TY - JOUR
T1 - Relationship between enteric pathogens and acute gastroenteritis disease severity
T2 - a prospective cohort study
AU - Pediatric Emergency Research Canada (PERC) and the Alberta Provincial Pediatric EnTeric Infection TEam (APPETITE Team)
AU - Xie, J.
AU - Nettel-Aguirre, A.
AU - Lee, B. E.
AU - Chui, L.
AU - Pang, X. L.
AU - Zhuo, R.
AU - Parsons, B.
AU - Vanderkooi, O. G.
AU - Tarr, P. I.
AU - Ali, S.
AU - Dickinson, J. A.
AU - Hagen, E.
AU - Svenson, L. W.
AU - MacDonald, S. E.
AU - Drews, S. J.
AU - Tellier, R.
AU - Graham, T.
AU - Lavoie, M.
AU - MacDonald, J.
AU - Freedman, S. B.
N1 - Publisher Copyright:
© 2018 European Society of Clinical Microbiology and Infectious Diseases
PY - 2019/4
Y1 - 2019/4
N2 - Objectives: To evaluate the relationship between individual bacterial and viral pathogens and disease severity. Methods: Children <18 years with three or more episodes of vomiting and/or diarrhoea were enrolled in two Canadian paediatric emergency departments between December 2014 and August 2016. Specimens were analysed employing molecular panels, and outcome data were collected 14 days after enrolment. The primary outcome was severe disease over the entire illness (symptom onset until 14-day follow-up), quantified employing the Modified Vesikari Scale (MVS) score. The score was additionally analysed in two other time periods: index (symptom onset until enrolment) and follow-up (enrolment until 14-day follow-up). Results: Median participant age was 20.7 (IQR: 11.3, 44.2) months; 47.4% (518/1093) and 73.4% (802/1093) of participants had index and total MVS scores ≥11, respectively. The most commonly identified pathogens were rotavirus (289/1093; 26.4%) and norovirus (258/1093; 23.6%). In multivariable analysis, severe disease over the entire illness was associated with rotavirus (OR = 9.60; 95%CI: 5.69, 16.19), Salmonella (OR = 6.61; 95%CI: 1.50, 29.17), adenovirus (OR = 2.53; 95%CI: 1.62, 3.97), and norovirus (OR = 1.43; 95%CI: 1.01, 2.01). Pathogens associated with severe disease at the index visit were: rotavirus only (OR = 6.13; 95%CI: 4.29, 8.75), Salmonella (OR = 4.59; 95%CI: 1.71, 12.29), adenovirus only (OR = 2.06; 95%CI: 1.41, 3.00), rotavirus plus adenovirus (OR = 3.15; 95%CI: 1.35, 7.37), and norovirus (OR = 0.68; 95%CI: 0.49, 0.94). During the follow-up period, rotavirus (OR = 2.21; 95%CI: 1.50, 3.25) and adenovirus (OR = 2.10; 95%CI: 1.39, 3.18) were associated with severe disease. Conclusions: In children presenting for emergency department care with acute gastroenteritis, pathogens identified were predominantly viruses, and several of which were associated with severe disease. Salmonella was the sole bacterium independently associated with severe disease.
AB - Objectives: To evaluate the relationship between individual bacterial and viral pathogens and disease severity. Methods: Children <18 years with three or more episodes of vomiting and/or diarrhoea were enrolled in two Canadian paediatric emergency departments between December 2014 and August 2016. Specimens were analysed employing molecular panels, and outcome data were collected 14 days after enrolment. The primary outcome was severe disease over the entire illness (symptom onset until 14-day follow-up), quantified employing the Modified Vesikari Scale (MVS) score. The score was additionally analysed in two other time periods: index (symptom onset until enrolment) and follow-up (enrolment until 14-day follow-up). Results: Median participant age was 20.7 (IQR: 11.3, 44.2) months; 47.4% (518/1093) and 73.4% (802/1093) of participants had index and total MVS scores ≥11, respectively. The most commonly identified pathogens were rotavirus (289/1093; 26.4%) and norovirus (258/1093; 23.6%). In multivariable analysis, severe disease over the entire illness was associated with rotavirus (OR = 9.60; 95%CI: 5.69, 16.19), Salmonella (OR = 6.61; 95%CI: 1.50, 29.17), adenovirus (OR = 2.53; 95%CI: 1.62, 3.97), and norovirus (OR = 1.43; 95%CI: 1.01, 2.01). Pathogens associated with severe disease at the index visit were: rotavirus only (OR = 6.13; 95%CI: 4.29, 8.75), Salmonella (OR = 4.59; 95%CI: 1.71, 12.29), adenovirus only (OR = 2.06; 95%CI: 1.41, 3.00), rotavirus plus adenovirus (OR = 3.15; 95%CI: 1.35, 7.37), and norovirus (OR = 0.68; 95%CI: 0.49, 0.94). During the follow-up period, rotavirus (OR = 2.21; 95%CI: 1.50, 3.25) and adenovirus (OR = 2.10; 95%CI: 1.39, 3.18) were associated with severe disease. Conclusions: In children presenting for emergency department care with acute gastroenteritis, pathogens identified were predominantly viruses, and several of which were associated with severe disease. Salmonella was the sole bacterium independently associated with severe disease.
KW - Adenoviridae
KW - Child
KW - Diarrhoea
KW - Gastroenteritis
KW - Hospital Emergency Service
KW - Norovirus
KW - Rotavirus
KW - Salmonella
KW - Vomiting
UR - http://www.scopus.com/inward/record.url?scp=85050509814&partnerID=8YFLogxK
U2 - 10.1016/j.cmi.2018.06.016
DO - 10.1016/j.cmi.2018.06.016
M3 - Article
C2 - 29964235
AN - SCOPUS:85050509814
SN - 1198-743X
VL - 25
SP - 454
EP - 461
JO - Clinical Microbiology and Infection
JF - Clinical Microbiology and Infection
IS - 4
ER -