{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T16:34:03Z","timestamp":1792168443357,"version":"4.4.0"},"reference-count":48,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,10,20]],"date-time":"2025-10-20T00:00:00Z","timestamp":1760918400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,10,20]],"date-time":"2025-10-20T00:00:00Z","timestamp":1760918400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Klinikum der Universit\u00e4t M\u00fcnchen"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Infection"],"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>To identify enteric pathogens in pediatric acute gastroenteritis (AGE) and assess their etiological relevance by comparison with samples during asymptomatic period.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Children\u2009&lt;\u20092 years of age (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200989) were prospectively enrolled as part of the population-based birth cohort LoewenKIDS. Asymptomatic stool samples were collected regularly, and symptomatic samples were collected after the occurrence of &gt;\u20093 loose stools and\/or one vomiting in 24\u00a0h. Intraindividual pairs of symptomatic and preceding asymptomatic samples for each child were analyzed for 25 enteric pathogens via multiplex real-time RT-PCR.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Enteric viruses were detected in 64% (57\/89) of symptomatic samples and significantly associated with gastrointestinal symptoms (Odds Ratio [OR] 3.9; 95% Confidence Interval [CI] 2.1\u20137.3). The most common viruses in AGE were norovirus (Genogroups GI and GII) (36%, 32\/89) and adenovirus (27%, 24\/89). Bacteria were detected in 46% (41\/89) of symptomatic samples and 43% (38\/89) of asymptomatic ones, with no association to symptoms (OR 1.1; 95% CI 0.6-2). The most common bacteria in AGE were Enteropathogenic\n                      <jats:italic>Escherichia coli<\/jats:italic>\n                      (28%, 25\/89) and\n                      <jats:italic>Clostridium difficile<\/jats:italic>\n                      (16%, 14\/89).\n                      <jats:italic>Dientamoeba fragilis<\/jats:italic>\n                      was the only detected parasite in AGE (7%, 6\/89), and was not associated with symptoms (OR 1.4; 95% CI 0.4\u20135.5). Pathogen loads in symptomatic and asymptomatic pairs correlated with symptoms for norovirus GII, astrovirus and sapovirus (each\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.01), but not for other pathogens.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This study supports the clinical significance of detection of viral pathogens in young children with acute gastroenteritis and without relevant comorbidities in high-income countries, but limits the significance of enteric bacterial and parasitic pathogens detection, partly due to constraints in their specific identification.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration<\/jats:title>\n                    <jats:p>Clinicaltrials.Gov Identifier: NCT02654210.