{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,2]],"date-time":"2026-11-02T18:02:16Z","timestamp":1793642536067,"version":"4.5.1"},"reference-count":34,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2021,1,6]],"date-time":"2021-01-06T00:00:00Z","timestamp":1609891200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2021,1,6]],"date-time":"2021-01-06T00:00:00Z","timestamp":1609891200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100006014","name":"College of Medicine and Health Sciences, United Arab Emirates University","doi-asserted-by":"publisher","award":["31M319"],"award-info":[{"award-number":["31M319"]}],"id":[{"id":"10.13039\/501100006014","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Infect Dis"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Little is known about the etiology of childhood diarrhea in the United Arab Emirates (UAE) especially after the introduction of rotavirus vaccines. This study aimed to identify gastrointestinal pathogens in children with diarrhea (cases) and the carriage rate of these pathogens in asymptomatic children (controls).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Stool samples were collected from 203 cases and 73 controls who presented to two major hospitals in Al Ain city, UAE. Samples were analyzed with Allplex\u2122 Gastrointestinal Full Panel Assay for common entero-pathogens. The association between diarrhea and the isolated pathogens was calculated in a multivariate logistic regression model. The adjusted attributable fractions (aAFs) were calculated for all pathogens significantly associated with cases.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>At least one pathogen was identified in 87 samples (42.8%) from cases and 17 (23.3%) from controls (<jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001). Rotavirus, norovirus GII and adenovirus were significantly more prevalent in cases. Their aAFs with 95% ci are 0.95 (0.64, 1.00) for rotavirus, 0.86 (0.38, 0.97) for norovirus GII and 0.84 (0.29, 0.96) for adenovirus. None of the 13 bacteria tested for were more commonly found in the cases than in controls. Cryptosporidium spp. were more significantly detected in cases than in controls. Co-infections occurred in 27.9% of the children. Viruses and parasites were significantly more likely to occur together only in the cases.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Multiplex PCR revealed high positivity rates in both cases and controls which demand a cautious interpretation. Rotavirus remains the main childhood diarrhea pathogen in UAE. Effective strategies are needed to better control rotavirus and other causative pathogens.<\/jats:p><\/jats:sec>","DOI":"10.1186\/s12879-020-05693-1","type":"journal-article","created":{"date-parts":[[2021,1,6]],"date-time":"2021-01-06T17:13:16Z","timestamp":1609953196000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":23,"title":["Etiology of diarrhea by multiplex polymerase chain reaction among young children in the United Arab Emirates: a case-control study"],"prefix":"10.1186","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1187-522X","authenticated-orcid":false,"given":"Ahmed R.","family":"Alsuwaidi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Klaithem","family":"Al Dhaheri","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sania","family":"Al Hamad","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Junu","family":"George","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Judy","family":"Ibrahim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ghassan","family":"Ghatasheh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammed","family":"Issa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suleiman","family":"Al-Hammadi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hassib","family":"Narchi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,1,6]]},"reference":[{"key":"5693_CR1","doi-asserted-by":"publisher","first-page":"1211","DOI":"10.1016\/S1473-3099(18)30362-1","volume":"18","author":"GBD 2016 Diarrhoeal Disease Collaborators","year":"2018","unstructured":"GBD 2016 Diarrhoeal Disease Collaborators. 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.","journal-title":"Lancet Infect Dis"},{"key":"5693_CR2","unstructured":"Made S. GUIDE TO INFECTION CONTROL IN The HOSPITAL - diarrhea. In: ISID GUIDE TO INFECTION CONTROL IN THE HEALTHCARE SETTING https:\/\/isid.org\/guide\/hospital\/diarrhea\/. Accessed 28 Nov 2020."