Heterogeneity in enterotoxigenic Escherichia coli and shigella infections in children under 5 years of age from 11 African countries: a subnational approach quantifying risk, mortality, morbidity, and stunting (original) (raw)
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The Lancet Global Health, 2019
Background Enterotoxigenic Escherichia coli (ETEC) and shigella are two major pathogens that cause moderate-to-severe diarrhoea in children younger than 5 years. Diarrhoea is associated with an increased risk of stunting, which puts children at risk of death due to other infectious diseases. Methods We modelled ETEC-related and shigella-related mortality and the effect of moderate-to-severe diarrhoea episodes to determine the number of children with stunting due to these infections in 79 low-income and lower middle-income countries. We applied population attributable risk for increased number of deaths due to other infectious diseases in children who are stunted. We calculated 95% uncertainty intervals (UIs) for the point estimates. Findings In children younger than 5 years, we estimate 196 million (95% UI 135-269) episodes of ETEC and shigella diarrhoea occur annually, resulting in 3•5 million (0•8-5•4) cases of moderate-to-severe stunting and 44 400 (29 400-59 800) total ETEC deaths and 63 100 (44 000-81 900) total shigella deaths in 2015. Additional infectious disease mortality due to stunting resulted in increases of 24% (8-34; for ETEC) and 28% (10-39; for shigella) over direct deaths due to diarrhoeal episodes. The distribution of mortality and morbidity varied geographically, with African Region and Eastern Mediterranean Region countries bearing the greatest burden. Interpretation The expanded effects of non-fatal ETEC and shigella-related diarrhoeal episodes can have lasting consequences. Prevention of these infections could reduce the risk of direct death and stunting and deaths due to other infectious diseases. Understanding the countries and populations with the highest disease risk helps to target interventions for the most vulnerable populations. Funding The Bill & Melinda Gates Foundation.
Escherichia coli pathotypes and Shigella sero-groups in diarrheic children in Nairobi city, Kenya
2017
Aim: In the present study, we investigated the prevalence of E. coli pathotypes and Shigella sero-groups and their antimicrobial profiles among diarrheic children in Nairobi city, Kenya. Background: Although diarrheagenic E. coli pathotypes and Shigella sero-groups are leading causes of diarrhea in children under five years in developing countries, their distribution and antimicrobial resistance vary from place to place and over time in a given region. Methods: In a cross-sectional study, we enrolled diarrheic children (n=354) under five years seeking treatment at Mbagathi Hospital, Nairobi city, Kenya,. Stool samples were collected from all children for bacterial culture. Bacterial isolation and identification was performed by conventional microbiological methods. Polymerase chain amplification was used to detect aspU, aggR, andpcvd432 for EAEC, est and elt for ETEC, eae for EPEC, stx for EHEC, and ipaH for EIEC and Shigella species. Antimicrobial profile was determined by disk dif...
2020
Background: Salmonella and Shigella is a major health problem worldwide, in developing countries like Ethiopia, it is responsible for high morbidity and mortality of children. This study aimed to determine the prevalence of Salmonella and Shigella infection, their antibiotic susceptibility pattern and associated risk factor among the diarrheic paediatrics patients that visited Alamura Health Center in southern Ethiopia. Method: A facility-based cross-sectional study was conducted at Alamura Health Center from April 2018 – July 2019. The study was performed on paediatrics below the age of 14 years in which consecutive children with diarrhoea were included for the study. A structured questionnaire was used to collect socio-demographic and clinical data after assent and consent obtained from parents or caretaker. The stool sample cultured as per the standard operating procedure (SOP) of the microbiology laboratory. Antibiogram was performed by Kirby-Bauer disc diffusion method and was ...
Pediatric Infectious Diseases: Open Access
Background: Environmental Enteropathy (EE) is a complex syndrome involving intestinal disorder which has been observed among children living in resource-poor settings. We investigated stored stool samples collected from children under-5 for relationships between specific enteric pathogens and levels of stool EE markers: Calprotectin (CALP), Alpha-1-Anti-Trypsin (AAT) and Myeloperoxidase (MPO). Methods: We used clinical data and stored stool samples collected prior to, and during the early months of widespread rotavirus vaccine implementation in Lusaka between July 2012 and October 2013 in Lusaka, Zambia. Children were considered eligible if they presented to the facility with symptoms of moderate-to-severe diarrhoea defined by having one or more of the following signs or symptoms: dehydration evidenced by sunken eyes, loss of normal skin turgor, or requiring intravenous resuscitation; dysentery (diarrhoea with blood in stool); or hospitalisation. We randomly selected 320 stool samples from the pool of 2,050 for analysis. We tested for 15 enteric pathogens using the Luminex XTag GPP panel and used commercial ELISA kits to assess the presence and levels of three known fecal markers of EE. We derived an EE score using a weighted sum of CALP, AAT, and MPO and applied a multivariable linear regression model to identify enteric pathogens independently associated with EE score. Results: After excluding insufficient samples (24) and those with missing clinical data (62), a total of the 234 were available for analysis. Of these, 114 (49%) were female, 103 (44%) were asymptomatic for diarrhoea, 181 (77%) had two or more enteric pathogens detected in stool. Fifty-six percent (131/234) children were positive for Rotavirus, 43.2% (101/234) Enterotoxigenic E. coli, 36% (86/234) Giardia, 35% (82/234) Adenovirus and 34.2% (80/234) had Shigella. The mean EE score was 5 (SD=2.25). The median concentration of MPO, CALP, and AAT were 2560.4 ng/ml (interquartile range (IQR)=806.1, 6522.9), 79.1 ng/ml (IQR=0, 362.5), and 48.6 mg/ml (IQR=12.1, 139.5) respectively. Shigella (coefficient=0.92; 95%CI=(0.14, 1.70); p=0.022) and Salmonella (coefficient=0.83; 95%CI=(0.08, 1.58); p=0.030) were independently associated with increase in mean EE score and together with E. coli accounted for 68.5% of the predicted variance in EE score. Conclusions: Salmonella and Shigella were found to be associated with EE and together with accounted for over two-thirds of variability in the EE score.