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s15010-025-02670-1","type":"journal-article","created":{"date-parts":[[2025,10,20]],"date-time":"2025-10-20T09:08:43Z","timestamp":1760951323000},"page":"353-364","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Detection of enteric pathogens in young children before and during acute gastroenteritis: results from a prospective German birth cohort study (LoewenKIDS)"],"prefix":"10.1007","volume":"54","author":[{"given":"Chiara","family":"Lincetto","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Felipe","family":"Romero-Saavedra","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diana","family":"Laverde","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Riccardo","family":"Lincetto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melanie","family":"Meyer-Buehn","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bianca","family":"Klee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cornelia","family":"Gottschick","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rafael","family":"Mikolajczyk","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johannes","family":"Huebner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tilmann","family":"Schober","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,10,20]]},"reference":[{"key":"2670_CR1","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1007\/s11908-020-0713-6","volume":"22","author":"ID Florez","year":"2020","unstructured":"Florez ID, Ni\u00f1o-Serna LF, Beltr\u00e1n-Arroyave CP. Acute infectious diarrhea and gastroenteritis in children. Curr Infect Dis Rep. 2020;22:1\u201312. https:\/\/doi.org\/10.1007\/s11908-020-0713-6.","journal-title":"Curr Infect Dis Rep"},{"key":"2670_CR2","unstructured":"Sharrow D, Hug L, Liu Y, Lindt N, Fell GW, Wanli Nie DY. Levels & Trends in Child Mortality - Report 2024. 2024. https:\/\/doi.org\/https:\/\/childmortality.org\/wp-content\/uploads\/2025\/03\/UNIGME-2024-Child-Mortality-Report.pdf"},{"key":"2670_CR3","doi-asserted-by":"publisher","first-page":"1211","DOI":"10.1016\/S1473-3099(18)30362-1","volume":"18","author":"C Troeger","year":"2018","unstructured":"Troeger C, Blacker BF, Khalil IA, Rao PC, Cao S, Zimsen SR, et al. Estimates of the global, regional, and National morbidity, mortality, and aetiologies of diarrhoea in 195 countries: a systematic analysis for the global burden of disease study 2016. Lancet Infect Dis. 2018;18:1211\u201328. https:\/\/doi.org\/10.1016\/S1473-3099(18)30362-1.","journal-title":"Lancet Infect Dis"},{"key":"2670_CR4","doi-asserted-by":"publisher","first-page":"36","DOI":"10.1186\/s41182-023-00525-9","volume":"51","author":"MW Merid","year":"2023","unstructured":"Merid MW, Alem AZ, Chilot D, Belay DG, Kibret AA, Asratie MH, et al. Impact of access to improved water and sanitation on diarrhea reduction among rural under-five children in low and middle-income countries: a propensity score matched analysis. Trop Med Health. 2023;51:36. https:\/\/doi.org\/10.1186\/s41182-023-00525-9.","journal-title":"Trop Med Health"},{"key":"2670_CR5","doi-asserted-by":"publisher","first-page":"547","DOI":"10.1542\/hpeds.2019-0310","volume":"10","author":"AM Nabower","year":"2020","unstructured":"Nabower AM, Hall M, Burrows J, Dave A, Deschamp A, Dike CR, et al. Trends and variation in care and outcomes for children hospitalized with acute gastroenteritis. Hosp Pediatr. 2020;10:547\u201354. https:\/\/doi.org\/10.1542\/hpeds.2019-0310.","journal-title":"Hosp Pediatr"},{"key":"2670_CR6","doi-asserted-by":"publisher","first-page":"968","DOI":"10.3201\/eid3005.230356","volume":"30","author":"JF Dickerson","year":"2024","unstructured":"Dickerson JF, Salas SB, Donald J, Groom HC, Lee MH, Mattison CP, et al. Economic burden of acute gastroenteritis among members of integrated healthcare delivery System, united States, 2014\u20132016. Emerg Infect Dis. 2024;30:968. https:\/\/doi.org\/10.3201\/eid3005.230356.","journal-title":"Emerg Infect Dis"},{"key":"2670_CR7","doi-asserted-by":"publisher","first-page":"e146","DOI":"10.1017\/S095026881900044X","volume":"147","author":"T Papadopoulos","year":"2019","unstructured":"Papadopoulos T, Klamer S, Jacquinet S, Catry B, Litzroth A, Mortgat L, et al. The health and economic impact of acute gastroenteritis in Belgium, 2010\u20132014. Epidemiol Infect. 