Blinded application of microscopy, bacteriological culture, immunoassays and PCR to detect gastrointestinal pathogens from faecal samples of patients with community-acquired diarrhoea

A blinded trial in two different laboratories was performed to compare the detection of selected enteric pathogens in 92 unselected faecal samples collected from patients with community-acquired diarrhoea by conventional and PCR-based techniques. Conventional techniques detected a single potential etiological agent in 15% of the samples, whereas results of PCR detected evidence of at least one agent in 41% of the samples. Overall, the detection rates for the different pathogens were as follows: adenovirus serogroup F, 1%; Campylobacter spp., 7.6%; Salmonella spp., 4%; enteroaggregative Escherichia coli, 9.8%; enteropathogenic E. coli, 6.5%; enterotoxigenic Clostridium perfringens, 3%; Cryptosporidium spp., 13%; and Giardia spp., 11%. Results for the detection of Salmonella spp., Campylobacter spp. and C. perfringens were similar by both techniques, whereas Cryptosporidium and Giardia spp. were detected 22 times more often by PCR than by conventional microscopy. It was not possible to compare the results for detection of enteroaggregative E. coli and enteropathogenic E. coli since these were only investigated by PCR. The results of this small study clearly demonstrate the advantages of PCR-based methods compared to conventional techniques for the detection of gastrointestinal pathogens.