Association between stool enteropathogen quantity and disease in Tanzanian children using TaqMan array cards: a nested case-control study - PubMed (original) (raw)

doi: 10.4269/ajtmh.13-0439. Epub 2013 Nov 4.

Jean Gratz, Esto Mduma, Erling Svensen, Caroline Amour, Jie Liu, Athanasia Maro, Queen Saidi, Ndealilia Swai, Happiness Kumburu, Benjamin J J McCormick, Gibson Kibiki, Eric R Houpt

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Association between stool enteropathogen quantity and disease in Tanzanian children using TaqMan array cards: a nested case-control study

James A Platts-Mills et al. Am J Trop Med Hyg. 2014 Jan.

Abstract

Etiologic studies of diarrhea are limited by uneven diagnostic methods and frequent asymptomatic detection of enteropathogens. Polymerase chain reaction-based stool pathogen quantification may help distinguish clinically significant infections. We performed a nested case-control study of diarrhea in infants from a community-based birth cohort in Tanzania. We tested 71 diarrheal samples and pre-diarrheal matched controls with a laboratory-developed TaqMan Array Card for 19 enteropathogens. With qualitative detection, no pathogens were significantly associated with diarrhea. When pathogen quantity was considered, rotavirus (odds ratio [OR] = 2.70 per log10 increase, P < 0.001), astrovirus (OR = 1.49, P = 0.01), and Shigella/enteroinvasive Escherichia coli (OR = 1.47, P = 0.04) were associated with diarrhea. Enterotoxigenic E. coli (0.15 SD decline in length-for-age z score after 3 months per log10 increase, P < 0.001) and Campylobacter jejuni/C. coli (0.11 SD decline, P = 0.003) in pre-diarrheal stools were associated with poor linear growth. Quantitative analysis can help refine the association between enteropathogens and disease in endemic settings.

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Figures

Figure 1.

Figure 1.

Comparison of the proportions of case and control stools (N = 71 pairs) positive for each pathogen. All stools were tested with TaqMan Array Cards for 19 enteropathogens. No significant differences were detected.

Figure 2.

Figure 2.

Box plots of quantification cycle results in case and control samples positive for each pathogen. Only pathogens with more than two detections in cases are shown. Whiskers represent minimum and maximum values. * The quantities of rotavirus (P = 0.03) and Shigella (P = 0.05) were significantly higher in diarrheal stools.

Figure 3.

Figure 3.

Quantification cycle results for each case and asymptomatic matched control collected before the episode (N = 71 pairs) for the pathogens found to be associated with diarrhea in this study. (A) Astrovirus. (B) Rotavirus. (C) Shigella/EIEC.

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