Diagnostic microbiologic methods in the GEMS-1 case/control study

Sandra Panchalingam, Martin Antonio, Anowar Hossain, Inacio Mandomando, Ben Ochieng, Joseph Oundo, T. Ramamurthy, Boubou Tamboura, Anita K.M. Zaidi, William Petri, Eric Houpt, Patrick Murray, Valeria Prado, Roberto Vidal, Duncan Steele, Nancy Strockbine, Philippe Sansonetti, Roger I. Glass, Roy M. Robins-Browne, Marija TauschekAnn Marie Svennerholm, Karen Kotloff, Myron M. Levine, James P. Nataro

Research output: Contribution to journalArticlepeer-review

152 Citations (Scopus)


To understand the etiology of moderate-to-severe diarrhea among children in high mortality areas of sub-Saharan Africa and South Asia, we performed a comprehensive case/control study of children aged <5 years at 7 sites. Each site employed an identical case/control study design and each utilized a uniform comprehensive set of microbiological assays to identify the likely bacterial, viral and protozoal etiologies. The selected assays effected a balanced consideration of cost, robustness and performance, and all assays were performed at the study sites. Identification of bacterial pathogens employed streamlined conventional bacteriologic biochemical and serological algorithms. Diarrheagenic Escherichia coli were identified by application of a multiplex polymerase chain reaction assay for enterotoxigenic, enteroaggregative, and enteropathogenic E. coli. Rotavirus, adenovirus, Entamoeba histolytica, Giardia enterica, and Cryptosporidium species were detected by commercially available enzyme immunoassays on stool samples. Samples positive for adenovirus were further evaluated for adenovirus serotypes 40 and 41. We developed a novel multiplex assay to detect norovirus (types 1 and 2), astrovirus, and sapovirus. The portfolio of diagnostic assays used in the GEMS study can be broadly applied in developing countries seeking robust cost-effective methods for enteric pathogen detection.

Original languageEnglish
Pages (from-to)S294-S302
JournalClinical Infectious Diseases
Issue numberSUPPL. 4
Publication statusPublished - 15 Dec 2012


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