Objectives

Studies of acute gastroenteritis (AGE) are hampered by the lack of routine diagnostic methods with good sensitivity and specificity. Molecular methods are increasingly used for clinical purposes, but the clinical significance of a positive result remains a challenge. In this study we aimed to compare results of routine diagnostic methods and molecular methods in symptomatic children and asymptomatic controls.

Methods

Patients presenting to the pediatric emergency departments of two university hospitals in Brussels with AGE were recruited prospectively from May 2015 to October 2016; asymptomatic controls were recruited from the same hospitals. Stool analyses were performed for all participants for common pathogenic bacteria (culture), virus (immunochromatography) and parasites (microscopy). Stools were also analysed with the Luminex Gastrointestinal Pathogen Panel, a multiplex-PCR for common enteropathogens.

Results

Stools from 178 patients and 165 controls were analysed. An enteropathogen was detected in 62.4% (111/178) of cases when combining the two methods (56.2% (100/178) by Luminex, 42.7% (76/178) with routine methods) and 29.1% (48/165) of controls (24.2% (40/165) by Luminex and 10.3% (17/165) by routine methods). Some pathogens were detected more often with Luminex than with routine methods, such as Salmonella (16.3% (29/178) with Luminex and 3.9% (7/178) with routine method, p < 0.05), whereas others identified by culture methods, such as Campylobacter, Shigella, Yersinia, were missed by Luminex.

Conclusions

Molecular tools seem attractive methods, providing high positivity and a rapid turn-around time for the diagnosis of AGE. However, high rates of positivity in both cases and controls highlight the difficulty in interpreting results. Pathogens missed by Luminex but detected by culture methods raise more questions about the true clinical interest of the technique for our patients.

中文翻译：

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小儿胃肠炎中的病原菌：常规诊断方法与分子方法的比较

目标

缺乏具有良好敏感性和特异性的常规诊断方法阻碍了急性胃肠炎（AGE）的研究。分子方法越来越多地用于临床目的，但是阳性结果的临床意义仍然是一个挑战。在这项研究中，我们旨在比较有症状儿童和无症状对照的常规诊断方法和分子方法的结果。

方法

从2015年5月至2016年10月前瞻性招募了在布鲁塞尔的两家大学医院的儿科急诊科就诊的患者。从同一家医院招募无症状对照。对所有参与者进行了粪便分析，包括常见病原菌（培养物），病毒（免疫色谱法）和寄生虫（显微镜）。粪便还通过Luminex胃肠道病原体组进行了分析，这是常见肠病原体的多重PCR。

结果

分析了来自178位患者和165位对照的凳子。当将两种方法（Luminex的56.2％（100/178），常规方法的42.7％（76/178））组合使用时，在62.4％（111/178）的病例中检出了肠病原体。对照（Luminex使用24.2％（40/165），常规方法使用10.3％（17/165））。与常规方法相比，使用Luminex检出的病原体更多，例如沙门氏菌（Luminex（16.3％（29/178））和常规方法检出的3.9％（7/178），p <0.05），而其他病原体则通过培养方法检出，如弯曲杆菌，志贺氏菌，耶尔森氏菌，通过Luminex错过。

结论

分子工具似乎是有吸引力的方法，为AGE诊断提供了高阳性和快速的周转时间。但是，在两种情况下和对照中阳性率都很高，这突出了解释结果的难度。Luminex遗漏但通过培养方法检测到的病原体对该技术对我们的患者的真正临床兴趣提出了更多问题。