Pediatric Diarrhea in Southern Ghana: Etiology and Association with Intestinal Inflammation and Malnutrition

Opintan, Japheth A.; Newman, Mercy J.; Ayeh‐Kumi, Patrick F.; Affrim, Raymond; Gepi-Attee, Rosina; Sevilleja, Jesus Emmanuel; Roche, James K.; Nataro, James P.; Warren, Cirle A.; Guerrant, Richard L.

doi:10.4269/ajtmh.2010.09-0792

Cited by 100 publications

(108 citation statements)

References 50 publications

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“…Shigella-infected children are found to be often malnourished because of their poor immune responses, which may be caused by loss of appetite and consequent inadequate intake, increased catabolism, damage of intestinal epithelium, reduced absorptive functions, and loss of nutrients in stool as well as protein loosing enteropathy. 40,41 Interestingly, no such significant relationship was found in cases of V. cholerae.…”

Section: Discussionmentioning

confidence: 85%

Severity of Diarrhea and Malnutrition among Under Five-Year-Old Children in Rural Bangladesh

Ferdous¹,

Das²,

Ahmed³

et al. 2013

The American Journal of Tropical Medicine and Hygiene

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Abstract. Enteric pathogens are commonly associated with diarrhea among malnourished children. This study aimed to determine the association between the severity of diarrheal illnesses and malnutrition among under 5-year-old children. During 2010 and 2011, we studied 2,324 under 5-year-old diarrheal children with mild disease (MD) and moderateto-severe disease (MSD) attending a hospital in Bangladesh. Children with MSD were more likely to be malnourished compared with children with MD (35% versus 24%, P 0.001). In multivariate analysis, malnutrition (odds ratio [95% confidence interval] = 1

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Section: Discussionmentioning

confidence: 85%

Severity of Diarrhea and Malnutrition among Under Five-Year-Old Children in Rural Bangladesh

Ferdous¹,

Das²,

Ahmed³

et al. 2013

The American Journal of Tropical Medicine and Hygiene

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“…A study by Steiner et al investigated childhood diarrhea and found increased levels of inflammation mediators, even in asymptomatic EAECpositive carriers, compared to healthy EAEC-negative controls (93). In another study performed in southern Ghana, children who were asymptomatic carriers of EAEC showed increased levels of fecal lactoferrin (105). These findings suggest that EAEC could have pathogenic potential in asymptomatic carriers.…”

Section: Inflammatory Responsementioning

confidence: 76%

Epidemiology and Clinical Manifestations of Enteroaggregative Escherichia coli

et al. 2014

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SUMMARY Enteroaggregative Escherichia coli (EAEC) represents a heterogeneous group of E. coli strains. The pathogenicity and clinical relevance of these bacteria are still controversial. In this review, we describe the clinical significance of EAEC regarding patterns of infection in humans, transmission, reservoirs, and symptoms. Manifestations associated with EAEC infection include watery diarrhea, mucoid diarrhea, low-grade fever, nausea, tenesmus, and borborygmi. In early studies, EAEC was considered to be an opportunistic pathogen associated with diarrhea in HIV patients and in malnourished children in developing countries. In recent studies, associations with traveler's diarrhea, the occurrence of diarrhea cases in industrialized countries, and outbreaks of diarrhea in Europe and Asia have been reported. In the spring of 2011, a large outbreak of hemolytic-uremic syndrome (HUS) and hemorrhagic colitis occurred in Germany due to an EAEC O104:H4 strain, causing 54 deaths and 855 cases of HUS. This strain produces the potent Shiga toxin along with the aggregative fimbriae. An outbreak of urinary tract infection associated with EAEC in Copenhagen, Denmark, occurred in 1991; this involved extensive production of biofilm, an important characteristic of the pathogenicity of EAEC. However, the heterogeneity of EAEC continues to complicate diagnostics and also our understanding of pathogenicity.

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“…The incidence of disease due to Cryptosporidium spp. and E. histolytica, and possibly Giardia spp., is increased with malnutrition (13,14). Repeated infections are common and can cause developmental delay in children (6, 15).…”

mentioning

confidence: 99%

Multisite Performance Evaluation of an Enzyme-Linked Immunosorbent Assay for Detection of Giardia, Cryptosporidium, and Entamoeba histolytica Antigens in Human Stool

et al. 2012

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A novel fecal antigen detection assay for fresh and frozen human samples that detects but does not differentiate Giardia spp, Cryptosporidium spp, and Entamoeba histolytica, the Tri-Combo parasite screen, was compared to three established enzymelinked immunosorbent assays (ELISAs) at three international sites. It exhibited 97.9% sensitivity and 97.0% specificity, with positive and negative predictive values of 93.4% and 99.1%, respectively. The Tri-Combo test proved a reliable means to limit the use of individual parasite ELISAs to positive samples. While death from diarrheal infections has decreased, levels of morbidity have not declined in comparison to historical levels and thus remain a significant health problem, especially in the developing world (7,11). Three of the most common causes of protozoan-associated diarrheal infections are Giardia spp., Cryptosporidium spp., and Entamoeba histolytica (16). All three of these parasites are transmitted via a classical fecal-oral cycle (1). Cryptosporidium spp. are common throughout both the developed and developing world and can cause persistent diarrhea in HIV-infected individuals (2,12,19). Control of this organism can prove difficult due to its resistance to standard disinfection methods (e.g., chlorination of water sources) (3). E. histolytica is a singlecell ameba that is the cause of amebiasis (20). Clinical manifestations include diarrhea, dysentery, toxic megacolon, and liver abscess (5). The incidence of disease due to Cryptosporidium spp. and E. histolytica, and possibly Giardia spp., is increased with malnutrition (13,14). Repeated infections are common and can cause developmental delay in children (6, 15). Because treatment regimens for these infections are available, there is a need for rapid and cost-effective diagnostic screening methods (8,10,16,17).The Tri-Combo parasite screen test (TechLab, Blacksburg, VA), intended for clearance by the U.S. Food and Drug Administration (FDA), is an enzyme-linked immunosorbent assay developed to simultaneously detect Giardia spp., Cryptosporidium spp., and E. histolytica antigens in human fecal specimens. The microtiter plate format allows the rapid screening of large numbers of clinical specimens. Similar to other immunoassay-type tests for these three parasites, the Tri-Combo test is not designed for use with fixed fecal specimens. When a clinical sample is positive by the Tri-Combo test, additional testing for the presence of Giardia spp., Cryptosporidium spp., and/or E. histolytica parasites is indicated, as the test does not distinguish between these parasites.A panel of 618 diarrheal and nondiarrheal human fecal specimens from male and female subjects aged 4 months to 89 years were tested with the Tri-Combo test at three international sites: 87 clinical samples at the National Institute for Infectious Disease (NIID) in Tokyo, Japan; 297 clinical samples at the International Center for Diarrheal Disease Research, Bangladesh (ICDDR,B), in Dhaka, Bangladesh; and 234 clinical samples at the Bernard Nocht Insti...

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Pediatric Diarrhea in Southern Ghana: Etiology and Association with Intestinal Inflammation and Malnutrition

Cited by 100 publications

References 50 publications

Severity of Diarrhea and Malnutrition among Under Five-Year-Old Children in Rural Bangladesh

Severity of Diarrhea and Malnutrition among Under Five-Year-Old Children in Rural Bangladesh

Epidemiology and Clinical Manifestations of Enteroaggregative Escherichia coli

Multisite Performance Evaluation of an Enzyme-Linked Immunosorbent Assay for Detection of Giardia, Cryptosporidium, and Entamoeba histolytica Antigens in Human Stool

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