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Rapid stool test decreases recurring pediatric diarrhea in Botswana
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Treatment targeting specific enteropathogens, detected by novel rapid-stool testing, decreased the incidence of diarrhea in children in Botswana with gastroenteritis, according to a recently published study.
“For many of the leading causes of severe diarrhea in children, there are effective low-cost treatments available,” Jeffrey M. Pernica, MD, FRCPC, from the division of infectious disease and department of pediatrics at McMaster University, said in a press release. “The issue, however, is that up until recently it was not possible to determine the specific pathogen causing illness in a timely manner.”
Rapid testing was performed with a flocked rectal swab designed by researchers at McMaster University, according to the release. The device resembles a cotton swab with a 3.2 cm tip of nylon fibers. Using the swab and a 15 pathogen PCR assay, Pernica and colleagues identified enteropathogic species typically unrecognized in patients with gastroenteritis. More than 650 children (median age, 8.3 months) were tested and diagnosed in the same day. Eleven percent of the patients had severe acute malnutrition, and 6% were HIV-positive.
Almost 4% of the patients died before hospital discharge. The presence of treatable pathogens, including Campylobacter, Shigella and enterotoxigenic Escherichia coli, in stool samples (OR = 2.57; 95% CI, 1.07-6.17), severe acute malnutrition (OR = 4.34; 95% CI, 1.79-10.5) and delivery of antimicrobials (OR = 8.82; 95% CI, 2.03-38.2) were the strongest covariates of death.
Rapid stool testing was associated with a 55% risk reduction in recurring diarrhea, according to the press release. In addition, significant growth in patient height 60 days after treatment indicated the possibility of normal development.
Most patients had at least one (49%) or two (24%) enteropathogens present in their stool.
Thirty-three percent of patients did not have blood in their stool, but were infected with treatable pathogens. Based on this finding, the researchers recommended that current guidelines limiting antibacterial treatment to patients with bloody stools be reevaluated.
“Our results would suggest that the current WHO treatment algorithm may not be effective in Botswana, where many children with acute gastroenteritis harboring a potentially treatable pathogen do not have bloody stools, and bacterial dysentery does not appear to be associated with worse outcomes than bacterial enteritis without blood in the stool, even when adjusted for antibiotic use,” Pernica and colleagues wrote.
Only 11% of patients presented with bloody diarrhea, and Shigella was the only pathogen associated with bloody stools.
Following the outcomes, officials in Botswana developed an anti-rotavirus immunization program and rapid antibiotic treatment protocols. More than 100,000 children were vaccinated and all-cause infant diarrhea-related mortality and hospitalizations decreased by 32% and 26%, respectively, according to the release. – by Stephanie Viguers
Disclosure: The study was funded by Grand Challenges Canada. The researchers report no relevant financial disclosures.
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