Exploring the Less Common Pathogens of Infectious Diarrhea

Abstract

ABSTRACT Objective: Gastrointestinal (GI) panels have allowed for faster and accurate detection, treatment, and control of pathogens. Because of the large number of potential pathogens included in the panel the clinical significance and manifestations of some organisms, such as Enteroaggregative Escherichia coli (EAEC) and Enteropathogenic E. coli (EPEC), remains undetermined. Methodology: We performed a single-institution retrospective chart review for 222 patients with a stool sample tested on BioFire FilmArray Gastrointestinal Panel (GI Panel) between June 1, 2016 and March 9, 2017. Results: Of the 222 patients, four had EAEC and 17 and EPEC. Patients who tested positive for EAEC and EPEC were younger (26.3 years and 33.9 years, respectively) than patients that did not test positive for a GI pathogen (47.7 years). In cases where multiple organisms were detected, EPEC was present 56.3% of the time. Analysis of symptoms showed that EPEC patients had a high prevalence of abdominal pain (p=0.0425) and vomiting (p=0.0045), but not diarrhea, when compared to the presence of these symptoms in patients with no targets detected. With only four patients positive for EAEC in this study, the results of symptoms in EAEC patients were inconclusive. Cases involving EPEC and EAEC were treated similarly to other cases of diarrhea with no significant difference in the number of imaging studies and medication changes. Conclusions: While further studies are required to determine the specific clinical significance of EAEC or EPEC, it is evident that patients positive for EPEC often experience abdominal pain and diarrhea, suggesting EPEC may be more pathogenic than previously thought. J Microbiol Infect Dis 2019; 9(1):1-9.