Correlation between gut pathogens and fecal calprotectin levels in young children with acute diarrhea

Background In cases of acute diarrhea, it is difficult to distinguish between bacterial and non-bacterial causes. Increased fecal calprotectin (f-CP) level is a marker of neutrophil migration in the intestinal lumen and is associated with intestinal inflammation. Previous studies reported an increase in f-CP levels in children with acute diarrhea, which is caused by bacteria, but only few have studied the relationship between intestinal pathogens with f-CP levels in acute diarrhea. Objective To assess for a correlation between gut pathogens and fecal calprotectin levels in children with acute diarrhea. Methods We conducted a cross-sectional study between July to November 2012 on children aged 1-5 years with acute diarrhea, and underwent routine blood tests, stool microscopy, f-CP tests, and stool cultures. We used a simple linear regression and correlation analysis with a significance level of P<0.05. Results Forty-two children enrolled in this study. The mean age of subjects was 2.27 (SD 1.34) years. Their mean f-CP level was 93.88 (SD 14.68) mu g/g. On microscopic stool examination, 26 patients (61.9%) had positive leukocytes, 1 had Ancylostoma duodenale, 1 had Ascaris lumbricoides, and 2 had Blastocystis hominis. Positive stool cultures were found in 14 children (33.3%) with acute diarrhea. There was a significant positive correlation between gut pathogens and f-CP levels (r=0.605; P<0.0001). Conclusion In young children with acute diarrhea, the average f-CP levels are higher in those with positive intestinal pathogens.