Intestinal pathogen clearance in children with severe acute malnutrition is unrelated to inpatient morbidity

Versloot, Christian J.; Attia, Suzanna; Bourdon, Céline; Richardson, Susan E.; Potani, Isabel; Bandsma, Robert; Voskuijl, Wieger

doi:10.1016/j.clnesp.2018.01.004

Cited by 13 publications

(15 citation statements)

References 15 publications

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“…Two studies among children with SAM, using PCR, reported a prevalence of Giardia of 33% and 38%, respectively [14,15], which is in line with our findings. The lack of association between Giardia and diarrhoea in our study might be due to lack of power, but our finding is in line with several studies, some of which reported higher detection rates of Giardia among non-diarrhoeal controls than among children with diarrhoea [16,30].…”

Section: Discussionsupporting

confidence: 92%

“…The lack of association between Giardia and diarrhoea in our study might be due to lack of power, but our finding is in line with several studies, some of which reported higher detection rates of Giardia among non-diarrhoeal controls than among children with diarrhoea [16,30]. Previous studies also failed to find an association between G. duodenalis and clinical outcome among children with SAM [14,15]. This questions the relevance of diagnosing children with SAM for G. duodenalis.…”

Section: Discussionsupporting

confidence: 79%

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Metronidazole-sensitive organisms in children with severe acute malnutrition: an evaluation of the indication for empiric metronidazole treatment

Zangenberg

Abdissa

Johansen

et al. 2020

Clinical Microbiology and Infection

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a b s t r a c tObjectives: Children with severe acute malnutrition (SAM) are treated with empiric amoxicillin or penicillin and gentamicin because of the high risk of severe infections. Experts have suggested, based on available evidence, adding metronidazole to cover anaerobic bacteraemia and diarrhoea caused by Giardia duodenalis or Clostridium difficile. The objective of this study was to assess the importance of these infections in children with SAM. Methods: Children from 6 months to 15 years with SAM were enrolled and followed clinically. Aerobic and, when patient weight permitted, anaerobic blood cultures were done using Bactec® system, and isolates identified with matrix-assisted laser desorption ionizationetime of flight mass spectrometry. Stool samples were tested for C. difficile, G. duodenalis and Entamoeba histolytica by PCR. Results: A total of 334 children were enrolled and 174 out of 331 (53%) for which data on this was available had diarrhoea. Of 273 patients tested by blood culture, 11 had bacteraemia (4.0%, 95% CI 2.3 e7.1%) but none with strict anaerobic bacteria (0/153, 95% CI 0e2.4%). There was no difference in the prevalence of C. difficile between children with (5/128, 4%) and without (7/87, 8%) diarrhoea (OR 0.47, 95% CI 0.14e1.53), and no difference in the prevalence of Giardia between these groups (78/138, 60% vs. 46/87, 53%; OR 1.34, 95% CI 0.77e2.32). Children with C. difficile had higher mortality than those without this infection (3/11,27%, vs. 7/186,4%; OR 43, 95% CI 3.9e483). Conclusion: Our results do not provide support for empiric metronidazole to cover for anaerobic bacteraemia. Trials evaluating the effect of empiric treatment and its effect on G. duodenalis and C. difficile are warranted. M. Zangenberg, Clin Microbiol Infect 2020;26:255.e7e255.e11

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Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 79%

Metronidazole-sensitive organisms in children with severe acute malnutrition: an evaluation of the indication for empiric metronidazole treatment

Zangenberg

Abdissa

Johansen

et al. 2020

Clinical Microbiology and Infection

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“…It is known that a direct correlation between the content of calprotectin and linear growth is present 21 . Clarifying the relationship between intestinal pathogens [22][23] , ecological enteropathy 24 and growth retardation 25 can help to develop behavioral and therapeutic interventions to reduce this disease manifestation in susceptible pediatric populations.…”

