Concurrent infections of Giardia duodenalis, Enterocytozoon bieneusi, and Clostridium difficile in children during a cryptosporidiosis outbreak in a pediatric hospital in China
Over 200 cryptosporidiosis outbreaks have been reported, but little is known if other enteric pathogens were also involved in some of these outbreaks. Recently, an outbreak of cryptosporidiosis linked to poor hygiene by two Cryptosporidium hominis subtypes occurred in a pediatric hospital ward (Ward...
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| description | Over 200 cryptosporidiosis outbreaks have been reported, but little is known if other enteric pathogens were also involved in some of these outbreaks. Recently, an outbreak of cryptosporidiosis linked to poor hygiene by two Cryptosporidium hominis subtypes occurred in a pediatric hospital ward (Ward A) in China, lasting for more than 14 months. In this study, the concurrence during the outbreak of three other enteric pathogens with a similar transmission route, Giardia duodenalis, Enterocytozoon bieneusi, and Clostridium difficile, was assessed.
The occurrence of G. duodenalis, E. bieneusi, and C. difficile in 78 inpatients from Ward A and 283 and 216 inpatients from two control wards (Wards C and D) in the same hospital was examined using molecular diagnostic tools. Significantly higher infection rates were found in children in Ward A for all study pathogens than in Wards C and D (P |
| doi_str_mv | 10.1371/journal.pntd.0002437 |
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The occurrence of G. duodenalis, E. bieneusi, and C. difficile in 78 inpatients from Ward A and 283 and 216 inpatients from two control wards (Wards C and D) in the same hospital was examined using molecular diagnostic tools. Significantly higher infection rates were found in children in Ward A for all study pathogens than in Wards C and D (P<0.01): 9.5% versus 1.4% and 0% for G. duodenalis, 10.8% versus 2.8% and 3.7% for E. bieneusi, and 60.8% versus 37.8% and 27.8% for C. difficile, respectively. These differences were mostly seen in children ≤ 12 months. Enteric pathogen-positive children in Ward A (31/58 or 53.4%) were more likely to have mixed infections than those in Ward C (4/119 or 3.4%) or D (5/68, 7.4%; P<0.01). Having cryptosporidiosis was a risk factor for G. duodenalis (OR = 4.3; P = 0.08), E. bieneusi (OR = 3.1; P = 0.04), and C. difficile (OR = 4.7; P<0.01) infection. In addition, a lower diversity of G. duodenalis, E. bieneusi, and C. difficile genotypes/subtypes was observed in Ward A.
Data from this study suggest that multiple pathogens were concurrently present during the previous cryptosporidiosis outbreak. Examination of multiple enteric pathogens should be conducted when poor hygiene is the likely cause of outbreaks of diarrhea.</description><identifier>ISSN: 1935-2735</identifier><identifier>ISSN: 1935-2727</identifier><identifier>EISSN: 1935-2735</identifier><identifier>DOI: 10.1371/journal.pntd.0002437</identifier><identifier>PMID: 24069491</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Adolescent ; Analysis ; Child ; Child, Preschool ; China - epidemiology ; Clostridium difficile ; Clostridium difficile - isolation & purification ; Coinfection - epidemiology ; Cryptosporidiosis ; Cryptosporidiosis - complications ; Cryptosporidiosis - epidemiology ; Cryptosporidium - isolation & purification ; Developing countries ; Diarrhea ; Disease Outbreaks ; Distribution ; Enterocytozoon - isolation & purification ; Epidemiology ; Female ; Genetic diversity ; Giardia ; Giardia lamblia ; Giardia lamblia - isolation & purification ; Health facilities ; Hospitals ; Hospitals, Pediatric ; Host-parasite relationships ; Humans ; Hygiene ; Infant ; Infant, Newborn ; Infections ; LDCs ; Male ; Microsporidia ; Molecular Sequence Data ; Pediatrics ; Physiological aspects ; Prevalence studies (Epidemiology) ; Sequence Analysis, DNA ; Studies ; Testing ; Virulence (Microbiology)</subject><ispartof>PLoS neglected tropical diseases, 2013-09, Vol.7 (9), p.e2437-e2437</ispartof><rights>COPYRIGHT 2013 Public Library of Science</rights><rights>2013</rights><rights>2013 Public Library of Science. