Molecular detection of bacterial enteric pathogens in Lebanese patients with diarrhea : insights on mixed infections and pathogen/s-disease associations

Abstract

Background: Acute gastroenteritis (AGE) is a common infectious disease syndrome worldwide with many pathogen sources and modes of transmission. Enteric infections cause significant morbidity and mortality worldwide with an estimate of 1.6 million people dying each year of infectious gastroenteritis. However, various cases of infections are underreported and underdiagnosed. In Lebanon, there is a lack of national surveillance for gastroenteritis and limited data about the prevalence of pathogens causing diarrhea. Therefore, the objective of the study was to conduct a one-year surveillance study to investigate the occurrence, epidemiology, and clinical significance of common bacteria causing gastroenteritis. Methods: The study is a cross-sectional study that was conducted in eight health care facilities in Lebanon between June 2020 and May 2021. Patients of all age groups were recruited using a convenience sample of 271. Total DNA extraction was extracted from patients’ stool and enteric bacteria were detected by a commercially available multiplex real time PCR kit. Results: Bacteria were observed in 47.5% (N=130) and were prevalent in all age groups. Enteroaggregative Escherichia coli (EAEC) (26.6%), Enterotoxigenic Escherichia coli (ETEC) (23.2%) and Enteropathogenic Escherichia coli (EPEC) (20.3%) were the most frequently identified followed by Aeromonas spp. (7%) and C. difficile (6.3%). Among the total tested samples, 54.2% contained mixed infections. Conclusions: Implementing new diagnostic platforms relying on multiplex molecular panels was very potent in giving an improved diagnosis on the infectious agents causing gastroenteritis, their corresponding prevalence, and their association with the diarrheal disease.