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J Pediatr Gastroenterol Nutr. 2018 Feb;66(2):325-333. doi: 10.1097/MPG.0000000000001717.

Enteroaggregative Escherichia coli Subclinical Infection and Coinfections and Impaired Child Growth in the MAL-ED Cohort Study.

Author information

1
Clinical Research Unit and Institute of Biomedicine, Universidade Federal do Ceara, Fortaleza, Ceará, Brazil.
2
Duke Global Health Institute, Duke University, Durham, NC.
3
Institute for Health Metrics and Evaluation, Seattle, WA.
4
National Institutes of Health, Fogarty International Center, Bethesda, MD.
5
Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA.
6
Department of Microbiology, University of Venda.
7
Division of Gastrointestinal Sciences, Christian Medical College and Hospital Vellore, Vellore, India.
8
Department of Gastrointestinal Sciences Christian Medical College.
9
Aga Khan University.
10
Department of Pediatrics, Aga Khan University, Naushahro Feroze, Pakistan.
11
International Centre for Diarrhoeal Disease Research, ICDDR-B, Dhaka, Bangladesh.
12
Haydom Lutheran Hospital, Moshi, Tanzania.
13
Haukeland University Hospital, Haydom, Tanzania.
14
Johns Hopkins University, Baltimore, MD.
15
Walter Reed AFRIMS Research Unit Nepal.
16
Armed Forces Research Institute of Medical Sciences, Kathmandu, Nepal.
17
Foundation for the National Institutes of Health, Baltimore, MD.

Abstract

OBJECTIVE:

We evaluated the impact of subclinical enteroaggregative Escherichia coli (EAEC) infection alone and in combination with other pathogens in the first 6 months of life on child growth.

METHODS:

Nondiarrheal samples from 1684 children across 8 Multisite Birth Cohort Study, Malnutrition and Enteric Diseases (MAL-ED) sites in Asia, Africa, and Latin America were tested monthly; more than 90% of children were followed-up twice weekly for the first 6 months of life.

RESULTS:

Children with subclinical EAEC infection did not show altered growth between enrollment and 6 months. Conversely, EAEC coinfection with any other pathogen was negatively associated with delta weight-for-length (P < 0.05) and weight-for-age (P > 0.05) z scores between 0 and 6 months. The presence of 2 or more pathogens without EAEC was not significantly associated with delta weight-for-length and weight-for-age. The most frequent EAEC coinfections included Campylobacter spp, heat-labile toxin-producing enterotoxigenic E coli, Cryptosporidium spp, and atypical enteropathogenic E coli. Myeloperoxidase levels were increased with EAEC coinfection (P < 0.05). EAEC pathogen codetection was associated with lower neopterin levels compared to those of no-pathogen control children (P < 0.05). Mothers of children with EAEC coinfections had lower levels of education, poorer hygiene and sanitation, lower socioeconomic status, and lower breast-feeding rates compared to mothers of children in whom no pathogen was detected (P < 0.05).

CONCLUSIONS:

These data emphasize the public health importance of subclinical EAEC infection in early infancy in association with other pathogens and the need for improved maternal and child care, hygiene, sanitation, and socioeconomic factors.

PMID:
29356769
DOI:
10.1097/MPG.0000000000001717
[Indexed for MEDLINE]

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