},{"key":"5693_CR3","doi-asserted-by":"publisher","first-page":"74","DOI":"10.1186\/1471-2431-12-74","volume":"12","author":"M Howidi","year":"2012","unstructured":"Howidi M, Al Kaabi N, El Khoury AC, Brandtm\u00fcller A, Nagy L, Richer E, et al. Burden of acute gastroenteritis among children younger than 5 years of age--a survey among parents in the United Arab Emirates. BMC Pediatr. 2012;12:74.","journal-title":"BMC Pediatr"},{"key":"5693_CR4","doi-asserted-by":"publisher","first-page":"2284","DOI":"10.4161\/hv.29386","volume":"10","author":"M Howidi","year":"2014","unstructured":"Howidi M, Balhaj G, Yaseen H, Gopala K, Van Doorn LJ, DeAntonio R. Burden and genotyping of rotavirus disease in the United Arab Emirates: a multicenter hospital-based surveillance. Hum Vaccin Immunother. 2014;10:2284\u20139.","journal-title":"Hum Vaccin Immunother"},{"key":"5693_CR5","doi-asserted-by":"publisher","first-page":"8135724","DOI":"10.1155\/2020\/8135724","volume":"2020","author":"M Amjad","year":"2020","unstructured":"Amjad M. An overview of the molecular methods in the diagnosis of gastrointestinal infectious diseases. Int J Microbiol. 2020;2020:8135724.","journal-title":"Int J Microbiol"},{"key":"5693_CR6","doi-asserted-by":"publisher","first-page":"461","DOI":"10.1016\/j.cll.2015.02.006","volume":"35","author":"H Zhang","year":"2015","unstructured":"Zhang H, Morrison S, Tang Y-W. Multiplex polymerase chain reaction tests for detection of pathogens associated with gastroenteritis. Clin Lab Med. 2015;35:461\u201386.","journal-title":"Clin Lab Med"},{"key":"5693_CR7","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1017\/S0950268813002367","volume":"142","author":"J Gray","year":"2014","unstructured":"Gray J, Coupland LJ. The increasing application of multiplex nucleic acid detection tests to the diagnosis of syndromic infections. Epidemiol Infect. 2014;142:1\u201311.","journal-title":"Epidemiol Infect"},{"key":"5693_CR8","doi-asserted-by":"publisher","first-page":"1519","DOI":"10.1016\/j.cmi.2019.07.021","volume":"25","author":"A Tilmanne","year":"2019","unstructured":"Tilmanne A, Martiny D, Quach C, Wautier M, Vandenberg O, Lepage P, et al. Enteropathogens in paediatric gastroenteritis: comparison of routine diagnostic and molecular methods. Clin Microbiol Infect. 2019;25:1519\u201324.","journal-title":"Clin Microbiol Infect"},{"key":"5693_CR9","unstructured":"Statistics Centre - Abu Dhabi. Statistical Yearbook of Abu Dhabi 2020. https:\/\/www.scad.gov.ae\/Release%20Documents\/Statistical%20Yearbook%20of%20Abu%20Dhabi_2020_Annual_Yearly_en.pdf."},{"key":"5693_CR10","unstructured":"WHO Regional Office for the Eastern Mediterranean. Demographic, social and health indicators for countries of the Eastern Mediterranean 2011. 2011."},{"key":"5693_CR11","doi-asserted-by":"crossref","unstructured":"Zimmermann S, Horner S, Altwegg M, Dalpke AH. Workflow optimization for syndromic diarrhea diagnosis using the molecular Seegene Allplex\u2122 GI-Bacteria(I) assay. Eur J Clin Microbiol Infect Dis. 2020.","DOI":"10.1007\/s10096-020-03837-4"},{"key":"5693_CR12","doi-asserted-by":"publisher","first-page":"999","DOI":"10.5858\/arpa.2018-0002-OA","volume":"143","author":"J Yoo","year":"2019","unstructured":"Yoo J, Park J, Lee HK, Yu JK, Lee GD, Park KG, et al. Comparative evaluation of Seegene Allplex gastrointestinal, Luminex xTAG gastrointestinal pathogen panel, and BD MAX enteric assays for detection of gastrointestinal pathogens in clinical stool specimens. Arch Pathol Lab Med. 2019;143:999\u20131005.","journal-title":"Arch Pathol Lab Med"},{"key":"5693_CR13","doi-asserted-by":"publisher","first-page":"220","DOI":"10.1093\/infdis\/jix294","volume":"216","author":"DJ Operario","year":"2017","unstructured":"Operario DJ, Platts-Mills JA, Nadan S, Page N, Seheri M, Mphahlele J, et al. Etiology of severe acute watery diarrhea in children in the global rotavirus surveillance network using quantitative polymerase chain reaction. J Infect Dis. 2017;216:220\u20137.","journal-title":"J Infect Dis"},{"key":"5693_CR14","doi-asserted-by":"publisher","first-page":"1121","DOI":"10.1056\/NEJMsa1206589","volume":"368","author":"DC Payne","year":"2013","unstructured":"Payne DC, Vinj\u00e9 J, Szilagyi PG, Edwards KM, Staat MA, Weinberg GA, et al. Norovirus and medically attended gastroenteritis in U.s. children. N Engl J Med. 2013;368:1121\u201330.","journal-title":"N Engl J Med"},{"key":"5693_CR15","unstructured":"The ROTA Council. Global Introduction Status https:\/\/preventrotavirus.org\/vaccine-introduction\/global-introduction-status\/. Accessed 28 Nov 2020."