Real-time PCR Identification of Agents Causing Diarrhea in Rwandan Children Less Than 5 Years of Age
Artikel i vetenskaplig tidskrift, 2014

Background: Knowledge about causes of acute diarrhea among children in developing countries is insufficient. Molecular methods might improve diagnostics of infectious gastroenteritis, but due to the high sensitivity, findings may be difficult to interpret. Methods: Feces samples from Rwandan children 0.5-5.0 years of age, with diarrhea for < 96 hours (patients, n = 544) or without diarrhea for 14 days (controls, n = 162), were analyzed by real-time polymerase chain reaction targeting 17 pathogens. Results: At least 1 agent was detected in 94% of patients and in 79% of controls, with higher rates in sick children for rotavirus (42% vs. 2%, P < 0.0001) and enterotoxigenic Escherichia coli (ETEC)-estA (21% vs. 9%, P = 0.0006). Detection rates did not differ significantly for adenovirus (39% vs. 36%), ETEC-eltB (29% vs. 30%), Campylobacter (14% vs. 17%) or Shigella (13% vs. 10%), but for Shigella the threshold cycle (Ct) values were lower (pathogen loads were higher) in sick children than in controls. By multivariate analysis, including gender and age, detection of rotavirus (P < 0.0001), ETEC-estA (P = 0.001), Shigella (P = 0.004) and norovirus genogroup II (P = 0.009) was associated with symptomatic infection, and a Ct value below a cutoff (in the range 28-29) improved identification of ETEC-estA, Shigella and norovirus genogroup II. Conclusion: Real-time polymerase chain reaction can detect essentially all diarrheagenic agents, and provides Ct values that improve identification of clinically relevant infections.



rectal swabs

rotavirus diarrhea

enteropathogenic escherichia-coli


viral load

stool specimens

global enteric multicenter



Jean-Claude Kabayiza

Göteborgs universitet

Maria Andersson

Göteborgs universitet

Staffan Nilsson

Chalmers, Matematiska vetenskaper, Matematisk statistik

Göteborgs universitet

Tomas Bergström

Göteborgs universitet

Gregoire Muhirwa

National University of Rwanda

Magnus Lindh

Göteborgs universitet

Pediatric Infectious Disease Journal

0891-3668 (ISSN)

Vol. 33 10 1037-1042



Immunologi inom det medicinska området



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