Infection With Escherichia Coli Pathotypes Is Associated With Biomarkers of Gut Enteropathy and Nutritional Status Among Malnourished Children in Bangladesh

Abstract

Escherichia coli (E. coli) pathotypes are the most common cause of diarrhea, especially in developing countries. Environmental Enteric Dysfunction (EED) is presumed to be the result of infection with one or more pathotypes and can affect intestinal health and childhood growth. We sought to investigate the association of E. coli pathotypes infection with biomarkers of EED and nutritional status among slum-dwelling malnourished children in Bangladesh. This study comprised a total of 1050 stunted and at risk of stunting children. TaqMan Array Card assays were used to determine the presence of E. coli pathotypes in feces. Prevalence of infection with EAEC was highest (68.8%) in this cohort of children, followed by EPEC (55.9%), ETEC (44%), Shigella/EIEC (19.4%) and STEC (3.2%). The levels of myeloperoxidase and calprotectin were significantly higher in EAEC (P=0.02 and P=0.04), EPEC (P=0.02 and P=0.03) and Shigella/EIEC (P=0.05 and P=0.02) positive participants while, only calprotectin was significantly higher in ETEC (P=0.01) positive participants. Reg1B was significantly higher in participants with EAEC (P=0.004) while, neopterin levels were significantly lower in ETEC (P=0.003) and Shigella/EIEC (P=0.003) positive cases. A significant positive relationship was observed between EAEC and fecal levels of Reg1B (β = 0.28; 95% CI = 0.12, 0.43; p-value<0.001). Besides, ETEC was found to be positively and significantly associated with the levels of calprotectin (β = 0.14; 95 percent CI = 0.01, 0.26; p-value=0.037) and negatively with neopterin (β = -0.16; 95% CI = -0.30, -0.02; p-value=0.021). On the other hand, infection with EPEC was found to be negatively associated with length-for-age (β = -0.12; 95% CI = -0.22, -0.03; p-value=0.011) and weight-for-age (β = -0.11; 95% CI = -0.22, -0.01; p-value=0.037). The study findings suggest that infection with certain E. coli pathotypes (EAEC and ETEC) influences gut health and EPEC is associated with linear growth and underweight in Bangladeshi children.

Inflammation, the kynurenines, and mucosal injury during human experimental enterotoxigenic Escherichia coli infection

“…A similar increase has been previously reported in individuals infected with Shigella [ 47 ], an invasive pathogen that normally causes more severe infections than ETEC. In contrast, previous studies found lower fecal neopterin levels in infants positive for ETEC and other gut pathogens in infants in LMIC [ 8 , 48 ]. This discrepancy can be explained by neopterin functioning as an immunoattractant in circulation rather than secretion into the gastrointestinal tract or biological differences in infants in LMIC.…”

“…S100A9 itself is also known to enhance phagocytosis by neutrophil granulocytes, as reported for E. coli in vivo [ 50 ]. In Bangladesh, higher fecal calprotectin levels have been observed in ETEC-positive infants [ 8 ]. In patients with inflammatory bowel diseases (IBD) with high fecal calprotectin, fecal and plasma calprotectin usually showed positive associations [ 51 ].…”

“…The gastrointestinal tract is well protected against enteric pathogens, but enteric pathogens can break through these defenses to colonize or invade the cell wall and cause gastrointestinal diseases [ 6 ]. Although ETEC is a non-invasive pathogen, infection with ETEC is assumed to induce mild systemic inflammation [ 7 ], which is supported by recent studies that have identified increased concentrations of fecal inflammation markers in infected adults and infants [ 2 , 8 ].…”

“…compared the levels of different fecal markers of inflammation in ETEC-positive and ETEC-negative children aged 12–18 months. They found that ETEC infections led to increased calprotectin levels and reduced neopterin levels in stools, while myeloperoxidase (MPO) levels did not seem to change [ 8 ]. Brubaker et al .…”

Feature selection and association rule learning identify risk factors of malnutrition among Ethiopian schoolchildren

“…Previously, having access to a clean latrine has been identified as an important determinant of child malnutrition ( 67 , 68 ). Repeated exposure to fecal matter in an unclean school latrine may result in undernutrition through enteric dysfunction, as pathogenic bacteria present in the feces, such as E. Coli , may damage the intestinal mucosa and prevent nutrient absorption ( 69 , 70 ). Additionally, parasites such as Ascaris lumbricoides shed eggs in feces.…”