},{"key":"5693_CR16","doi-asserted-by":"publisher","first-page":"2281","DOI":"10.1080\/21645515.2018.1470725","volume":"14","author":"AJ Abou-Nader","year":"2018","unstructured":"Abou-Nader AJ, Sauer MA, Steele AD, Tate JE, Atherly D, Parashar UD, et al. Global rotavirus vaccine introductions and coverage: 2006\u20132016. Hum Vaccin Immunother. 2018;14:2281\u201396.","journal-title":"Hum Vaccin Immunother."},{"key":"5693_CR17","unstructured":"World Health Organization. WHO vaccine-preventable diseases: monitoring system. 2020 global summary Coverage time series for United Arab Emirates (ARE). https:\/\/apps.who.int\/immunization_monitoring\/globalsummary\/coverages?c=ARE."},{"key":"5693_CR18","unstructured":"Department of Health - Abu Dhabi. Communicable Diseases Bulletin, Second Quarter\u2013 2019 (Apr-Jun). 2019. file:\/\/\/Users\/aalsuwaidi\/Downloads\/Q22019%20CD%20Bulletin%20%20Vol201020Issue%2022022%20Dec%202019%20(5).pdf."},{"key":"5693_CR19","doi-asserted-by":"publisher","first-page":"220","DOI":"10.1186\/s12985-017-0877-3","volume":"14","author":"K Kreidieh","year":"2017","unstructured":"Kreidieh K, Charide R, Dbaibo G, Melhem NM. The epidemiology of Norovirus in the Middle East and North Africa (MENA) region: a systematic review. Virol J. 2017;14:220.","journal-title":"Virol J"},{"key":"5693_CR20","doi-asserted-by":"publisher","first-page":"539","DOI":"10.1080\/14760584.2020.1777860","volume":"19","author":"JE Cates","year":"2020","unstructured":"Cates JE, Vinj\u00e9 J, Parashar U, Hall AJ. Recent advances in human norovirus research and implications for candidate vaccines. Expert Rev Vaccines. 2020;19:539\u201348.","journal-title":"Expert Rev Vaccines"},{"key":"5693_CR21","doi-asserted-by":"publisher","first-page":"142912","DOI":"10.1155\/2015\/627201","volume":"2015","author":"G La Rosa","year":"2015","unstructured":"La Rosa G, Della Libera S, Petricca S, Iaconelli M, Donia D, Saccucci P, et al. Genetic diversity of human adenovirus in children with acute gastroenteritis, Albania, 2013-2015. Biomed Res Int. 2015;2015:142912.","journal-title":"Biomed Res Int"},{"key":"5693_CR22","doi-asserted-by":"publisher","first-page":"666","DOI":"10.1186\/s12879-014-0666-1","volume":"14","author":"SJ Moyo","year":"2014","unstructured":"Moyo SJ, Hanevik K, Blomberg B, Kommedal O, Nordb\u00f8 SA, Maselle S, et al. Prevalence and molecular characterisation of human adenovirus in diarrhoeic children in Tanzania; a case control study. BMC Infect Dis. 2014;14:666.","journal-title":"BMC Infect Dis"},{"key":"5693_CR23","doi-asserted-by":"publisher","first-page":"450","DOI":"10.1186\/s12879-018-3340-1","volume":"18","author":"F-Z Qiu","year":"2018","unstructured":"Qiu F-Z, Shen X-X, Li G-X, Zhao L, Chen C, Duan S-X, et al. Adenovirus associated with acute diarrhea: a case-control study. BMC Infect Dis. 2018;18:450.","journal-title":"BMC Infect Dis"},{"key":"5693_CR24","doi-asserted-by":"publisher","first-page":"114893","DOI":"10.1016\/j.diagmicrobio.2019.114893","volume":"96","author":"I Sciandra","year":"2020","unstructured":"Sciandra I, Piccioni L, Coltella L, Ranno S, Giannelli G, Falasca F, et al. Comparative analysis of 2 commercial molecular tests for the detection of gastroenteric viruses on stool samples. Diagn Microbiol Infect Dis. 2020;96:114893.","journal-title":"Diagn Microbiol Infect Dis"},{"key":"5693_CR25","doi-asserted-by":"publisher","first-page":"701","DOI":"10.1016\/j.cmi.2015.03.011","volume":"21","author":"L Feghoul","year":"2015","unstructured":"Feghoul L, Chevret S, Cuinet A, Dalle J-H, Ouach\u00e9e M, Yacouben K, et al. Adenovirus infection and disease in paediatric haematopoietic stem cell transplant patients: clues for antiviral pre-emptive treatment. Clin Microbiol Infect. 2015;21:701\u20139.","journal-title":"Clin Microbiol Infect"},{"key":"5693_CR26","doi-asserted-by":"publisher","first-page":"508","DOI":"10.3201\/eid0805.010385","volume":"8","author":"LR Trabulsi","year":"2002","unstructured":"Trabulsi LR, Keller R, Tardelli Gomes TA. Typical and atypical enteropathogenic Escherichia coli. Emerg Infect Dis. 2002;8:508\u201313.","journal-title":"Emerg Infect Dis"},{"key":"5693_CR27","doi-asserted-by":"publisher","first-page":"729","DOI":"10.1016\/j.cmi.2015.01.015","volume":"21","author":"J Hu","year":"2015","unstructured":"Hu J, Torres AG. Enteropathogenic Escherichia coli: foe or innocent bystander? Clin Microbiol Infect. 