Pathogens Associated With Linear Growth Faltering in Children With Diarrhea and Impact of Antibiotic Treatment: The Global Enteric Multicenter Study.
Anti-Bacterial Agents
/ therapeutic use
Case-Control Studies
Child
Cryptosporidiosis
/ drug therapy
Cryptosporidium
/ isolation & purification
Diarrhea
/ drug therapy
Escherichia coli
/ isolation & purification
Female
Growth Disorders
/ etiology
Humans
Infant
Male
Shigella
/ isolation & purification
Diarrhea
antibiotics
children
growth faltering
pathogens
stunting
Journal
The Journal of infectious diseases
ISSN: 1537-6613
Titre abrégé: J Infect Dis
Pays: United States
ID NLM: 0413675
Informations de publication
Date de publication:
20 12 2021
20 12 2021
Historique:
pubmed:
17
9
2021
medline:
27
1
2022
entrez:
16
9
2021
Statut:
ppublish
Résumé
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. 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. 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). 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.
Sections du résumé
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.
Identifiants
pubmed: 34528677
pii: 6371002
doi: 10.1093/infdis/jiab434
pmc: PMC8958895
doi:
Substances chimiques
Anti-Bacterial Agents
0
Types de publication
Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
S848-S855Informations de copyright
© The Author(s) 2021. Published by Oxford University Press for the Infectious Diseases Society of America.
Références
Clin Infect Dis. 2012 Dec;55 Suppl 4:S246-53
pubmed: 23169937
N Engl J Med. 1971 Jul 1;285(1):1-9
pubmed: 4996788
Int J Epidemiol. 2010 Apr;39 Suppl 1:i70-4
pubmed: 20348130
Clin Infect Dis. 2012 Dec;55 Suppl 4:S232-45
pubmed: 23169936
Pediatrics. 1984 Jun;73(6):799-805
pubmed: 6374599
Lancet. 2013 Jul 20;382(9888):209-22
pubmed: 23680352
Int J Epidemiol. 2008 Aug;37(4):816-30
pubmed: 18567626
Clin Infect Dis. 2012 Dec;55 Suppl 4:S294-302
pubmed: 23169941
Infect Immun. 2007 May;75(5):2269-74
pubmed: 17296752
Clin Infect Dis. 2012 Dec;55 Suppl 4:S215-24
pubmed: 23169934
Am J Epidemiol. 2013 Oct 1;178(7):1129-38
pubmed: 23966558
J Nutr. 2007 Dec;137(12):2709-16
pubmed: 18029488
Am J Epidemiol. 1998 Sep 1;148(5):497-506
pubmed: 9737562
Infect Immun. 2007 Aug;75(8):3961-8
pubmed: 17548483
Antimicrob Agents Chemother. 1986 Apr;29(4):645-8
pubmed: 3518625
Infect Immun. 1977 Jul;17(1):78-82
pubmed: 328397
J Clin Microbiol. 2011 Apr;49(4):1376-81
pubmed: 21325554
Am J Clin Nutr. 1997 Jan;65(1):149-52
pubmed: 8988927
Am J Clin Nutr. 2013 Nov;98(5):1170-8
pubmed: 24004889
Lancet. 2018 Feb 24;391(10122):801-812
pubmed: 29254859
PLoS One. 2013 May 29;8(5):e64636
pubmed: 23734210
Ann Intern Med. 1972 May;76(5):697-703
pubmed: 4554412
Clin Diagn Lab Immunol. 2004 May;11(3):548-51
pubmed: 15138180