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Provincial team uses test to better identify intestinal infections

Lab test identifies bacterial pathogens in hours, not days, says Cumming researcher Stephen Freedman
December 14, 2015
Dr. Stephen Freedman, a pediatric emergency physician at the Alberta Children's Hospital, is the lead of a provincial-wide study which is testing a research platform to improve identification of enteric infections. Photo by Laura Herperger

Dr. Stephen Freedman, a pediatric emergency physician at the Alberta Children's Hospital, is the lead of a provincial-wide study which is testing a research platform to improve identification of enteric infections. Photo by Laura Herperger, University of Calgary 

Shigella bacteria is highly contagious and can lead to a variety of complications including joint pains, blood stream infections, convulsions and sometimes, kidney failure. Photo courtesy of Center for Disease Control and Prevention

Shigella bacteria is highly contagious and can lead to a variety of complications including joint pains, blood stream infections, convulsions and sometimes, kidney failure. Photo courtesy of Center for Disease Control and Prevention

Stephanie Yanow is the mother to a nine-year-old child, one of at least two children who became ill in an Edmonton school last month with shigellosis, a serious infection similar to E. coli that causes bloody diarrhea in children. The bacterium is highly contagious and can lead to significant complications.

“I have never seen my son sick like that," says Yanow. "I was really concerned and wanted to know what kind of infection it was." She ended up taking her child to the Stollery Children’s Hospital where routine tests were run and she enrolled in the APPETITE (Alberta Provincial Pediatric Enteric Infection Team) study.

Lab test provides rapid identification of infection

A provincial research team with APPETITE quickly identified the presence of this serious infection using a novel molecular diagnostic lab test that they are evaluating.

“This was the great proof of principal test for our research platform which is aimed primarily at improving the response time and ability to identify enteric infections in the population”, says Dr. Stephen Freedman, the lead investigator in the APPETITE study and a clinical scientist at the Cumming School of Medicine’s Alberta Children’s Hospital Research Institute for Child and Maternal Health (ACHRI).

“This case shows that we are finding a better way of identifying pathogens to improve enteric diagnostics and enhance the ability of clinicians and public health officials in the community,” says Dr. Bonita Lee, research co-lead and the assistant medical director of infection control at the Stollery Children’s Hospital.

Culture test a gold standard in identifying bacterial pathogens

The novel technology being evaluated has the ability to identify bacterial, viral and parasitic stool pathogens in hours rather than days. In this child’s case, it showed a positive result for the bacteria while the traditional lab culture test failed to identify the threat. The culture test has been considered the gold standard in labs to identify bacterial pathogens for decades.

“An APPETITE sample reported as a molecular positive for shigella helped to identify an outbreak that otherwise likely would not have been detected,” says Lance Honish, PhD, lead of outbreak management at Alberta Health Services, Edmonton Zone.

“If it wasn’t for the molecular test, the diagnosis would never have been made. We found out very quickly what was the nature of my son’s illness and once he was on antibiotics, he was better within a day,” says Yanow. Close connections with health officials led to the rapid initiation of outbreak management to prevent further spread of the pathogen.

Provincial collaboration of researchers and clinicians

The provincial research study was enabled by a $5 million grant from Alberta Innovates - Health Solutions. The team consists of a multi-disciplinary group of microbiologists, clinicians, lab experts and policymakers. So far, nearly 1,000 children have been enrolled in the study. Children are recruited to participate in the study from across the province when they present either to children’s emergency departments or through a collaborative effort with HealthLinkAlberta.

More than 30,000 children are admitted to emergency departments in Alberta each year with intestinal infections, with symptoms varying form vomiting and diarrhea to fever and dehydration.

Freedman is a pediatric emergency medicine physician at the Alberta Children’s Hospital, an associate professor in the Department of Paediatrics at the Cumming School of Medicine, the lead of the Healthy Outcomes theme at ACHRI, a member of the O’Brien Institute for Public Health, and the Alberta Children’s Hospital Foundation Professor in Child Health and Wellness.

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