Comparative Evaluation of Multiplex PCR And Antigen Testing for Rotavirus Diagnosis in Symptomatic Children Aged 0 To 5 Years in Douala, Cameroon

Background: Rotavirus is a common cause of acute gastroenteritis in children under 5 years of age. Diagnosis is often based on antigen tests, but multiplex PCR could offer better accuracy. It would therefore be useful to evaluate the value of multiplex PCR in the diagnosis of rotavirus infections in symptomatic children aged 0 to 5 years, with the aim of improving diagnostic strategies and the management of rotavirus infections. Methodology: This cross-sectional and analytical study was conducted between September 2023 and September 2024. The participants, children aged 0 to 5 years presenting symptoms of gastroenteritis were recruited in two hospitals in Douala: the Douala Gyneco-Obstetric and Pediatric Hospital and Laquintinie Hospital. After informed consent obtained from the participants, samples were analysed using antigenic tests and multiplex PCR to detect the presence of rotavirus. The data were processed with SPSS and STATA software for statistical analyses. Results: Of the 75 samples analysed, 16% (12/75) were positive for rotavirus with antigen tests and 34.67% (26/75) with multiplex PCR. Co-infections with other germs were found in 17.33% (13/75) of cases, the most frequent pathogens being Shigella spp (5.33%) and Adenovirus (6.67%). The antigen test showed a sensitivity of 38.5% and a specificity of 95.9%. The ROC curve revealed that multiplex RT-PCR outperformed the antigen test with an AUC of 0.765 compared to 0.593 for the antigen test. The agreement between the two tests was low (Kappa value = 0.394). Factors associated with rotavirus include number of stools per day (OR = 3.09; p = 0.023), nature of stool (OR = 6.00; p = 0.001), and vaccination (OR = 1.68; p = 0.009). Logistic regression showed that vaccinated children were 3.579 times more likely to be rotavirus positive (p = 0.015). Conclusion: Multiplex PCR was found to perform better than antigen testing in the diagnosis of rotavirus infections. Its implementation in hospitals should be encouraged to optimize the detection of rotavirus and/or other pathogens responsible for diarrhoea.