2015;21:729\u201334.","journal-title":"Clin Microbiol Infect"},{"key":"5693_CR28","doi-asserted-by":"publisher","first-page":"793","DOI":"10.1016\/j.gtc.2018.07.006","volume":"47","author":"NW Anderson","year":"2018","unstructured":"Anderson NW, Tarr PI. Multiplex nucleic acid amplification testing to diagnose gut infections: challenges, opportunities, and result interpretation. Gastroenterol Clin N Am. 2018;47:793\u2013812.","journal-title":"Gastroenterol Clin N Am"},{"key":"5693_CR29","doi-asserted-by":"publisher","first-page":"e45","DOI":"10.1093\/cid\/cix669","volume":"65","author":"AL Shane","year":"2017","unstructured":"Shane AL, Mody RK, Crump JA, Tarr PI, Steiner TS, Kotloff K, et al. 2017 Infectious Diseases Society of America clinical practice guidelines for the diagnosis and Management of Infectious Diarrhea. Clin Infect Dis. 2017;65:e45\u201380.","journal-title":"Clin Infect Dis"},{"key":"5693_CR30","doi-asserted-by":"publisher","first-page":"115","DOI":"10.1128\/CMR.00076-12","volume":"26","author":"M Bouzid","year":"2013","unstructured":"Bouzid M, Hunter PR, Chalmers RM, Tyler KM. Cryptosporidium pathogenicity and virulence. Clin Microbiol Rev. 2013;26:115\u201334.","journal-title":"Clin Microbiol Rev"},{"key":"5693_CR31","doi-asserted-by":"crossref","first-page":"7","DOI":"10.21010\/ajid.v12i2.2","volume":"12","author":"A ElBakri","year":"2018","unstructured":"ElBakri A, Mogane L, Ezzedine S, Potgieter N, Bessong P, AbuOdeh R, et al. Prevalence of CRYPTOSPORIDIUM SPP. among asymptomatic healthy expatriate workers in Sharjah, United Arab Emirates. Afr J Infect Dis. 2018;12:7\u201313.","journal-title":"Afr J Infect Dis"},{"key":"5693_CR32","doi-asserted-by":"publisher","first-page":"64","DOI":"10.1186\/s40249-016-0157-2","volume":"5","author":"S-X Zhang","year":"2016","unstructured":"Zhang S-X, Zhou Y-M, Xu W, Tian L-G, Chen J-X, Chen S-H, et al. Impact of co-infections with enteric pathogens on children suffering from acute diarrhea in Southwest China. Infect Dis Poverty. 2016;5:64.","journal-title":"Infect Dis Poverty"},{"key":"5693_CR33","doi-asserted-by":"publisher","first-page":"387","DOI":"10.1093\/aje\/kws220","volume":"176","author":"D Bhavnani","year":"2012","unstructured":"Bhavnani D, Goldstick JE, Cevallos W, Trueba G, Eisenberg JNS. Synergistic effects between rotavirus and coinfecting pathogens on diarrheal disease: evidence from a community-based study in northwestern Ecuador. Am J Epidemiol. 2012;176:387\u201395.","journal-title":"Am J Epidemiol"},{"key":"5693_CR34","doi-asserted-by":"publisher","first-page":"150","DOI":"10.1186\/s12879-016-1481-7","volume":"16","author":"D Eibach","year":"2016","unstructured":"Eibach D, Krumkamp R, Hahn A, Sarpong N, Adu-Sarkodie Y, Leva A, et al. Application of a multiplex PCR assay for the detection of gastrointestinal pathogens in a rural African setting. BMC Infect Dis. 2016;16:150.","journal-title":"BMC Infect Dis"}],"container-title":["BMC Infectious Diseases"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1186\/s12879-020-05693-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/article\/10.1186\/s12879-020-05693-1\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1186\/s12879-020-05693-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,10,17]],"date-time":"2023-10-17T02:24:52Z","timestamp":1697509492000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcinfectdis.biomedcentral.com\/articles\/10.1186\/s12879-020-05693-1"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,1,6]]},"references-count":34,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2021,12]]}},"alternative-id":["5693"],"URL":"https:\/\/doi.org\/10.1186\/s12879-020-05693-1","relation":{},"ISSN":["1471-2334"],"issn-type":[{"value":"1471-2334","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,1,6]]},"assertion":[{"value":"6 August 2020","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"8 December 2020","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"6 January 2021","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"Ethics approval was granted by the Al Ain Medical District Human Research Ethics Committee (ERH-2016-5482-16-87). Written informed consents were obtained from the parents of the participating children.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"7"}}