Use of TaqMan Array Cards to investigate the etiological agents of diarrhea among young infants with severe acute malnutrition.

OBJECTIVES Studies involving less sensitive conventional microscopy and culture-based approaches have identified distinct differences in diarrheal etiology in childhood malnutrition. Our study involved the use of an advanced molecular biology technique, the TaqMan Array Cards (TAC), to elucidate the diarrheal etiology among young infants with severe acute malnutrition (SAM). METHOD A total of 113 fecal samples were collected from SAM infants, aged 2-6 months, upon admission to the Dhaka Hospital of the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) with complications of diarrhea and related comorbidities. We used TAC for the detection of 29 different diarrheal enteropathogens from a single fecal sample. For comparison, we also analyzed 25 diarrheal samples from well-nourished infants of similar age. RESULTS Higher odds of detection of all bacterial enteropathogens were associated with diarrhea among SAM infants. In particular, the detection of Aeromonas sp (aOR: 25.7, p=0.011), Campylobacter sp (aOR: 9.6, p<0.01) and ETEC (aOR: 5.2, p=0.022) was significantly associated with diarrhea among SAM infants in comparison to well-nourished infants. 80% higher odds of detection of rotavirus and norovirus GII were associated with diarrhea among well-nourished infants in comparison to SAM infants (aOR: 0.2, p<0.05). CONCLUSION Our study findings demonstrate a difference in diarrheal etiology among SAM and well-nourished young infants, which may be useful in providing an evidence-based logic for possible revision of treatment guidelines for treatment of young diarrheal infants with SAM in the early management of the menace of antimicrobial resistance.