global Health and Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado.; Berman S; Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado.; Center for Global Health and Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado.; Melgar MA; Hospital Roosevelt, Guatemala City, Guatemala. |
| Source: | The American journal of tropical medicine and hygiene [Am J Trop Med Hyg] 2019 Sep; Vol. 101 (3), pp. 534-540. |
| Publication Type: | Journal Article; Research Support, Non-U.S. Gov't |
| Language: | English |
| Journal Info: | Publisher: American Society of Tropical Medicine and Hygiene Country of Publication: United States NLM ID: 0370507 Publication Model: Print Cited Medium: Internet ISSN: 1476-1645 (Electronic) Linking ISSN: 00029637 NLM ISO Abbreviation: Am J Trop Med Hyg Subsets: MEDLINE |
| Imprint Name(s): | Publication: Northbrook, IL : American Society of Tropical Medicine and Hygiene; Original Publication: Baltimore. |
| MeSH Terms: | Multiplex Polymerase Chain Reaction* ; Rural Population* ; Urban Population*; Diarrhea/*diagnosis; Bacteria/genetics ; Bacteria/pathogenicity ; Coinfection/diagnosis ; Coinfection/microbiology ; Coinfection/parasitology ; Coinfection/virology ; Diarrhea/microbiology ; Diarrhea/parasitology ; Diarrhea/virology ; Gastrointestinal Tract/microbiology ; Gastrointestinal Tract/parasitology ; Gastrointestinal Tract/virology ; Parasites/genetics ; Parasites/pathogenicity ; Viruses/genetics ; Viruses/pathogenicity ; Acute Disease ; Animals ; Child, Preschool ; Female ; Humans ; Infant ; Male |
| Abstract: | Multiplex polymerase chain reaction (PCR) platforms have enhanced understanding of intestinal pathogens in low- and middle-income countries (LMICs). However, few such studies have been performed in Latin America, where poverty, poor sanitation, and undernutrition persist. Multiplex PCR (BioFire, Salt Lake City, UT) was used to identify viral, bacterial, and parasitic pathogens in stool collected on day 1 and 31 from children aged 6 to 35 months with acute, non-bloody diarrhea in two locations (rural and urban) in Guatemala. We analyzed correlation between pathogens and clinical, demographic, and socioeconomic variables; described patterns of pathogen acquisition, persistence, and clearance over the 30-day period; and calculated population attributable fractions (PAFs) for diarrheal causation for individual pathogens. We analyzed 316 subjects (144 urban; 172 rural) enrolled between March 2015 and January 2016. Rural subjects had significantly more malnutrition, animal exposure, and unimproved water/sanitation infrastructure. The majority of subjects had multiple pathogens/sample (4.8 rural and 2.7 urban). Few meaningful correlates were identified between individual pathogens and clinical, demographic, or environmental variables. Escherichia coli pathotypes, Shigella, Campylobacter, and Giardia had high rates of persistence between initial and 30-day follow-up. Statistically significant adjusted PAFs were identified for Campylobacter (14.9%, 95% CI: 3.2-23.1), norovirus (10.2%, 95% CI: 0.4-17.1), sapovirus (7.6%, 95% CI: 2.3-10.9), and adenovirus 40/41 (5.6%, 95% CI: 0.3-8.7). These observations further characterize the diversity and complexity of enteric pathogens in children in LMICs. Patterns of chronic symptomatic and asymptomatic infection among Latin American children are similar to those observed in other LMIC regions. Findings have direct implications for practitioners treating individuals with acute infectious diarrhea and should inform regional public health strategies. |
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| Entry Date(s): | Date Created: 20190809 Date Completed: 20200305 Latest Revision: 20210110 |
| Update Code: | 20260130 |
| PubMed Central ID: | PMC6726947 |
| DOI: | 10.4269/ajtmh.18-0962 |
| PMID: | 31392942 |
| Database: | MEDLINE |
Journal Article; Research Support, Non-U.S. Gov't