2019;147:e146. https:\/\/doi.org\/10.1017\/S095026881900044X.","journal-title":"Epidemiol Infect"},{"key":"2670_CR8","doi-asserted-by":"publisher","first-page":"175","DOI":"10.1016\/S0140-6736(18)31128-0","volume":"392","author":"K B\u00e1nyai","year":"2018","unstructured":"B\u00e1nyai K, Estes MK, Martella V, Parashar UD. Viral gastroenteritis. Lancet. 2018;392:175\u201386. https:\/\/doi.org\/10.1016\/S0140-6736(18)31128-0.","journal-title":"Lancet"},{"key":"2670_CR9","doi-asserted-by":"publisher","first-page":"862","DOI":"10.1016\/S0140-6736(23)02037-8","volume":"403","author":"TG Flynn","year":"2024","unstructured":"Flynn TG, Olortegui MP, Kosek MN. Viral gastroenteritis. Lancet. 2024;403:862\u201376. https:\/\/doi.org\/10.1016\/S0140-6736(23)02037-8.","journal-title":"Lancet"},{"key":"2670_CR10","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1128\/CMR.00073-14","volume":"28","author":"RM Humphries","year":"2015","unstructured":"Humphries RM, Linscott AJ. Laboratory diagnosis of bacterial gastroenteritis. Clin Microbiol Rev. 2015;28:3\u201331. https:\/\/doi.org\/10.1128\/CMR.00073-14.","journal-title":"Clin Microbiol Rev"},{"key":"2670_CR11","doi-asserted-by":"publisher","first-page":"283","DOI":"10.1016\/j.gtc.2021.02.002","volume":"50","author":"JM Fleckenstein","year":"2021","unstructured":"Fleckenstein JM, Matthew Kuhlmann F, Sheikh A. Acute bacterial gastroenteritis. Gastroenterol Clin North Am. 2021;50:283\u2013304. https:\/\/doi.org\/10.1016\/j.gtc.2021.02.002.","journal-title":"Gastroenterol Clin North Am"},{"key":"2670_CR12","doi-asserted-by":"publisher","unstructured":"Ahmed SA, Kotepui M, Masangkay FR, Milanez GD, Karanis P. Gastrointestinal parasites in Africa: A review. Adv. Parasitol, Academic Press; 2023;119:1\u201364. https:\/\/doi.org\/10.1016\/bs.apar.2022.10.001","DOI":"10.1016\/bs.apar.2022.10.001"},{"key":"2670_CR13","doi-asserted-by":"publisher","first-page":"67","DOI":"10.1186\/s40249-016-0159-0","volume":"5","author":"J-L Wang","year":"2016","unstructured":"Wang J-L, Li T-T, Huang S-Y, Cong W, Zhu X-Q. Major parasitic diseases of poverty in Mainland china: perspectives for better control. Infect Dis Poverty. 2016;5:67. https:\/\/doi.org\/10.1186\/s40249-016-0159-0.","journal-title":"Infect Dis Poverty"},{"key":"2670_CR14","doi-asserted-by":"publisher","first-page":"2020049884","DOI":"10.1542\/peds.2020-049884","volume":"149","author":"S-B Ballard","year":"2022","unstructured":"Ballard S-B, Requena D, Mayta H, Sanchez GJ, Oyola-Lozada MG, Colquechagua Aliaga FD, et al. Enteropathogen changes after rotavirus vaccine Scale-up. Pediatrics. 2022;149:2020049884. https:\/\/doi.org\/10.1542\/peds.2020-049884.","journal-title":"Pediatrics"},{"key":"2670_CR15","doi-asserted-by":"publisher","first-page":"153","DOI":"10.1016\/j.meegid.2013.04.011","volume":"17","author":"DC Rao","year":"2013","unstructured":"Rao DC, Ananda Babu M, Raghavendra A, Dhananjaya D, Kumar S, Maiya PP. Non-polio enteroviruses and their association with acute diarrhea in children in India. Infect Genet Evol. 2013;17:153\u201361. https:\/\/doi.org\/10.1016\/j.meegid.2013.04.011.","journal-title":"Infect Genet