Rehan Muhammad, MacBain Elspeth, Shajib M Sharif, Mokomane Margaret, Lechiile Kwana, Arscott-Mills Tonya, Steenhoff Andrew P, Mazhani Loeto, Main Cheryl, Smieja Marek, Khan Waliul I, Goldfarb David M, Pernica Jeffrey M
Department of Pathology and Laboratory Medicine, The University of British Columbia, Vancouver, British Columbia, Canada.
Department of Pediatrics, The University of British Columbia, Vancouver, British Columbia, Canada.
PLoS One. 2025 Aug 21;20(8):e0328764. doi: 10.1371/journal.pone.0328764. eCollection 2025.
Diarrheal disease is a leading cause of death among young children globally. Current guidelines recommend supportive treatment of acute diarrhea and using antimicrobials only with presence of blood in the stool. Select enteric pathogens, including Shigella, commonly cause disease in high-burden settings; targeted treatment of these pathogens could decrease morbidity and mortality. In settings with limited access to microbiological testing, practical diagnostics are needed to differentiate treatable causes of pediatric diarrhea. Evolving evidence suggests fecal calprotectin (fCal) could help differentiate viral and bacterial gastroenteritis. This study describes a post hoc analysis of stool samples prospectively collected from children hospitalized with severe acute diarrheal disease in Botswana. Specimens were characterized using multiplex PCR panels for selected enteropathogens and assayed for fCal. Stool samples from 312 participants were tested. Samples positive for Shigella had significantly higher fCal than samples positive for rotavirus. Stools that were negative for all assayed pathogens had higher fCal values than expected using standard normative values for healthy children in higher-income settings. Given the prevalence of Shigella and rotavirus infections in young children globally, fCal may be a useful aid to identify children with acute diarrhea for whom antimicrobials could provide benefit and potentially reduce growth failure and mortality.
腹泻病是全球幼儿死亡的主要原因。当前指南建议对急性腹泻进行支持性治疗，仅在粪便带血时使用抗菌药物。包括志贺菌在内的某些肠道病原体，在高负担地区通常会引发疾病；针对性治疗这些病原体可降低发病率和死亡率。在微生物检测条件有限的地区，需要实用的诊断方法来区分小儿腹泻的可治疗病因。越来越多的证据表明，粪便钙卫蛋白（fCal）有助于区分病毒性和细菌性肠胃炎。本研究描述了一项对在博茨瓦纳因严重急性腹泻病住院儿童的粪便样本进行的事后分析。使用针对选定肠道病原体的多重PCR检测板对样本进行特征分析，并检测fCal。对312名参与者的粪便样本进行了检测。志贺菌阳性样本的fCal显著高于轮状病毒阳性样本。所有检测病原体均为阴性的粪便样本，其fCal值高于高收入地区健康儿童的标准规范值。鉴于志贺菌和轮状病毒感染在全球幼儿中的流行情况，fCal可能有助于识别使用抗菌药物可能有益且有可能减少生长发育不良和死亡的急性腹泻儿童。
