Potential causative agents of acute gastroenteritis in households with preschool children: prevalence, risk factors, clinical relevance and household transmission

Abstract

Acute gastroenteritis (AGE) morbidity remains high amongst preschool children, posing a significant societal burden. Empirical data on AGE-causing agents is needed to gauge their clinical relevance and identify agent-specific targets for control. We assessed the prevalence, risk factors and association with symptoms for enteropathogens in households with preschool children. A monthly-repeated cross-sectional survey of enteropathogens in households with preschool children was performed. A parent-child pair per household (n = 907 households) provided faecal samples and reported their symptoms and potential risk exposures. Samples were tested by multiplex reverse transcription polymerase chain reaction (RT-PCR) for 19 enteropathogens. Associations were assessed using logistic regression. 28.3 % of children (n = 981) and 15.6 % of parents (n = 971) carried pathogenic bacteria and/or Escherichia coli-associated pathogenicity genes, and 6.5 % and 3.3 % carried viruses, respectively. Giardia lamblia (4.6 % of children, 2.5 % of parents) and Dientamoeba fragilis (36 %, 39 %, respectively) were the main parasites, and were associated with pet exposure. Living in rural areas was associated with carriage of pathogenic E. coli, norovirus I and D. fragilis. Pathogenic E. coli was associated with summertime and livestock exposure. Attending day-care centres increased the risk of carrying norovirus, sapovirus and G. lamblia. Viruses occurred mainly in winter and were associated with AGE symptoms. Child-parent associations were found for bacterial pathogenicity genes, viruses, G. lamblia and D. fragilis. Enteropathogens spread widely in households with preschool children, particularly viruses, which more often cause symptoms. While bacteria predominate during summer and in those exposed to livestock, viruses predominate in wintertime and, like G. lamblia, are widespread amongst day-care centre attendees.

Dientamoeba fragilis, a Commensal in Children in Danish Day Care Centers

“…Moreover, this study illustrates that D. fragilis is commonly acquired at an early age. These results are in line with the results of the recent Dutch studies (3,5) and with the observed peak in the positive proportion in clinical samples at the age of seven in Denmark (9).…”

“…Because few children had several siblings, the increase in odds of testing positive and highly positive with number of siblings should be interpreted cautiously. However, similar results were obtained in the recent Dutch study (5). The epidemiological role of siblings remains unknown, as the transmission routes of D. fragilis need clarification (15).…”

“…The result supports the previous observations of D. fragilis being common in Denmark (8, 9) but might not represent the situation for children who do not attend day care centers or for children who live outside the urban environment of the capital city. In the Netherlands, D. fragilis was a common finding in children attending day care centers (3); however, attending a day care center was not associated with testing positive for D. fragilis, while living in rural areas was a risk factor (5).…”

“…ientamoeba fragilis is an intestinal protozoan of debated clinical significance (1)(2)(3)(4)(5)(6)(7). In Denmark, D. fragilis appears to be common in the apparently healthy adult population (8); meanwhile, baseline data on the prevalence in apparently healthy children are lacking.…”

Environmental factors associated with childhood norovirus diarrhoea in León, Nicaragua

“…A study of children in the Netherlands found an association between exposure to livestock and detection of norovirus in stool (23). Finally, although the association in our analyzed cohort was not significant, we were surprised to find that having an indoor toilet tended to be associated with norovirus diarrhoea.…”