Evol"},{"key":"2670_CR16","doi-asserted-by":"publisher","first-page":"2185","DOI":"10.1007\/S10096-021-04275-6\/TABLES\/5","volume":"40","author":"Z P\u00e9rez-Mart\u00ednez","year":"2021","unstructured":"P\u00e9rez-Mart\u00ednez Z, \u00c1lvarez-Arg\u00fcelles ME, Rojo-Alba S, Castello-Abietar C, Boga JA, Morilla-Morilla A, et al. Incidence of enterovirus in patients with acute gastroenteritis. Eur J Clin Microbiol Infect Dis. 2021;40:2185\u201390. https:\/\/doi.org\/10.1007\/S10096-021-04275-6\/TABLES\/5.","journal-title":"Eur J Clin Microbiol Infect Dis"},{"key":"2670_CR17","doi-asserted-by":"publisher","unstructured":"Bero DM, da Silva EE, J\u00fanior IP, de Nhassengo S, Machado SA, Bauhofer RS. Enterovirus detection in stool samples from Mozambican children with acute gastroenteritis. Acta Trop. 2023;238. https:\/\/doi.org\/10.1016\/j.actatropica.2022.106755.","DOI":"10.1016\/j.actatropica.2022.106755"},{"key":"2670_CR18","doi-asserted-by":"publisher","first-page":"514","DOI":"10.1016\/j.ijmm.2018.04.007","volume":"308","author":"A Calderaro","year":"2018","unstructured":"Calderaro A, Martinelli M, Buttrini M, Montecchini S, Covan S, Rossi S, et al. Contribution of the FilmArray\u00ae Gastrointestinal panel in the laboratory diagnosis of gastroenteritis in a cohort of children: a two-year prospective study. Int J Med Microbiol. 2018;308:514\u201321. https:\/\/doi.org\/10.1016\/j.ijmm.2018.04.007.","journal-title":"Int J Med Microbiol"},{"key":"2670_CR19","doi-asserted-by":"publisher","first-page":"2185","DOI":"10.1007\/s10096-021-04275-6","volume":"40","author":"Z P\u00e9rez-Mart\u00ednez","year":"2021","unstructured":"P\u00e9rez-Mart\u00ednez Z, \u00c1lvarez-Arg\u00fcelles ME, Rojo-Alba S, Castello-Abietar C, Boga JA, Morilla-Morilla A, et al. Incidence of enterovirus in patients with acute gastroenteritis. Eur J Clin Microbiol Infect Dis. 2021;40:2185\u201390. https:\/\/doi.org\/10.1007\/s10096-021-04275-6.","journal-title":"Eur J Clin Microbiol Infect Dis"},{"key":"2670_CR20","doi-asserted-by":"publisher","first-page":"431","DOI":"10.1093\/infdis\/jir757","volume":"205","author":"N Boisen","year":"2012","unstructured":"Boisen N, Scheutz F, Rasko DA, Redman JC, Persson S, Simon J, et al. Genomic characterization of enteroaggregative Escherichia coli from children in Mali. J Infect Dis. 2012;205:431\u201344. https:\/\/doi.org\/10.1093\/infdis\/jir757.","journal-title":"J Infect Dis"},{"key":"2670_CR21","doi-asserted-by":"publisher","first-page":"75","DOI":"10.3389\/fcimb.2016.00075","volume":"6","author":"B Hebbelstrup Jensen","year":"2016","unstructured":"Hebbelstrup Jensen B, Stensvold CR, Struve C, Olsen KEP, Scheutz F, Boisen N, et al. Enteroaggregative Escherichia coli in Daycare\u2014A 1-Year dynamic cohort study. Front Cell Infect Microbiol. 2016;6:75. https:\/\/doi.org\/10.3389\/fcimb.2016.00075.","journal-title":"Front Cell Infect Microbiol"},{"key":"2670_CR22","doi-asserted-by":"publisher","first-page":"349","DOI":"10.1007\/s00431-021-04210-z","volume":"181","author":"B Stanyevic","year":"2022","unstructured":"Stanyevic B, Sepich M, Biondi S, Baroncelli GI, Peroni D, Di Cicco M. The evolving epidemiology of acute gastroenteritis in hospitalized children in Italy. Eur J Pediatr. 