Aetiology of diarrhoeal disease and evaluation of viral-bacterial coinfection in children under 5 years old in China: A matched case-control study

L. L. Li, N. Liu, E. M. Humphries, J. M. Yu, S. Li, B. R. Lindsay, O. C. Stine, Z. J. Duan

Research output: Contribution to journalArticle

Abstract

Globally, diarrhoeal diseases are the second leading cause of death among children under 5 years old. Few case-control studies on the aetiology of diarrhoea have been conducted in China. A case-control study on 922 children under 5 years old who presented with diarrhoea and individually matched controls was conducted in China between May 2011 and January 2013. Quantitative PCR was used to analyze stool samples for 10 diarrhoeal pathogens. Potential enteric pathogens were detected in 377 (81.8%) of 461 children with diarrhoea and 215 controls (46.6%, p 4 copies per reaction for rotavirus (odds ratio 259), norovirus GII (odds ratio 10.6) and Shigella (odds ratio 5.1). The attributable fractions were 0.18 for rotavirus, 0.08 for norovirus GII, 0.01 for Shigella and 0.04 for adenovirus. Coinfections between pathogens were common. Two pairs, rotavirus and adenovirus, and norovirus GII and Salmonella were positively associated. The co-occurrence of rotavirus and sapovirus, astrovirus, enterotoxigenic Escherichia coli or Campylobacter jejuni only occurred in children with disease. Coinfection was not correlated with clinical symptoms. Quantitative data are critical. Our results indicate that increased pathogen loads increase the OR between diarrhoea and rotavirus, norovirus GII and Shigella. Coinfections with rotavirus and norovirus GII are common and occur in a nonrandom distribution. Despite testing for ten diarrhoeal pathogens, over two-thirds of cases do not have a recognized attributable cause.

Original languageEnglish (US)
Pages (from-to)381.e9-381.e16
JournalClinical Microbiology and Infection
Volume22
Issue number4
DOIs
StatePublished - Apr 1 2016
Externally publishedYes

Keywords

  • Aetiology
  • Bacteria
  • Diarrhoea
  • Quantitative PCR
  • Virus

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases

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