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

Main Article Content

Yanever Angela Lam
Sarah M. Warouw
Audrey M.I. Wahani
Jeanette I.C. Manoppo
Praevilia Margareth Salendu


Background In cases of acute diarrhea, it is difficult to distinguish
between bact erial and non-bacterial causes . Increased fecal
calprotectin (f-CP) level is a marker of neutrophil migration in the
intestinal lumen and is associated with intes tinal 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 ye ars 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 134) years. Theirmeanf-CP level was 93.88
(SD 14.68) μg/g. On microscopic stool examination, 26 patients
( 61.9%) had positive leukocytes, 1 had Ancy lo stoma 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.

Article Details

How to Cite
Lam Y, Warouw S, Wahani A, Manoppo J, Salendu P. Correlation between gut pathogens and fecal calprotectin levels in young children with acute diarrhea. PI [Internet]. 31Aug.2014 [cited 16Sep.2019];54(4):193-. Available from:
Received 2016-09-16
Accepted 2016-09-16
Published 2014-08-31


1. Podewils LJ, Mintz ED, Nataro JP, Parashar VD. Acute, infectious diarrhea among children in developing countries. Semin Pediatr Infect Dis. 2004;15:155-65.
2. Subagyo B, Santoso NB. Diareakut. In: Juffrie M, Soenarto SSY, Oswari H, Arief S, Rosalina I, Mulyani NS, editors. Buku ajar gastroenterologi-hepatologi. Jakarta: IDAI; 2010. p. 87-120.
3. Chiabi A, Monebenimp F, Bagne JB, Takou V, Ndikontar R, Nankap M, et al. Current approach in the management of diarrhea in children: from theory and research to practice and pragmatism. Clin Mother Child Health. 2010;7:1243-51.
4. Chang CW, Chen PY, Huang FL. Epidemiology of diarrhea among young children: a questionnaire-based study in Taiwan. J Microbial Immunol Infect. 2009;42:265-70.
5. Sykora J, Siala K, Humi M, Varvarovska J, Schawrz J, Pomahacova R. Evaluation of faecal calprotectin as a valuable non-invasive marker in distinguishing gut pathogens in young children with acute gastroenteritis. Acta Paediatr. 2010;99: 1389-95.
6. Shastri YM, Bergis D, Povse N, Schafer V, Shastri S, Weindel M, et al. Prospective multicenter study evaluating fecal calprotectin in adult acute bacterial diarrhea. Am J Med. 2008;121: 1099-106.
7. Vermeire S, Van Assche G, Rutgeerts P. Laboratory markers in IBD: useful, magic, or unnecessary toys? Gut. 2006;55:426-31.
8. Foell D, Wittkowski H, Roth J. Monitoring disease activity by stool analyses: from occult blood to molecular markers of intestinal inflammation and damage. Gut. 2009;58:859-68.
9. Johne B, Fagerhol MK, Lyberg T, Prydz H, Brandtzaeg P, Naess-Andresen CF, et al. Functional and clinical aspects of the myelomonocyte protein calprotectin. Mol Pathol. 1997;50:113-23.
10. Abraham BP, Kane S. Fecal markers: calprotectin and lactoferrin. Gastroenterol Clin North Am. 2012;41:483-95.
11. Gisbert JP, Bermejo F, Perez-Calle JL, Taxonera C, Vera I, McNicholl AG, et al. Fecal calprotectin and lactofetrin for the prediction of inflammatory bowel disease relapse. Inflamm Bowel Dis. 2009;15:1190-98.
12. Dhas DB, Bhat BV, Gane DB. Role of calprotectin in infection and inflammation. Curr Pediatr Res. 2012;16:83-94.
13. Koletzko S, Osterrieder S. Acute infectious diarrhea in children. Dtsch Arztebl Int. 2009;106:539-47.
14. Petri WA, Miller M, Binder HJ, Levine MM, Dillingham R, Guerrant RL. Enteric infections, diarrhea, and their impact on function and development. J Clin Invest. 2008;118:1277-90.
15. Canani RB, Rapacciuolo L, Romano MT, Tanturri de Horatio L, Terrin G, Manguso GT, et al. Diagnostic value of faecal calprotectin in paediatric gastroenterology clinical practice. Dig Liver Dis. 2004;36:467-70.
16. Diniz-Santos DR, Santana JS, Barretto JR, Andrade MG, Silva LR. Epidemiological and microbiological aspects of acute bacterial diarrhea in children from Salvador, Bahia, Brazil. Braz J Infect Dis. 2005;9:77-83.
17. Bhutta ZA. Acute gastroenteritis in children. In: Kliegman RM, Behrman RE, Jenson HB, Stanton HB. Nelson textbook of pediatrics. 18th ed. Philadelphia: Saunders; 2007. p. 1605-21.
18. Lung E. Acute diarrheal disease. In: Friedman SL, McQuaid KR, Grendell JH, editors. Current diagnosis and treatment in gastroenterology. 2nd ed. New York: Lange Medical Books; 2003. p. 131-50.
19. Savala KL, Baron EJ, Tompkins LS, Passaro DJ. Fecal leukocyte stain has diagnostic value for outpatients but not inpatients. J Clin Microbial. 2001;39:266-9.
20. Granville LA, Cernoch P, Land GA, Davis JR. Performance assessment of the fecal leukocyte test for inpatients. J Clin Microbial. 2004;42:1254-56.
21. Stoll BJ, Glass RI, Banu H, Hug MI, Khan MU, Ahmed M. Value of stool examination in patients with diarrhoea. Br MedJ. 1983;286:2037-40.
22. Chin AC, Parkos CA. Pathobiology of neutrophil transepithelial migration: implications in mediating epithelial injury. Annu Rev Pathol. 2007;2:111-43.