2022;181:349\u201358. https:\/\/doi.org\/10.1007\/s00431-021-04210-z.","journal-title":"Eur J Pediatr"},{"key":"2670_CR23","doi-asserted-by":"publisher","first-page":"2103","DOI":"10.1007\/s10096-019-03646-4","volume":"38","author":"I Hannet","year":"2019","unstructured":"Hannet I, Engsbro AL, Pareja J, Schneider UV, Lisby JG, Pru\u017einec-Popovi\u0107 B, et al. Multicenter evaluation of the new QIAstat Gastrointestinal panel for the rapid syndromic testing of acute gastroenteritis. Eur J Clin Microbiol Infect Dis. 2019;38:2103\u201312. https:\/\/doi.org\/10.1007\/s10096-019-03646-4.","journal-title":"Eur J Clin Microbiol Infect Dis"},{"key":"2670_CR24","doi-asserted-by":"publisher","first-page":"414","DOI":"10.1093\/JPIDS\/PIY077","volume":"8","author":"F Hassan","year":"2019","unstructured":"Hassan F, Kanwar N, Harrison CJ, Halasa NB, Chappell JD, Englund JA, et al. Viral etiology of acute gastroenteritis in <\u20092-Year-Old US children in the Post\u2013Rotavirus vaccine era. J Pediatr Infect Dis Soc. 2019;8:414\u201321. https:\/\/doi.org\/10.1093\/JPIDS\/PIY077.","journal-title":"J Pediatr Infect Dis Soc"},{"key":"2670_CR25","doi-asserted-by":"publisher","unstructured":"Pabbaraju K, Tellier R, Pang X-L, Xie J, Lee BE, Chui L, et al. A clinical epidemiology and molecular attribution evaluation of adenoviruses in pediatric acute gastroenteritis: a Case-Control study. J Clin Microbiol. 2020;59. https:\/\/doi.org\/10.1128\/JCM.02287-20.","DOI":"10.1128\/JCM.02287-20"},{"key":"2670_CR26","doi-asserted-by":"publisher","first-page":"E203","DOI":"10.1097\/INF.0000000000003493","volume":"41","author":"O Pitk\u00e4nen","year":"2022","unstructured":"Pitk\u00e4nen O, Markkula J, Hemming-Harlo M. Sapovirus, Norovirus and rotavirus detections in stool samples of hospitalized Finnish children with and without acute gastroenteritis. Pediatr Infect Dis J. 2022;41:E203\u20137. https:\/\/doi.org\/10.1097\/INF.0000000000003493.","journal-title":"Pediatr Infect Dis J"},{"key":"2670_CR27","doi-asserted-by":"publisher","first-page":"598","DOI":"10.1016\/S1473-3099(20)30058-X","volume":"20","author":"FA Quee","year":"2020","unstructured":"Quee FA, de Hoog MLA, Schuurman R, Bruijning-Verhagen P. Community burden and transmission of acute gastroenteritis caused by Norovirus and rotavirus in the Netherlands (RotaFam): a prospective household-based cohort study. Lancet Infect Dis. 2020;20:598\u2013606. https:\/\/doi.org\/10.1016\/S1473-3099(20)30058-X.","journal-title":"Lancet Infect Dis"},{"key":"2670_CR28","doi-asserted-by":"publisher","first-page":"e89496","DOI":"10.1371\/journal.pone.0089496","volume":"9","author":"R Enserink","year":"2014","unstructured":"Enserink R, Scholts R, Bruijning-Verhagen P, Duizer E, Vennema H, de Boer R, et al. High detection rates of enteropathogens in asymptomatic children attending day care. PLoS ONE. 2014;9:e89496. https:\/\/doi.org\/10.1371\/journal.pone.0089496.","journal-title":"PLoS ONE"},{"key":"2670_CR29","doi-asserted-by":"publisher","first-page":"1042","DOI":"10.1093\/ije\/dyz001","volume":"48","author":"C Gottschick","year":"2019","unstructured":"Gottschick C, Raupach-Rosin H, Langer S, Hassan L, Horn J, Dorendorf E, et al. Cohort profile: the loewenkids Study - Life-course perspective on infections, the Microbiome and the development of the immune system in early childhood. Int J Epidemiol. 