Etiology of Diarrhea, Nutritional Outcomes, and Novel Intestinal Biomarkers in Tanzanian Infants

Abstract

Objective Diarrheal diseases are a leading cause of morbidity and mortality worldwide, but the etiology of diarrhea and its relationship to nutritional outcomes in resource-limited settings is poorly defined. We sought to determine the etiology of community-acquired diarrhea in Tanzanian infants, and to assess the association with anthropometrics and novel intestinal biomarkers. Methods A convenience sample of infants in a trial of zinc and/or multivitamin supplementation in Tanzania was selected. Subjects were enrolled at age 6 weeks and followed for 18 months. Stool samples were obtained from children with acute diarrhea. A novel, PCR-based TaqMan array was used to screen stool for 15 enteropathogens. A subset of subjects had serum gastrointestinal biomarkers measured. Results 123 subjects with diarrhea were enrolled. The mean ± SD age at stool sample collection was 12.4 ± 3.9 months. Thirty-five enteropathogens were identified in 34 (27.6%) subjects: 11 rotavirus, 9 Cryptosporidium spp, 7 Shigella spp, 3 Campylobacter jejuni / coli, 3 ST-enterotoxigenic E. coli and 2 enteropathogenic E. coli. Subjects with any identified enteropathogen had significantly lower weight-for-length z scores (−0.55 ± 1.10 vs. 0.03 ± 1.30, p=0.03) at the final clinic visit, compared to those without an identified pathogen. Fifty of the 123 subjects (40.7%) had serum analyzed for antibodies to LPS and flagellin. Subjects with any identified enteropathogen had lower IgA antibodies to LPS (0.75 ± 0.27 vs. 1.13 ± 0.77, p=0.01) and flagellin (0.52 ± 0.16 vs. 0.73 ± 0.47, p=0.02), compared to those without an identified pathogen. Conclusion This quantitative PCR method may allow identification of enteropathogens that place children at higher risk for suboptimal growth. IgA anti-LPS and flagellin antibodies hold promise as emerging intestinal biomarkers.

Epidemiology and multiple colonization of gastrointestinal pathogens in rural Tanzanian children with and without diarrhea: A case-control study

“…The groups were comparable regarding age and gender, more vomiting in the diarrhea group compared to the control group further confirmed clinically apparent gastroenteritis within the diarrheal group. Our findings confirmed a high prevalence of bacterial and protozoan intestinal infections previously reported in Tanzanians [ 18 , 19 ]. Among the identified enteropathogenic protozoa, G .…”

Rotavirus and bacterial diarrhoea among children in Ile-Ife, Nigeria: Burden, risk factors and seasonality

“…Rotavirus and bacteria coinfection was reported among diarrhoeic children in this study, with rotavirus and DEC coinfection being the most observed, rotavirus with Shigella coinfection was the next bacteria coinfection between Shigella and Salmonella was observed as the least co-infection in the study. Since there is no recent study in the country that has investigated the aetiology of diarrhoea from viral and bacterial origin to compare the result with, this result is similar to previous findings in developing countries where the combined infection between viral and bacterial etiologies of diarrhoea has been reported [ 21 , 22 , 24 , 36 ]. However, co-infection had no statistical significant on the severity of diarrhoea (P = 0.523).…”

Efficacy of Nitazoxanide Alone or Loaded with Silica Nanoparticle for Treatment of Cryptosporidiosis in Immunocompetent Hosts

“…The introduction of a highly effective rotavirus vaccine decreased overall incidence of rotavirus diarrhea. Thus, Crypto-sporidium is expected to become the leading cause of childhood diarrhea worldwide [5][6] . Few pharmaco-logical interventions are available for Cryptosporidium infection.…”