تقييم كفاءة اختبار الشرائط المناعية مقارنة بالتقنيات التقليدية والجزيئية في تشخيص بعض مسببات الإسهال الحاد في المرضى دون سن المدرسة في محافظة بابل / العراق

Efficiency Evaluation of Immunochromatographic Strips Test in Comparison with Conventional and Molecular Techniques in Diagnosis of Some Acute Diarrheal Causes in Pre School Patients in Babylon Provence/iraq

Summary
The present study includes the identification of parasites, bacteria and viruses responsible for diarrheal infection in children under six years old suffering from acute diarrhea during the period from begning December 2020 till the end of May 2021,they were attending to Babylon teaching Hospital for Maternity and Children in the babylon city.
A total of 320 stool samples from both genders have been collected from the hospitalized patients to identifiy the causative agent of acute diarrhea, the primary detection of parasitic infection was carried out using microscopic and immunochromatography test ( triage Rapid test) as well as Multiplex-PCR which used to detect three parasites infection by used (EHCP8-S1,GLCP6-S1and CRY18s-S1) genes. The Conventional PCR that used to identify bacteria were carried out to detect (pho) gene family for E.coli and 16srRNA gene for Salmonella spp. On the other hand , among the viruses that causes diarrhea the results found Rotavirus infection was carried out using immunochromatography test
(Rapid test) with Reverse Transcriptase-PCR assay used to detect virus infection by using structural gene (vp4 gene).
The results showed 86 (26.87%) samples of parasites from 320 children stool sample which were divided into three type of parasites as 25 (29.6%) E.histolytica, 48 (55.82%) G.lamblia, and 13 (15.12%) C.parvum by using direct microscopic examination while, in immunocromatography assay the result found 8 (13.34%) , 41 (68.33%) and 11 (18.33%) for these parasites ,respectivelly . PCR assay showed 11 (16.41%), 45 (67.16%) and 11 (16.41%) for E.histolytica,G.lamblia and C.parvum respectively, in order to evaulate immunocromatography assay. Among Rotavirus detection the virus was found 120 (37.5%) positive samples from 320 stool samples by using immunochromatography assay, while PCR assay it was found 84 (26.25%) positive Rota virus samples. Also the result found the sensitivity of Rotavirus (100%) and specificity (84.75%) , among bacterial isolates the results showed that there were 107 (33.43%) positive samples from 320 diarrhea children by using culturing and biochemical test. The results of bacterial infection by using PCR assay showed only 50 (15.62%) positive samples.it was found significant differences between parasitic and (viral,bacterial ) infection.as well as high prevelance in males as 61.62%, 67.5% and 57.94% more than females as 38.37%, 32.5% and 42.05% in the detection of parasite,virus and bacteria respectivelly.
The result found that a significant differences for bacteria,parasite and virus, the rural area was found as 60.46%, 54.16% and 71.02% more prevelence in the parasite, viruse and bacteria infection more than urban area as 39.53%, 45.83% and 28.97% for parasites, viruses and bacteria, respectivelly.
The present study showed the distribution of children age with infectious agent,it was found significant differences in the virus and parasite. The highest number of Rotavirus and bacterial infection occurred in children have aged group less than two years as (49.16%), and (36.44%) respectively, it was slightly higher compare with other groups, while the more prevelance of parasites was recorded as (51.16%) in the 4-6 years.
The present study showed a significant increasing in viral infection (Rotavirus) that cause diarrhea in children in the winter season compare with hot season, otherwise higher parasites infection in hot season more than winter season.
Finally, current study indicated that the immunocromatography test have sensitivity as (66.67%, 93.18% and 100%),for detection of intestinal parasites (E.histolytica,G.lamblia and C.parvum) respectively, while the specificity of result by immunocromatography test were 94.55%,82.61% and 100% for E.histolytica ,G.lamblia and C.parvum,respectively.
The immunocromatography test result identify two parasites C.parvum with G.lamblia as adouble rather than single infection.
Among bacterial causes diarrhea, It was found the high number of total positive isolates from cultured 107 stool samples, 61 isolates (57% ) for E.coli while 19 isolate (17.75%) for Salmonella spp.
The highest infection rate of watery diarrhea in children in the viral followed by bacterial then parasitic infection, (Triage panel test kit) was highly sensitive and specific for G.lamblia,C.parvum and E.histolytica and this assay could be utilized by personal that do not have extensive training in manual parasitological methods. The specificity and sensitivity of the triage panel test, it is approximaty to the Rotavirus kit that used for routine examination, which confirms the possibility of its use in the routine examination for the diagnosis of parasites.