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

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    Author
    Nasrin, Dilruba
    Blackwelder, 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
    Show allShow less

    Date
    2021-12
    Journal
    Journal of Infectious Diseases
    Publisher
    Oxford University Press
    Type
    Article
    
    Metadata
    Show full item record
    See at
    https://doi.org/10.1093/infdis/jiab434
    Abstract
    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.
    Keyword
    Diarrhea
    antibiotics
    children
    growth faltering
    pathogens
    stunting
    Identifier to cite or link to this item
    http://hdl.handle.net/10713/17762
    ae974a485f413a2113503eed53cd6c53
    10.1093/infdis/jiab434
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