Identification of Etiology-Specific Diarrhea Associated With Linear Growth Faltering in Bangladeshi Infants

Abstract

Childhood diarrhea in low-resource settings has been variably linked to linear growth shortfalls. However, the association between etiology-specific diarrhea and growth has not been comprehensively evaluated. We tested diarrheal stools collected from the Performance of Rotavirus and Oral Polio Vaccines in Developing Countries study from 2011 to 2013 in Dhaka, Bangladesh, by quantitative polymerase chain reaction for a broad range of enteropathogens to characterize diarrhea etiology and examine the association between etiology-specific diarrhea and linear growth and systemic inflammation. Pathogen-specific burdens of diarrhea were determined using attributable fractions. Linear regression was used to examine associations of pathogen-specific diarrhea with length-for-age z scores (LAZ) and serum C-reactive protein. There was no relationship between all-cause diarrhea and length at 12 months (change in 12-month LAZ per episode, −0.01, 95% confidence interval (CI): −0.06, 0.03). However, Cryptosporidium (change in 12-month LAZ per attributable episode, −0.23, 95% CI: −0.50, 0.03), Campylobacter jejuni/coli (change of −0.16, 95% CI: −0.32, −0.01), and Shigella/enteroinvasive Escherichia coli diarrhea (change of −0.12, 95% CI: −0.26, 0.03) were associated with linear growth deficits. Diarrhea attributable to C. jejuni/coli and Shigella/enteroinvasive E. coli were associated with elevated C-reactive protein. The association between diarrhea and linear growth appears to be pathogen-specific, reinforcing the need for pathogen-specific interventions.

Determinants of stunting during the first 1,000 days of life in Bangladesh: A review

“…Chakraborty (2009) reported that the odds of receiving any food at <4 months and at 4-6 months of age were higher, 1.4 times (aOR 1.40, 95% CI: 1.20-1.60) and 1.18 times (aOR 1.18, 95% CI: 1.02-1.40) in stunted children than in nonstunted children, respectively. Schnee et al (2018) identified the association between stunting and diarrhea was pathogen-specific. The diarrhea caused by Cryptosporidium, Campylobacter, and Shigella associated with stunting in the first year of life and persisted up to 24 months, but not viral diarrhea (Schnee et al, 2018).…”

“…Schnee et al (2018) identified the association between stunting and diarrhea was pathogen-specific. The diarrhea caused by Cryptosporidium, Campylobacter, and Shigella associated with stunting in the first year of life and persisted up to 24 months, but not viral diarrhea (Schnee et al, 2018). (Schnee et al, 2018).…”

“…The diarrhea caused by Cryptosporidium, Campylobacter, and Shigella associated with stunting in the first year of life and persisted up to 24 months, but not viral diarrhea (Schnee et al, 2018). (Schnee et al, 2018). The correlation of malaria, respiratory infection, and inflammation with stunting among children under 2 years of age was not studied in Bangladesh.…”

Risk factors and transmission pathways associated with infant Campylobacter spp. prevalence and malnutrition: A formative study in rural Ethiopia

“…On the other hand there was no evaluation of the prevalence of other pathogenic or parasitic organisms, so it is not certain that the presumptive Campylobacter isolated in samples was the definite cause of wasting and/or diarrhoeal prevalence seen here. A few studies have reported mixed infections of Campylobacter and viral pathogens and their associations with infant morbidities [32,85]. This presence of Campylobacter alongside the carriage of multiple pathogens may correlate as a proxy for infants with greater overall levels of exposure to enteric pathogens in their environment; this in turn may associate with those with poor growth and/or wasting.…”

High-throughput multi-parallel enteropathogen quantification via nano-liter qPCR

“…Over time, molecular diagnostics were developed from single-gene qPCR assays to multiplex reactions (10–14) and to multi-assay, multi-sample arrays that can be operated in parallel on a single chip or card (15–19). Specifically in the field of enteric pathogen detection, a TaqMan Array Card (TAC) was developed by Liu and colleagues (15, 16) and subsequently used in several studies to estimate pathogen-attributable diarrhea burdens (3, 4, 20), as well as the impact of enteric pathogens on child growth (21–23) and vaccine uptake (24, 25). However, despite advances in the throughput of molecular detection of pathogens, costs associated with broad multi-target molecular assays still pose a barrier to their widespread use in epidemiological studies.…”