General Pediatric Department, Robert Debré Hospital, Paris, France.
General Pediatric and Emergency Department, Hopital Jean Verdier, Bondy, France.
Arch Dis Child. 2019 Feb;104(2):141-146. doi: 10.1136/archdischild-2017-314327. Epub 2018 Jul 7.
Traveller's diarrhoea (TD) is one of the most frequent illnesses affecting children returning from tropical countries. The purpose of this study was to assess the distribution of pathogens associated with TD in children using a multiplex PCR assay on stool samples.
All the children admitted for TD in two university hospitals from 1 August to 15October during 2014 and 2015 were included in a prospective study. Stool samples were tested by a multiplex PCR FilmArray GI panel detecting 22 pathogens. Performances for the detection of major enteropathogenic bacteria ( and spp) by multiplex PCR and conventional culture methods were compared. The prevalence of extended spectrum beta-lactamase (ESBL)-producing was also determined.
Fifty-nine children were included. In 58 cases (98%), at least one pathogen was identified, including 9 different enteropathogenic bacteria, 5 viruses and 2 parasites. Multiplex PCR enhanced the enteropathogenic bacteria detection by 25%. The most frequent pathogens were enteroaggregative (n=32), enteropathogenic (n=26), enterotoxigenic (n=19), , enteroinvasive (n=16 each), , sapovirus (n=11 each), norovirus (n=10 each), rotavirus (n=9), (n=8) and Shiga-toxin-producing (n=4). Fifty-two coinfections were observed, notably including bacteria and viruses (n=21), multiple bacteria (n=14), or bacteria and parasites (n=10). ESBL were detected in 28 cases. Multiplex PCR could optimise the number of treated patients by 27% compared with stool cultures.
Multiplex PCR on stools revealed a high prevalence of diverse enteric pathogens and coinfections in children with TD. Major enteropathogenic bacteria were more frequently detected by multiplex PCR compared with conventional culture. Finally, this technique allows the start of appropriate and early antibiotic treatment and seems to optimise the number of correctly treated patients.
旅行者腹泻（TD）是影响从热带国家返回的儿童最常见的疾病之一。本研究的目的是使用粪便样本多重 PCR 检测评估与 TD 相关的病原体在儿童中的分布。
2014 年 8 月 1 日至 10 月 15 日期间，两所大学医院因 TD 入院的所有儿童均纳入前瞻性研究。粪便样本通过检测 22 种病原体的多重 PCR FilmArray GI 板进行检测。比较多重 PCR 和常规培养方法检测主要肠道致病菌（和 spp）的性能。还确定了产超广谱β-内酰胺酶（ESBL）的情况。
共纳入 59 例儿童。在 58 例（98%）中，至少鉴定出一种病原体，包括 9 种不同的肠道致病菌、5 种病毒和 2 种寄生虫。多重 PCR 提高了肠道致病菌的检出率 25%。最常见的病原体是聚集性肠（n=32）、肠致病性（n=26）、肠毒性（n=19）、、侵袭性肠（n=16 个）、、诺如病毒（n=10 个）、轮状病毒（n=9）、（n=8）和产志贺毒素（n=4）。观察到 52 例合并感染，尤其是细菌和病毒（n=21）、多种细菌（n=14）或细菌和寄生虫（n=10）。检测到 28 例 ESBL。与粪便培养相比，多重 PCR 可使接受治疗的患者数量增加 27%。
粪便多重 PCR 显示儿童 TD 中存在多种肠道病原体和合并感染的高流行率。与传统培养相比，多重 PCR 更能检测到主要肠道致病菌。最后，该技术可以启动适当和早期的抗生素治疗，并似乎优化了正确治疗患者的数量。