2019;48:1042\u20133. https:\/\/doi.org\/10.1093\/ije\/dyz001. H.","journal-title":"Int J Epidemiol"},{"key":"2670_CR30","doi-asserted-by":"publisher","first-page":"405","DOI":"10.1007\/s10096-011-1320-0","volume":"31","author":"IHM Friesema","year":"2012","unstructured":"Friesema IHM, De Boer RF, Duizer E, Kortbeek LM, Notermans DW, Norbruis OF, et al. Etiology of acute gastroenteritis in children requiring hospitalization in the Netherlands. Eur J Clin Microbiol Infect Dis. 2012;31:405\u201315. https:\/\/doi.org\/10.1007\/s10096-011-1320-0.","journal-title":"Eur J Clin Microbiol Infect Dis"},{"key":"2670_CR31","doi-asserted-by":"publisher","unstructured":"Cardemil CV, Balachandran N, Kambhampati A, Grytdal S, Dahl RM, Rodriguez-Barradas MC, Centers et al. 2016\u201320182016. https:\/\/doi.org\/10.1093\/cid\/ciaa806","DOI":"10.1093\/cid\/ciaa806"},{"key":"2670_CR32","doi-asserted-by":"publisher","first-page":"1031","DOI":"10.1097\/INF.0000000000000783","volume":"34","author":"PA Gasta\u00f1aduy","year":"2015","unstructured":"Gasta\u00f1aduy PA, Vicu\u00f1a Y, Salazar F, Broncano N, Gregoricus N, Vinj\u00e9 J, et al. Transmission of Norovirus within households in Quininde, Ecuador. Pediatr Infect Dis J. 2015;34:1031\u20133. https:\/\/doi.org\/10.1097\/INF.0000000000000783.","journal-title":"Pediatr Infect Dis J"},{"key":"2670_CR33","doi-asserted-by":"publisher","first-page":"516","DOI":"10.1016\/S0022-3476(05)82477-1","volume":"120","author":"R Van","year":"1992","unstructured":"Van R, Wun C-C, O\u2019Ryan ML, Matson DO, Jackson L, Pickering LK. Outbreaks of human enteric adenovirus types 40 and 41 in Houston day care centers. J Pediatr. 1992;120:516\u201321. https:\/\/doi.org\/10.1016\/S0022-3476(05)82477-1.","journal-title":"J Pediatr"},{"key":"2670_CR34","doi-asserted-by":"publisher","first-page":"3286","DOI":"10.1038\/s41598-019-40077-9","volume":"9","author":"B Hebbelstrup Jensen","year":"2019","unstructured":"Hebbelstrup Jensen B, Jokelainen P, Nielsen ACY, Franck KT, Rejkj\u00e6r Holm D, Sch\u00f8nning K, et al. Children attending day care centers are a Year-round reservoir of Gastrointestinal viruses. Sci Rep. 2019;9:3286. https:\/\/doi.org\/10.1038\/s41598-019-40077-9.","journal-title":"Sci Rep"},{"key":"2670_CR35","doi-asserted-by":"publisher","first-page":"822","DOI":"10.1128\/CMR.00022-13","volume":"26","author":"MA Croxen","year":"2013","unstructured":"Croxen MA, Law RJ, Scholz R, Keeney KM, Wlodarska M, Finlay BB. Recent advances in Understanding enteric pathogenic Escherichia coli. Clin Microbiol Rev. 2013;26:822\u201380. https:\/\/doi.org\/10.1128\/CMR.00022-13.","journal-title":"Clin Microbiol Rev"},{"key":"2670_CR36","doi-asserted-by":"publisher","first-page":"1824562","DOI":"10.1080\/19490976.2020.1824562","volume":"12","author":"M Carlino","year":"2020","unstructured":"Carlino M, Kralicek S, Santiago S, Sitaraman L, Harrington A, Hecht GA. Quantitative analysis and virulence phenotypes of atypical enteropathogenic Escherichia coli (EPEC) acquired from diarrheal stool samples from a Midwest US hospital. Gut Microbes. 2020;12:1824562. https:\/\/doi.org\/10.1080\/19490976.2020.1824562.","journal-title":"Gut Microbes"},{"key":"2670_CR37","doi-asserted-by":"publisher","first-page":"630","DOI":"10.1186\/s12879-019-4271-1","volume":"19","author":"J-E Berdal","year":"2019","unstructured":"Berdal J-E, Follin-Arbelet B, Bj\u00f8rnholt JV. Experiences from multiplex PCR diagnostics of faeces in hospitalised patients: clinical significance of enteropathogenic Escherichia coli (EPEC) and culture negative Campylobacter. BMC Infect Dis. 2019;19:630. https:\/\/doi.org\/10.1186\/s12879-019-4271-1.","journal-title":"BMC Infect Dis"},{"key":"2670_CR38","doi-asserted-by":"publisher","first-page":"e0008613","DOI":"10.1371\/journal.pntd.0008613","volume":"14","author":"N Boisen","year":"2020","unstructured":"Boisen N, \u00d8sterlund MT, Joensen KG, Santiago AE, Mandomando I, Cravioto A, et al. Redefining enteroaggregative Escherichia