Department of Infectious Diseases, University of Gothenburg, Gothenburg, Sweden.
Department of Pediatrics, University of Rwanda, Kigali, Rwanda.
Am J Trop Med Hyg. 2018 Jun;98(6):1566-1570. doi: 10.4269/ajtmh.17-0473. Epub 2018 Apr 19.
Enteric coinfections among children in low-income countries are very common, but it is not well known if specific pathogen combinations are associated or have clinical importance. In this analysis, feces samples from children in Rwanda and Zanzibar less than 5 years of age, with ( = 994) or without ( = 324) acute diarrhea, were analyzed by real-time polymerase chain reaction targeting a wide range of pathogens. Associations were investigated by comparing co-detection and mono-detection frequencies for all pairwise pathogen combinations. More than one pathogen was detected in 840 samples (65%). A negative association (coinfections being less common than expected from probability) was observed for rotavirus in combination with , , or norovirus genogroup II, but only in patients, which is statistically expected for agents that independently cause diarrhea. A positive correlation was observed, in both patients and controls, between Ct (threshold cycle) values for certain virulence factor genes in enteropathogenic (EPEC) ( and ) and toxin genes in enterotoxigenic ( and ), allowing estimation of how often these genes were present in the same bacteria. A significant positive association in patients only was observed for and EPEC, suggesting that this coinfection might interact in a manner that enhances symptoms. Although interaction between pathogens that affect symptoms is rare, this work emphasizes the importance and difference in interpretation of coinfections depending on whether they are positively or negatively associated.
发展中国家儿童的肠病原体共感染非常常见，但尚不清楚特定病原体组合是否相关或具有临床意义。在这项分析中，对来自卢旺达和桑给巴尔小于 5 岁的、有（=994）或无（=324）急性腹泻的儿童的粪便样本，通过实时聚合酶链反应靶向广泛的病原体进行了分析。通过比较所有成对病原体组合的共同检测和单一检测频率来研究关联。在 840 个样本（65%）中检测到一种以上的病原体。在患者中观察到轮状病毒与、或诺如病毒基因群 II 的组合呈负关联（共感染比从概率上预期的要少），但仅在独立引起腹泻的病原体中才具有统计学意义。在患者和对照中，肠致病性大肠杆菌（EPEC）（和）中某些毒力因子基因和肠毒素基因（和）的 Ct（阈值循环）值之间观察到正相关，这允许估计这些基因在同一细菌中存在的频率。仅在患者中观察到和 EPEC 的显著正关联，表明这种共感染可能以增强症状的方式相互作用。尽管影响症状的病原体之间的相互作用很少见，但这项工作强调了根据共感染是正相关还是负相关，对其进行解释的重要性和差异。
