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dc.contributor.authorPijnacker, R
dc.contributor.authorvan Pelt, W
dc.contributor.authorVennema, H
dc.contributor.authorKortbeek, L M
dc.contributor.authorNotermans, D W
dc.contributor.authorFranz, E
dc.contributor.authorMughini-Gras, L
dc.date.accessioned2019-02-18T09:21:08Z
dc.date.available2019-02-18T09:21:08Z
dc.date.issued2018-12-13
dc.identifier.issn1469-0691
dc.identifier.pmid30553029
dc.identifier.doi10.1016/j.cmi.2018.11.029
dc.identifier.urihttp://hdl.handle.net/10029/622755
dc.description.abstractThis study aimed to (i) determine risk factors for enteropathogen co-infections, (ii) determine whether enteropathogen co-infections influence gastroenteritis risk, and (iii) determine whether enteropathogen co-infection occurred randomly in preschool children. A monthly-repeated cross-sectional survey in Dutch children aged 0-48 months was conducted during October 2012 to October 2014. A total of 981 stool samples were collected along with questionnaires collecting data on gastrointestinal symptoms and potential risk factors; 822 samples were successfully tested for 19 enteropathogens using real-time multiplex PCRs. Logistic regression analysis assessed co-infections in relation to gastroenteritis and potential risk factors. In all, 598/822 (72.7%) stool samples tested positive for at least one enteropathogen, of which 290 (48.5%) were positive for two or more enteropathogens. Risk factors for two or more enteropathogen co-infections were young age (<12 months, OR 1.9, 95% CI 1.1-3.3; 13-36 months, OR 1.7, 95% CI 1.1-2.5, versus 37-48 months), day-care attendance (OR 1.8, 95% CI 1.3-2.5), households with three or more children versus those with one child (OR 1.7, 95% CI 1.1-2.8). Stool samples collected in spring less often had two or more enteropathogens versus summer (OR 0.4, 95% CI 0.2-0.7). Food allergy was a risk factor for three or more enteropathogen co-infections (OR 3.2, 95% CI 1.1-8.9). The frequency of co-infection was higher than expected for norovirus GI/norovirus GII, Clostridium difficile/norovirus GI, C. difficile/rotavirus, astrovirus/Dientamoeba fragilis, atypical enteropathogenic Escherichia coli/adenovirus, typical enteropathogenic E. coli/adenovirus, and enteroaggregative E. coli/astrovirus. No co-infection was associated with increased gastroenteritis risk. Risk factors for enteropathogen co-infections were identified and specific enteropathogens co-occurred significantly more often than expected by chance. Enteropathogen co-infections were not associated with increased gastroenteritis risk, calling into question their clinical relevance in preschool children.en_US
dc.language.isoenen_US
dc.subjectChildhood infectionen_US
dc.subjectCo-infectionen_US
dc.subjectEpidemiologyen_US
dc.subjectGastroenteritisen_US
dc.subjectRisk factorsen_US
dc.titleClinical relevance of enteropathogen co-infections in preschool children-a population-based repeated cross-sectional study.en_US
dc.typeArticleen_US
dc.identifier.journalClin Microbiol Infect 2019; 25(8):1039.e7-1039.e13en_US
dc.source.journaltitleClinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases


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