coli (EAEC): genomic characterization of epidemiological EAEC strains. PLoS Negl Trop Dis. 2020;14:e0008613. https:\/\/doi.org\/10.1371\/journal.pntd.0008613.","journal-title":"PLoS Negl Trop Dis"},{"key":"2670_CR39","doi-asserted-by":"publisher","first-page":"97","DOI":"10.1016\/j.micpath.2018.12.030","volume":"128","author":"O Bamidele","year":"2019","unstructured":"Bamidele O, Jiang Z-D, Dupont H. Occurrence of putative virulence-related genes, aatA, AggR and aaiC, of enteroaggregative Escherichia coli (EAEC) among adults with travelers\u2019 diarrhea acquired in Guatemala and Mexico. Microb Pathog. 2019;128:97\u20139. https:\/\/doi.org\/10.1016\/j.micpath.2018.12.030.","journal-title":"Microb Pathog"},{"key":"2670_CR40","doi-asserted-by":"publisher","first-page":"825","DOI":"10.1056\/nejmoa1408913","volume":"372","author":"FC Lessa","year":"2015","unstructured":"Lessa FC, Mu Y, Bamberg WM, Beldavs ZG, Dumyati GK, Dunn JR, et al. Burden of clostridium difficile infection in the united States. N Engl J Med. 2015;372:825\u201334. https:\/\/doi.org\/10.1056\/nejmoa1408913.","journal-title":"N Engl J Med"},{"key":"2670_CR41","doi-asserted-by":"publisher","first-page":"987","DOI":"10.1093\/cid\/ciy149","volume":"66","author":"LC McDonald","year":"2018","unstructured":"McDonald LC, Gerding DN, Johnson S, Bakken JS, Carroll KC, Coffin SE, et al. Clinical practice guidelines for clostridium difficile infection in adults and children: 2017 update by the infectious diseases society of America (IDSA) and society for healthcare epidemiology of America (SHEA). Clin Infect Dis. 2018;66:987\u201394. https:\/\/doi.org\/10.1093\/cid\/ciy149.","journal-title":"Clin Infect Dis"},{"key":"2670_CR42","doi-asserted-by":"publisher","first-page":"S63","DOI":"10.1016\/j.cmi.2016.03.010","volume":"22","author":"MJT Crobach","year":"2016","unstructured":"Crobach MJT, Planche T, Eckert C, Barbut F, Terveer EM, Dekkers OM, et al. European society of clinical microbiology and infectious diseases: update of the diagnostic guidance document for clostridium difficile infection. Clin Microbiol Infect. 2016;22:S63\u201381. https:\/\/doi.org\/10.1016\/j.cmi.2016.03.010.","journal-title":"Clin Microbiol Infect"},{"key":"2670_CR43","doi-asserted-by":"publisher","first-page":"1209","DOI":"10.1093\/CID\/CIS637","volume":"55","author":"C Rousseau","year":"2012","unstructured":"Rousseau C, Poilane I, De Pontual L, Maherault AC, Le Monnier A, Collignon A. Clostridium difficile carriage in healthy infants in the community: A potential reservoir for pathogenic strains. Clin Infect Dis. 2012;55:1209\u201315. https:\/\/doi.org\/10.1093\/CID\/CIS637.","journal-title":"Clin Infect Dis"},{"key":"2670_CR44","doi-asserted-by":"publisher","unstructured":"R\u00f6ser D, Simonsen J, Stensvold CR un., Olsen KEP, Bytzer P, Nielsen HV et al. Metronidazole Therapy for Treating Dientamoebiasis in Children Is Not Associated With Better Clinical Outcomes: A Randomized, Double-Blinded and Placebo-Controlled Clinical Trial. Clin Infect Dis. 2014;58:1692\u20139. https:\/\/doi.org\/10.1093\/CID\/CIU188","DOI":"10.1093\/CID\/CIU188"},{"key":"2670_CR45","doi-asserted-by":"publisher","first-page":"711809","DOI":"10.3389\/fmed.2021.711809","volume":"8","author":"S Bonacorsi","year":"2021","unstructured":"Bonacorsi S, Visseaux B, Bouzid D, Pareja J, Rao SN, Manissero D, et al. Systematic review on the correlation of quantitative PCR cycle threshold values of Gastrointestinal pathogens with patient clinical presentation and outcomes. Front