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Multiplex PCR reveals a high prevalence of multiple pathogens in traveller’s diarrhoea in children
  1. Marie Pouletty1,
  2. Loïc De Pontual2,3,4,5,6,
  3. Moreen Lopez3,
  4. Laurence Morin4,
  5. Isabelle Poilane5,
  6. Luu Ly Pham2,
  7. Etienne Carbonnelle5,6,7,8,9,
  8. Luigi Titomanlio4,
  9. Albert Faye1,2,3,4,5,6,7,8,
  10. Stéphane Bonacorsi3,4,5,6,7
  1. 1 General Pediatric Department, Robert Debré Hospital, Paris, France
  2. 2 General Pediatric and Emergency Department, Hopital Jean Verdier, Bondy, France
  3. 3 Microbiology Laboratory, Robert Debré Hospital, Paris, France
  4. 4 Pediatric Emergency Department, Robert Debré Hospital, Paris, France
  5. 5 Microbiology Laboratory, Jean Verdier Hospital, Paris, France
  6. 6 University Paris 13, Sorbonne Paris Cité, Paris, France
  7. 7 University Paris Denis Diderot, Sorbonne Paris Cité, Paris, France
  8. 8 INSERM 1123, Paris, France
  9. 9 INSERM 1137, Paris, France
  1. Correspondence to Dr Marie Pouletty, General Pediatric department, Hopital Universitaire Robert Debre, Paris 75019, France; marie_pouletty{at}


Objective Traveller’s diarrhoea (TD) is one of the most frequent illnesses affecting children returning from tropical countries. The purpose of this study was to assess the distribution of pathogens associated with TD in children using a multiplex PCR assay on stool samples.

Design All the children admitted for TD in two university hospitals from 1 August to 15October during 2014 and 2015 were included in a prospective study. Stool samples were tested by a multiplex PCR FilmArray GI panel detecting 22 pathogens. Performances for the detection of major enteropathogenic bacteria (Salmonella, Shigella and Campylobacter spp) by multiplex PCR and conventional culture methods were compared. The prevalence of extended spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae was also determined.

Results Fifty-nine children were included. In 58 cases (98%), at least one pathogen was identified, including 9 different enteropathogenic bacteria, 5 viruses and 2 parasites. Multiplex PCR enhanced the enteropathogenic bacteria detection by 25%. The most frequent pathogens were enteroaggregative Escherichia coli (n=32), enteropathogenic E. coli (n=26), enterotoxigenic E. coli (n=19), Salmonella enterica, enteroinvasive E. coli/Shigella (n=16 each), Cryptosporidium, sapovirus (n=11 each), Campylobacter jejuni, norovirus (n=10 each), rotavirus (n=9), Giardia (n=8) and Shiga-toxin-producing E. coli (n=4). Fifty-two coinfections were observed, notably including bacteria and viruses (n=21), multiple bacteria (n=14), or bacteria and parasites (n=10). ESBL were detected in 28 cases. Multiplex PCR could optimise the number of treated patients by 27% compared with stool cultures.

Conclusion Multiplex PCR on stools revealed a high prevalence of diverse enteric pathogens and coinfections in children with TD. Major enteropathogenic bacteria were more frequently detected by multiplex PCR compared with conventional culture. Finally, this technique allows the start of appropriate and early antibiotic treatment and seems to optimise the number of correctly treated patients.

  • tropical inf dis
  • epidemiology
  • tropical paediatrics
  • gastroenterology

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  • Contributors SB and AF have substantially helped me with the conception and the progress of the study, the microbiological testing of the stool samples (stool culture as well as the multiplex PCR testing at Robert Debré Hospital) as well as the corrections of the drafts. IP, EC and ML have helped me with the acquisition of data by conducting the stool cultures at Jean Verdier Hospital and the multiplex PCR testing at Robert Debré Hospital. Patients were included from the emergency departments and the general pediatrics departments of both hospitals (Jean Verdier and Robert Debré) with the help of LT, LDP, LLP and LM. They helped with the analysis of these data.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Parental consent obtained.

  • Ethics approval The study was approved by the ethical committee of Robert Debré Hospital, Paris, IRB no. 2015/176 and the national committee for data management and control (CNIL, no. 1827516  v0).

  • Provenance and peer review Not commissioned; externally peer reviewed.