Combined stool-based multiplex PCR and microscopy for enhanced pathogen detection in patients with persistent diarrhoea and asymptomatic controls from Côte d'Ivoire.
Clin Microbiol Infect. 2015 Mar 2;
Authors: Becker SL, Chatigre JK, Gohou JP, Coulibaly JT, Leuppi R, Polman K, Chappuis F, Mertens P, Herrmann M, N'Goran EK, Utzinger J, von Müller L
Infectious diarrhoea ranks among the leading causes of morbidity worldwide. While most acute diarrhoeal episodes are self-limiting, diagnosis and treatment of persistent diarrhoea (≥2 weeks) are cumbersome and require laboratory identification of the causative pathogen. Stool-based PCR assays have greatly improved the previously disappointing pathogen detection rates in high-income countries, but there is a paucity of quality data from tropical settings. We performed a case-control study to elucidate the spectrum of intestinal pathogens in patients with persistent diarrhoea and asymptomatic controls in southern Côte d'Ivoire. Stool samples from 68 patients and 68 controls were obtained and subjected to molecular multiplex testing using the Luminex(®) Gastrointestinal Pathogen Panel (GPP), microscopy and rapid antigen detection tests for the diagnosis of diarrhoeagenic pathogens. Overall, 20 different bacteria, parasites and viruses were detected by the suite of diagnostic methods employed. At least one pathogen was observed in 84% and co-infections in more than 50% of the participants. Enterotoxigenic Escherichia coli (32%), Giardia intestinalis (29%) and Shigella spp. (20%) were the predominant pathogens, whilst Strongyloides stercoralis (10%) was the most prevalent helminth. Pathogen frequencies and number of co-infections were similar in patients and controls. Although Luminex(®) GPP detects a broad range of pathogens, microscopy for helminths and intestinal protozoa remains necessary to cover the full aetiological spectrum in tropical settings. We conclude that highly sensitive multiplex PCR assays constitute a useful screening tool, but positive results might need to be confirmed by independent methods to discriminate active infection from asymptomatic faecal shedding of nucleic acids.
PMID: 25743578 [PubMed - as supplied by publisher]