Section: Abbreviations Listmentioning

confidence: 99%

Giardiasis in children: molecular genotyping, growth and calprotectin levels

Сорокман¹,

Sokolnyk²,

POPELYUK³

et al. 2019

Arch Balk Med Union

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La giardiase chez les enfants: le génotype moléculaire, la croissance des enfants et la calprotectine fécaleIntroduction. La giardiase est la plus sévère infection parasitaire de l'intestin humain. L'objectif de l'étude a été d'investiguer la fréquence de la giardiase, trouver son génotype, estimer la croissance et déterminer le niveau de la calprotectine fécale chez les enfants. Matériel et méthodes. On a utilisé la méthode directe microscopique de 688 enfants, âgés de 6 à 18 ans pour G. duodenalis. Deux groupes se sont constitués: Groupe I -avec un test positif pour G. duodenalis (n = 90); groupe II -enfants avec un test négatif (n = 110). On a effectué pour ces enfants, le dosage génétique, l'anthropométrie et la calprotectine fécale. Résultats. Sur ces 688 enfants examinés pour G. duodenalis, 90 ont donné un résultat positif pour ABSTRACT Introduction. G iardiasis is the most frequently reported human intestinal parasitic infection. The objective of the study was to investigate the frequency of giardiasis, carry out the genotyping, estimate the growth and determine the level of fecal calprotectin in children. Material and methods. 688 children aged 6-18 years were examined for Giardia duodenalis by direct microscopy. Two groups were formed: group I -children with a positive test for Giardia duodenalis (n = 90); group II -children with a negative test (n = 110). Genetic examination, anthropometry and fecal calprotectin (FC) evaluation were carried out in these children.Results. Out of the 688 children examined, 90 had a positive result (G. duodenalis (+)). The leading clinical feature of G. duodenalis infection (+) was abdominal pain, followed by nausea and diarrhea. The FC content in the feces of the group I was significantly

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“…Children admitted to hospital with complicated SAM have a high burden of bacterial, parasitic and viral infections and mortality is driven by a range of species (6–8), highlighting that there is no single causative pathogen. After discharge from hospital, infectious morbidity and mortality persists among children recovering from SAM (7, 9, 10). One plausible interpretation is that immune defenses against infection are impaired during undernutrition and that resolution of these defects lags behind nutritional rehabilitation.…”

Section: Introductionmentioning

confidence: 99%

Current Understanding of Innate Immune Cell Dysfunction in Childhood Undernutrition

2019

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Undernutrition affects millions of children in low- and middle-income countries (LMIC) and underlies almost half of all deaths among children under 5 years old. The growth deficits that characterize childhood undernutrition (stunting and wasting) result from simultaneous underlying defects in multiple physiological processes, and current treatment regimens do not completely normalize these pathways. Most deaths among undernourished children are due to infections, indicating that their anti-pathogen immune responses are impaired. Defects in the body's first-line-of-defense against pathogens, the innate immune system, is a plausible yet understudied pathway that could contribute to this increased infection risk. In this review, we discuss the evidence for innate immune cell dysfunction from cohort studies of childhood undernutrition in LMIC, highlighting knowledge gaps in almost all innate immune cell types. We supplement these gaps with insights from relevant experimental models and make recommendations for how human and animal studies could be improved. A better understanding of innate immune function could inform future tractable immune-targeted interventions for childhood undernutrition to reduce mortality and improve long-term health, growth and development.

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Intestinal pathogen clearance in children with severe acute malnutrition is unrelated to inpatient morbidity

Cited by 13 publications

References 15 publications

Metronidazole-sensitive organisms in children with severe acute malnutrition: an evaluation of the indication for empiric metronidazole treatment

Metronidazole-sensitive organisms in children with severe acute malnutrition: an evaluation of the indication for empiric metronidazole treatment

Giardiasis in children: molecular genotyping, growth and calprotectin levels

Current Understanding of Innate Immune Cell Dysfunction in Childhood Undernutrition

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