Pathogens Associated With Linear Growth Faltering in Children With Diarrhea and Impact of Antibiotic Treatment: The Global Enteric Multicenter Study,The Journal of Infectious Diseases

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Pathogens Associated With Linear Growth Faltering in Children With Diarrhea and Impact of Antibiotic Treatment: The Global Enteric Multicenter Study
The Journal of Infectious Diseases ( IF 6.4 ) Pub Date : 2021-09-08 , DOI: 10.1093/infdis/jiab434
Dilruba Nasrin _{1,

2} , William C Blackwelder _{1,

2} , Halvor Sommerfelt _{3,

4} , Yukun Wu _{1,

2} , Tamer H Farag _{1,

2} , Sandra Panchalingam _{1,

2} , Kousick Biswas ₅ , Debasish Saha ₆ , M Jahangir Hossain ₆ , Samba O Sow ₇ , Robert F B Reiman ₈ , Dipika Sur ₉ , Abu S G Faruque ₁₀ , Anita K M Zaidi ₁₁ , Doh Sanogo ₇ , Boubou Tamboura ₇ , Uma Onwuchekwa ₇ , Byomkesh Manna ₉ , Thandavarayan Ramamurthy ₉ , Suman Kanungo ₉ , Richard Omore ₁₂ , John B Ochieng ₁₂ , Joseph O Oundo ₁₂ , Sumon K Das ₁₀ , Shahnawaz Ahmed ₁₀ , Shahida Qureshi ₁₁ , Farheen Quadri ₁₁ , Richard A Adegbola ₆ , Martin Antonio ₆ , Inacio Mandomando _{13,

14} , Tacilta Nhampossa _{13,

14} , Quique Bassat _{13,

14,

15} , Anna Roose _{1,

16} , Ciara E O'Reilly ₁₇ , Eric D Mintz ₁₇ , Usha Ramakrishnan ₁₈ , Helen Powell _{1,

2} , Yuanyuan Liang ₁₉ , James P Nataro _{1,

2,

16} , Myron M Levine _{1,

2,

16} , Karen L Kotloff _{1,

2,

16}

Affiliation

Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA.
Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA.
Centre for Intervention Science in Maternal and Child health (CISMAC) and Centre for International Health, University of Bergen, Bergen.
Cluster for Global Health, Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway.
Department of Veterans Affairs, Cooperative Studies Program Coordinating Center, Perry Point, MD, USA.
Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, Fajara, The Gambia.
Centre pour le Développement des Vaccins, Bamako, Mali.
Global Disease Detection Division, Kenya Office of the US Centers for Disease Control and Prevention, Nairobi, Kenya.
National Institute of Cholera and Enteric Diseases, Kolkata, India.
International Centre for Diarrhoeal Disease Research, Mohakhali, Dhaka, Bangladesh.
Department of Paediatrics and Child Health, the Aga Khan University, Karachi, Pakistan.
Kenya Medical Research Institute/Center for Global Health Research (KEMRI-CGHR), Kisumu, Kenya.
Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique.
Institució Catalana de Recerca i Estudis Avançats (ICREA), Barcelona, Spain.
ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain.
Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland, USA.
Division of Foodborne, Waterborne, and Environmental Diseases, US Centers for Disease Control and Prevention, Atlanta, GA, USA.
Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA.
Department of Epidemiology and public health, University of Maryland School of Medicine, Baltimore, Maryland, USA.

Background The association between childhood diarrheal disease and linear growth faltering in developing countries is well described. However, the impact attributed to specific pathogens has not been elucidated, nor has the impact of recommended antibiotic treatment. Methods The Global Enteric Multicenter Study enrolled children with moderate to severe diarrhea (MSD) seeking healthcare at 7 sites in sub-Saharan Africa and South Asia. At enrollment, we collected stool samples to identify enteropathogens. Length/height was measured at enrollment and follow-up, approximately 60 days later, to calculate change in height-for-age z scores (ΔHAZ). The association of pathogens with ΔHAZ was tested using linear mixed effects regression models. Results Among 8077 MSD cases analyzed, the proportion with stunting (HAZ below −1) increased from 59% at enrollment to 65% at follow-up (P < .0001). Pathogens significantly associated with linear growth decline included Cryptosporidium (P < .001), typical enteropathogenic Escherichia coli (P = .01), and untreated Shigella (P = .009) among infants (aged 0–11 months) and enterotoxigenic E. coli encoding heat-stable toxin (P < .001) and Cryptosporidium (P = .03) among toddlers (aged 12–23 months). Shigella-infected toddlers given antibiotics had improved linear growth (P = .02). Conclusions Linear growth faltering among children aged 0–23 months with MSD is associated with specific pathogens and can be mitigated with targeted treatment strategies, as demonstrated for Shigella.

更新日期：2021-09-08

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