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Infectious Causes of Acute Gastroenteritis in US Children Undergoing Allogeneic Hematopoietic Cell Transplant: A Longitudinal, Multicenter Study.

Abstract：

BACKGROUND:Acute gastroenteritis (AGE) in hematopoietic cell transplant (HCT) patients causes significant morbidity and mortality. Data regarding the longitudinal assessment of infectious pathogens during symptomatic AGE and asymptomatic periods, particularly in children, are limited. We investigated the prevalence of AGE-associated infectious pathogens in children undergoing allogeneic HCT. METHODS:From March 2015 through May 2016, 31 pediatric patients at 4 US children's hospitals were enrolled and had stool collected weekly from pre-HCT through 100 days post-HCT for infectious AGE pathogens by molecular testing. Demographics, clinical symptoms, antimicrobials, vaccination history, and outcomes were manually abstracted from the medical record into a standardized case report form. RESULTS:We identified a pathogen in 18% (38/206) of samples, with many detections occurring during asymptomatic periods. Clostridioides difficile was the most commonly detected pathogen in 39% (15/38) of positive specimens, although only 20% (3/15) of C. difficile-positive specimens were obtained from children with diarrhea. Detection of sapovirus, in 21% (8/38) of pathogen-positive specimens, was commonly associated with AGE, with 87.5% of specimens obtained during symptomatic periods. Norovirus was not detected, and rotavirus was detected infrequently. Prolonged shedding of infectious pathogens was rare. CONCLUSIONS:This multicenter, prospective, longitudinal study suggests that the epidemiology of AGE pathogens identified from allogeneic HCT patients may be changing. Previously reported viruses, such as rotavirus and norovirus, may be less common due to widespread vaccination and institution of infection control precautions, and emerging viruses such as sapoviruses may be increasingly recognized due to the use of molecular diagnostics.

journal_name

J Pediatric Infect Dis Soc

journal_title

Journal of the Pediatric Infectious Diseases Society

authors

Schuster JE,Johnston SH,Piya B,Dulek DE,Wikswo ME,McHenry R,Browne H,Gautam R,Bowen MD,Vinjé J,Payne DC,Azimi P,Selvarangan R,Halasa N,Englund JA

doi

10.1093/jpids/piz063

subject

Has Abstract

pub_date

2020-09-17 00:00:00

pages

421-427

issue

eissn

2048-7193

issn

2048-7207

pii

5573380

journal_volume

pub_type

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Infectious Causes of Acute Gastroenteritis in US Children Undergoing Allogeneic Hematopoietic Cell Transplant: A Longitudinal, Multicenter Study.