Application of Polymerase Chain Reaction (PCR), Bacteriological Culture, Immunoassay, and Microscopy for Detection and Identification of Gastrointestinal Pathogens in Children, Gaza – Palestine

Acute gastroenteritis and diarrhea are common and costly problems that cause significant morbidity and mortality in children worldwide. In Palestine, diarrhea is one of the major causes of many outpatient visits and hospitalizations. In order to improve knowledge on the etiology of gastroenteritis and diarrhea in our patient population, stool specimens from 150 children less than 5 years of age suffering from acute gastroenteritis and diarrhea and admitted to the central pediatric hospital in Gaza strip (ElNasser pediatric hospital) were investigated for various common enteropathogens by conventional and molecular techniques. Enteropathogens were detected in 51.3% of the diarrheal samples. A single enteric pathogen was detected in 40.0% of the children, while, multiple pathogens were detected in 11.3% of the specimens. The most important cause of diarrhea revealed by this study was rotavirus as it represented 28.0% of the etiologic agents, detected by immunochromatographic assay. Shigella was the most common bacterial pathogen as identified by PCR (6.0%), although bacteriological culture showed (4.0%) only, followed by Campylobacter (4.7%) identified by PCR only, E.coli O157:H7 identified by PCR and culture (4.7%, 4.0%, respectively), Salmonella sp was found in only 2.0% of the specimens by both PCR and culture.By microscopical examination Entamoeba histolytica/dispar was found in 15.3%, Giardia intestinalis in 1.33%, and Strongyloids stercolaris in 0.7% of the samples. Shigella and Salmonella isolates were tested for their susceptibility to common antimicrobial agents and most of the isolates were resistant to ampicillin, and trimethoprim/sulfamethoxazole. Findings from this study demonstrated that rotavirus, E. coli O157:H7 and Campylobacter, which are not screened for during routine examinations of stool samples in Palestinian health laboratories in Gaza strip, were significant enteropathogens in the studied children. The detection of rotavirus will decrease the cost of hospitalization and prevent the unnecessary use of antibiotics. Moreover, the high detection rate of rotavirus points toward the need for considering a childhood vaccine for this pathogen. The results of the study highlight the value of using a combination of traditional and molecular techniques in the diagnosis of diarrheal disease in this population. To the best of our knowledge, this is the first study in Gaza investigating severa kinds of possible enteric pathogens in diarrhea in children less than 5 years of age