![]() Either at the point of collection or upon accession in the laboratory, a fecal aliquot was introduced into 2 tubes, one containing Cary-Blair medium and one buffered glycerol saline (BGS). Most of these assays were adapted from published methods that had independently been developed, validated and subjected to peer review.Collection and Processing of Stool Samplesįecal samples in the GEMS study were delivered to the laboratory in cold containers (see Kotloff et al in this supplement). ![]() Herein we describe the clinical microbiology laboratory methods and protocols utilized in the GEMS study. The Delphic perspective: We enlisted respected experts on each pathogen to ensure expert support in method selection, personnel training, and QA programs. In order to accomplish the challenging but important task of identifying consistently the key pathogens at all GEMS sites, within the significant internal and external constraints, we established the following requirements for a comprehensive set of diagnostic tests: Thus, a goal of GEMS has been to assure accurate and consistent identification of relevant pathogens at all the GEMS study sites. This deficit is understandable, considering that sites with high diarrheal mortality are typically those with the greatest challenges to performing the technically demanding portfolio of assays and protocols required to identify bacterial, viral, and protozoal pathogens. A major shortcoming of diarrheal disease studies conducted prior to The Global Enteric Multicenter Study (GEMS) has been the failure to perform a comprehensive ascertainment of major enteric pathogens, particularly at sites of greatest diarrheal burden. 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.ĭiarrheal diseases remain among the leading global causes of death for children <5 years of age. We developed a novel multiplex assay to detect norovirus (types 1 and 2), astrovirus, and sapovirus. Samples positive for adenovirus were further evaluated for adenovirus serotypes 40 and 41. Rotavirus, adenovirus, Entamoeba histolytica, Giardia enterica, and Cryptosporidium species were detected by commercially available enzyme immunoassays on stool samples. Diarrheagenic Escherichia coli were identified by application of a multiplex polymerase chain reaction assay for enterotoxigenic, enteroaggregative, and enteropathogenic E. Identification of bacterial pathogens employed streamlined conventional bacteriologic biochemical and serological algorithms. The selected assays effected a balanced consideration of cost, robustness and performance, and all assays were performed at the study 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. It does not store any personal data.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. The cookie is set by the GDPR Cookie Consent plugin and is used to store whether or not user has consented to the use of cookies. The cookie is used to store the user consent for the cookies in the category "Performance". This cookie is set by GDPR Cookie Consent plugin. The cookie is used to store the user consent for the cookies in the category "Other. The cookies is used to store the user consent for the cookies in the category "Necessary". The cookie is set by GDPR cookie consent to record the user consent for the cookies in the category "Functional". The cookie is used to store the user consent for the cookies in the category "Analytics". These cookies ensure basic functionalities and security features of the website, anonymously. Necessary cookies are absolutely essential for the website to function properly.
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