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