Med. 2021;8:711809. https:\/\/doi.org\/10.3389\/fmed.2021.711809.","journal-title":"Front Med"},{"key":"2670_CR46","doi-asserted-by":"publisher","first-page":"671","DOI":"10.1016\/S1473-3099(11)70165-7","volume":"11","author":"M Bielaszewska","year":"2011","unstructured":"Bielaszewska M, Mellmann A, Zhang W, K\u00f6ck R, Fruth A, Bauwens A, et al. Characterisation of the Escherichia coli strain associated with an outbreak of haemolytic uraemic syndrome in Germany, 2011: A Microbiological study. Lancet Infect Dis. 2011;11:671\u20136. https:\/\/doi.org\/10.1016\/S1473-3099(11)70165-7.","journal-title":"Lancet Infect Dis"},{"key":"2670_CR47","doi-asserted-by":"publisher","first-page":"4116","DOI":"10.1128\/JCM.02047-12","volume":"50","author":"T Dallman","year":"2012","unstructured":"Dallman T, Smith GP, O\u2019Brien B, Chattaway MA, Finlay D, Grant KA, et al. Characterization of a Verocytotoxin-Producing enteroaggregative Escherichia coli serogroup O111:H21 strain associated with a household outbreak in Northern Ireland. J Clin Microbiol. 2012;50:4116\u20139. https:\/\/doi.org\/10.1128\/JCM.02047-12.","journal-title":"J Clin Microbiol"},{"key":"2670_CR48","doi-asserted-by":"publisher","first-page":"1792","DOI":"10.1016\/j.cmi.2021.03.020","volume":"27","author":"M Heinemann","year":"2021","unstructured":"Heinemann M, Strauchs C, L\u00fctgehetmann M, Aepfelbacher M, Klupp EM, Owusu-Dabo E, et al. Polymicrobial enteric infections in African infants with diarrhoea\u2014results from a longitudinal prospective case\u2013control study. Clin Microbiol Infect. 2021;27:1792\u20138. https:\/\/doi.org\/10.1016\/j.cmi.2021.03.020.","journal-title":"Clin Microbiol Infect"}],"container-title":["Infection"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s15010-025-02670-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s15010-025-02670-1","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s15010-025-02670-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,2]],"date-time":"2026-02-02T08:39:52Z","timestamp":1770021592000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s15010-025-02670-1"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,20]]},"references-count":48,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2026,2]]}},"alternative-id":["2670"],"URL":"https:\/\/doi.org\/10.1007\/s15010-025-02670-1","relation":{},"ISSN":["0300-8126","1439-0973"],"issn-type":[{"value":"0300-8126","type":"print"},{"value":"1439-0973","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,20]]},"assertion":[{"value":"24 July 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"12 October 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"20 October 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The study was performed in line with the principles of the Declaration of Helsinki and it was approved by the respective ethics committees of the Martin Luther University Halle-Wittenberg, Medizinische Hochschule Hannover, and Ludwig-Maximilians-Universit\u00e4t Munich in Germany.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval"}},{"value":"All parents of study participants gave their written consent after receiving full information.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to participate"}},{"value":"Not applicable.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"TS and JH have received speaker fees from Biomerieux, not relative to the submitted work. All other authors report no conflict of interest.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}]}}