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited: Citation: Wang L, Xiao L, Duan L, Ye J, Guo Y, et al. (2013) Concurrent Infections of Giardia duodenalis, Enterocytozoon bieneusi, and Clostridium difficile in Children during a Cryptosporidiosis Outbreak in a Pediatric Hospital in China. PLoS Negl Trop Dis 7(9): e2437. doi:10.1371/journal.pntd.0002437</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c596t-eb0f7addec2bc49bed94f6627e194d4c64e32ec9cc8f311a008bf26df86c4b273</citedby><cites>FETCH-LOGICAL-c596t-eb0f7addec2bc49bed94f6627e194d4c64e32ec9cc8f311a008bf26df86c4b273</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3772047/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3772047/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,864,885,2102,2928,23866,27924,27925,53791,53793,79600,79601</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24069491$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><contributor>Kang, Gagandeep</contributor><creatorcontrib>Wang, Lin</creatorcontrib><creatorcontrib>Xiao, Lihua</creatorcontrib><creatorcontrib>Duan, Liping</creatorcontrib><creatorcontrib>Ye, Jianbin</creatorcontrib><creatorcontrib>Guo, Yaqiong</creatorcontrib><creatorcontrib>Guo, Meijin</creatorcontrib><creatorcontrib>Liu, Lili</creatorcontrib><creatorcontrib>Feng, Yaoyu</creatorcontrib><title>Concurrent infections of Giardia duodenalis, Enterocytozoon bieneusi, and Clostridium difficile in children during a cryptosporidiosis outbreak in a pediatric hospital in China</title><title>PLoS neglected tropical diseases</title><addtitle>PLoS Negl Trop Dis</addtitle><description>Over 200 cryptosporidiosis outbreaks have been reported, but little is known if other enteric pathogens were also involved in some of these outbreaks. Recently, an outbreak of cryptosporidiosis linked to poor hygiene by two Cryptosporidium hominis subtypes occurred in a pediatric hospital ward (Ward A) in China, lasting for more than 14 months. In this study, the concurrence during the outbreak of three other enteric pathogens with a similar transmission route, Giardia duodenalis, Enterocytozoon bieneusi, and Clostridium difficile, was assessed.
The occurrence of G. duodenalis, E. bieneusi, and C. difficile in 78 inpatients from Ward A and 283 and 216 inpatients from two control wards (Wards C and D) in the same hospital was examined using molecular diagnostic tools. Significantly higher infection rates were found in children in Ward A for all study pathogens than in Wards C and D (P<0.01): 9.5% versus 1.4% and 0% for G. duodenalis, 10.8% versus 2.8% and 3.7% for E. bieneusi, and 60.8% versus 37.8% and 27.8% for C. difficile, respectively. These differences were mostly seen in children ≤ 12 months. Enteric pathogen-positive children in Ward A (31/58 or 53.4%) were more likely to have mixed infections than those in Ward C (4/119 or 3.4%) or D (5/68, 7.4%; P<0.01). Having cryptosporidiosis was a risk factor for G. duodenalis (OR = 4.3; P = 0.08), E. bieneusi (OR = 3.1; P = 0.04), and C. difficile (OR = 4.7; P<0.01) infection. In addition, a lower diversity of G. duodenalis, E. bieneusi, and C. difficile genotypes/subtypes was observed in Ward A.
Data from this study suggest that multiple pathogens were concurrently present during the previous cryptosporidiosis outbreak. Examination of multiple enteric pathogens should be conducted when poor hygiene is the likely cause of outbreaks of diarrhea.</description><subject>Adolescent</subject><subject>Analysis</subject><subject>Child</subject><subject>Child, Preschool</subject><subject>China - epidemiology</subject><subject>Clostridium difficile</subject><subject>Clostridium difficile - isolation & purification</subject><subject>Coinfection - epidemiology</subject><subject>Cryptosporidiosis</subject><subject>Cryptosporidiosis - complications</subject><subject>Cryptosporidiosis - epidemiology</subject><subject>Cryptosporidium - isolation & purification</subject><subject>Developing countries</subject><subject>Diarrhea</subject><subject>Disease Outbreaks</subject><subject>Distribution</subject><subject>Enterocytozoon - isolation & purification</subject><subject>Epidemiology</subject><subject>Female</subject><subject>Genetic diversity</subject><subject>Giardia</subject><subject>Giardia lamblia</subject><subject>Giardia lamblia - isolation & purification</subject><subject>Health facilities</subject><subject>Hospitals</subject><subject>Hospitals, Pediatric</subject><subject>Host-parasite relationships</subject><subject>Humans</subject><subject>Hygiene</subject><subject>Infant</subject><subject>Infant, Newborn</subject><subject>Infections</subject><subject>LDCs</subject><subject>Male</subject><subject>Microsporidia</subject><subject>Molecular Sequence Data</subject><subject>Pediatrics</subject><subject>Physiological aspects</subject><subject>Prevalence studies (Epidemiology)</subject><subject>Sequence Analysis, DNA</subject><subject>Studies</subject><subject>Testing</subject><subject>Virulence (Microbiology)</subject><issn>1935-2735</issn><issn>1935-2727</issn><issn>1935-2735</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2013</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>DOA</sourceid><recordid>eNptktGK1DAUhoso7rr6BqIBQbzYGZMmbdobYRnWdWHBG70OaXIyzdhJapIujE_lI5ruzC4zIL1oSb_z_yfn_EXxluAloZx83vgpODksR5f0EmNcMsqfFeekpdWi5LR6fvR9VryKcYNx1VYNeVmclQzXLWvJefF35Z2aQgCXkHUGVLLeReQNurEyaCuRnryGbGTjJbp2CYJXu-T_eO9QZ8HBFO0lkk6j1eBjClbbaYu0NcYqO0AWRaq3g84OWSpYt0YSqbAbk4-jn3EfbTacUhdA_pp5iUbIzllLoT5TNslhPl_11snXxQsjhwhvDu-L4ufX6x-rb4u77ze3q6u7haraOi2gw4ZLrUGVnWJtB7plpq5LDqRlmqmaAS1BtUo1hhIiMW46U9baNLViXZ7ZRfF-rzvma4nDsKMgjJWMMY7rTNzuCe3lRozBbmXYCS-teDjwYS1kSFYNIFRJ6lbxiksDjGvZlBizrqONIZUE02WtLwe3qduCVnkdQQ4noqd_nO3F2t8LynmJ2dzup4NA8L8niElsbVQwDNKBn-a-abZvWUUz-mGPrmVuLS_dZ0U14-KKMl5XFcZtppb_ofKjYWuVd2Dydk8LPh4V9CCH1Ec_TA-BOgXZHlTBxxjAPF2TYDFH-3HaYo62OEQ7l707HtFT0WOW6T-76vwp</recordid><startdate>20130901</startdate><enddate>20130901</enddate><creator>Wang, Lin</creator><creator>Xiao, Lihua</creator><creator>Duan, Liping</creator><creator>Ye, Jianbin</creator><creator>Guo, Yaqiong</creator><creator>Guo, Meijin</creator><creator>Liu, Lili</creator><creator>Feng, Yaoyu</creator><general>Public Library of Science</general><general>Public Library of Science (PLoS)</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope><scope>DOA</scope></search><sort><creationdate>20130901</creationdate><title>Concurrent infections of Giardia duodenalis, Enterocytozoon bieneusi, and Clostridium difficile in children during a cryptosporidiosis outbreak in a pediatric hospital in China</title><author>Wang, Lin ; Xiao, Lihua ; Duan, Liping ; Ye, Jianbin ; Guo, Yaqiong ; Guo, Meijin ; Liu, Lili ; Feng, Yaoyu</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c596t-eb0f7addec2bc49bed94f6627e194d4c64e32ec9cc8f311a008bf26df86c4b273</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2013</creationdate><topic>Adolescent</topic><topic>Analysis</topic><topic>Child</topic><topic>Child, Preschool</topic><topic>China - epidemiology</topic><topic>Clostridium difficile</topic><topic>Clostridium difficile - isolation & purification</topic><topic>Coinfection - epidemiology</topic><topic>Cryptosporidiosis</topic><topic>Cryptosporidiosis - complications</topic><topic>Cryptosporidiosis - epidemiology</topic><topic>Cryptosporidium - isolation & purification</topic><topic>Developing countries</topic><topic>Diarrhea</topic><topic>Disease Outbreaks</topic><topic>Distribution</topic><topic>Enterocytozoon - isolation & purification</topic><topic>Epidemiology</topic><topic>Female</topic><topic>Genetic diversity</topic><topic>Giardia</topic><topic>Giardia lamblia</topic><topic>Giardia lamblia - isolation & purification</topic><topic>Health facilities</topic><topic>Hospitals</topic><topic>Hospitals, Pediatric</topic><topic>Host-parasite relationships</topic><topic>Humans</topic><topic>Hygiene</topic><topic>Infant</topic><topic>Infant, Newborn</topic><topic>Infections</topic><topic>LDCs</topic><topic>Male</topic><topic>Microsporidia</topic><topic>Molecular Sequence Data</topic><topic>Pediatrics</topic><topic>Physiological aspects</topic><topic>Prevalence studies (Epidemiology)</topic><topic>Sequence Analysis, DNA</topic><topic>Studies</topic><topic>Testing</topic><topic>Virulence (Microbiology)</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Wang, Lin</creatorcontrib><creatorcontrib>Xiao, Lihua</creatorcontrib><creatorcontrib>Duan, Liping</creatorcontrib><creatorcontrib>Ye, Jianbin</creatorcontrib><creatorcontrib>Guo, Yaqiong</creatorcontrib><creatorcontrib>Guo, Meijin</creatorcontrib><creatorcontrib>Liu, Lili</creatorcontrib><creatorcontrib>Feng, Yaoyu</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>PLoS