Pathogens Associated With Linear Growth Faltering in Children With Diarrhea and Impact of Antibiotic Treatment: The Global Enteric Multicenter Study.
Author
Nasrin, DilrubaBlackwelder, William C
Sommerfelt, Halvor
Wu, Yukun
Farag, Tamer H
Panchalingam, Sandra
Biswas, Kousick
Saha, Debasish
Jahangir Hossain, M
Sow, Samba O
Reiman, Robert F B
Sur, Dipika
Faruque, Abu S G
Zaidi, Anita K M
Sanogo, Doh
Tamboura, Boubou
Onwuchekwa, Uma
Manna, Byomkesh
Ramamurthy, Thandavarayan
Kanungo, Suman
Omore, Richard
Ochieng, John B
Oundo, Joseph O
Das, Sumon K
Ahmed, Shahnawaz
Qureshi, Shahida
Quadri, Farheen
Adegbola, Richard A
Antonio, Martin
Mandomando, Inacio
Nhampossa, Tacilta
Bassat, Quique
Roose, Anna
O'Reilly, Ciara E
Mintz, Eric D
Ramakrishnan, Usha
Powell, Helen
Liang, Yuanyuan
Nataro, James P
Levine, Myron M
Kotloff, Karen L
Date
2021-12Journal
Journal of Infectious DiseasesPublisher
Oxford University PressType
Article
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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. © The Author(s) 2021. Published by Oxford University Press for the Infectious Diseases Society of America.Rights/Terms
© The Author(s) 2021. Published by Oxford University Press for the Infectious Diseases Society of America.Identifier to cite or link to this item
http://hdl.handle.net/10713/17762ae974a485f413a2113503eed53cd6c53
10.1093/infdis/jiab434
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