neglected tropical diseases</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Wang, Lin</au><au>Xiao, Lihua</au><au>Duan, Liping</au><au>Ye, Jianbin</au><au>Guo, Yaqiong</au><au>Guo, Meijin</au><au>Liu, Lili</au><au>Feng, Yaoyu</au><au>Kang, Gagandeep</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Concurrent infections of Giardia duodenalis, Enterocytozoon bieneusi, and Clostridium difficile in children during a cryptosporidiosis outbreak in a pediatric hospital in China</atitle><jtitle>PLoS neglected tropical diseases</jtitle><addtitle>PLoS Negl Trop Dis</addtitle><date>2013-09-01</date><risdate>2013</risdate><volume>7</volume><issue>9</issue><spage>e2437</spage><epage>e2437</epage><pages>e2437-e2437</pages><issn>1935-2735</issn><issn>1935-2727</issn><eissn>1935-2735</eissn><abstract>Over 200 cryptosporidiosis outbreaks have been reported, but little is known if other enteric pathogens were also involved in some of these outbreaks. Recently, an outbreak of cryptosporidiosis linked to poor hygiene by two Cryptosporidium hominis subtypes occurred in a pediatric hospital ward (Ward A) in China, lasting for more than 14 months. In this study, the concurrence during the outbreak of three other enteric pathogens with a similar transmission route, Giardia duodenalis, Enterocytozoon bieneusi, and Clostridium difficile, was assessed.
The occurrence of G. duodenalis, E. bieneusi, and C. difficile in 78 inpatients from Ward A and 283 and 216 inpatients from two control wards (Wards C and D) in the same hospital was examined using molecular diagnostic tools. Significantly higher infection rates were found in children in Ward A for all study pathogens than in Wards C and D (P<0.01): 9.5% versus 1.4% and 0% for G. duodenalis, 10.8% versus 2.8% and 3.7% for E. bieneusi, and 60.8% versus 37.8% and 27.8% for C. difficile, respectively. These differences were mostly seen in children ≤ 12 months. Enteric pathogen-positive children in Ward A (31/58 or 53.4%) were more likely to have mixed infections than those in Ward C (4/119 or 3.4%) or D (5/68, 7.4%; P<0.01). Having cryptosporidiosis was a risk factor for G. duodenalis (OR = 4.3; P = 0.08), E. bieneusi (OR = 3.1; P = 0.04), and C. difficile (OR = 4.7; P<0.01) infection. In addition, a lower diversity of G. duodenalis, E. bieneusi, and C. difficile genotypes/subtypes was observed in Ward A.
Data from this study suggest that multiple pathogens were concurrently present during the previous cryptosporidiosis outbreak. Examination of multiple enteric pathogens should be conducted when poor hygiene is the likely cause of outbreaks of diarrhea.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>24069491</pmid><doi>10.1371/journal.pntd.0002437</doi><oa>free_for_read</oa></addata></record> |
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| source | MEDLINE; DOAJ Directory of Open Access Journals; PubMed Central Open Access; Public Library of Science (PLoS) Journals Open Access; EZB-FREE-00999 freely available EZB journals; PubMed Central |
| subjects | Adolescent Analysis Child Child, Preschool China - epidemiology Clostridium difficile Clostridium difficile - isolation & purification Coinfection - epidemiology Cryptosporidiosis Cryptosporidiosis - complications Cryptosporidiosis - epidemiology Cryptosporidium - isolation & purification Developing countries Diarrhea Disease Outbreaks Distribution Enterocytozoon - isolation & purification Epidemiology Female Genetic diversity Giardia Giardia lamblia Giardia lamblia - isolation & purification Health facilities Hospitals Hospitals, Pediatric Host-parasite relationships Humans Hygiene Infant Infant, Newborn Infections LDCs Male Microsporidia Molecular Sequence Data Pediatrics Physiological aspects Prevalence studies (Epidemiology) Sequence Analysis, DNA Studies Testing Virulence (Microbiology) |
| title | Concurrent infections of Giardia duodenalis, Enterocytozoon bieneusi, and Clostridium difficile in children during a cryptosporidiosis outbreak in a pediatric hospital in China |
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