Reducing stunting among children: the potential contribution of diagnostics

Ricci, Karen A.; Girosi, Federico; Tarr, Phillip I.; Lim, Yee-Wei; Mason, C.; Miller, Mark A.; Hughes, James G.; Seidlein, Lorenz von; Agosti, Jan M.; Guerrant, Richard L.

doi:10.1038/nature05444

Cited by 43 publications

(35 citation statements)

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“…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.…”

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confidence: 99%

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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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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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“…Infectious diarrheal diseases are the second highest global cause of morbidity and mortality, and repeated or prolonged episodes of diarrhea can stunt the growth of infected children and impair cognition (10,17,34). The World Health Organization has estimated that stunting affects approximately 147 million children in the developing world (4), where every child less than 5 years old suffers an average of three diarrheal episodes per year (21).…”

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Nitazoxanide Inhibits Biofilm Production and Hemagglutination by Enteroaggregative Escherichia coli Strains by Blocking Assembly of AafA Fimbriae

Shamir

Warthan

Brown

et al. 2010

Antimicrob Agents Chemother

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Enteroaggregative Escherichia coli (EAEC) strains have emerged as common causes of persistent diarrhea and malnutrition among children and HIV-infected persons. During infection, EAEC typically adheres to the intestinal mucosa via fimbrial adhesins, which results in a characteristic aggregative pattern. In the study described here we investigated whether the broad-spectrum antiparasitic and antidiarrheal drug nitazoxanide (NTZ) might be active against EAEC in vitro. While E. coli strains were resistant to NTZ in rich Luria-Bertani medium (MIC > 64 g/ml), the drug was slightly inhibitory in a minimal medium supplemented with glucose (MinA-G medium; MIC, ϳ32 g/ml). NTZ also inhibited biofilm production by strain EAEC 042 in both Dulbecco's modified Eagle's medium and MinA-G medium with a 50% inhibitory concentration of ϳ12 g/ml.Immunofluorescence and immunoblot analyses with antibody against the major fimbrial subunit AafA of aggregative adherence fimbriae vaariant II (AAF/II) established that the numbers of AAF/II filaments on bacteria grown in the presence of NTZ were dramatically reduced. Comparative quantitative reverse transcription-PCR and reporter gene fusions (aafA::phoA) indicated that aafA expression was unaffected by NTZ, while aggR transcript levels and aggR::lacZ expression were increased ϳ10-and 2.5-fold, respectively, compared with that for the untreated controls. More generally, NTZ inhibited hemagglutination (HA) of red blood cells by the non-biofilm-producing strain JM221 expressing either AAF/I or type I fimbriae. Our findings suggest that the inhibitory action of NTZ on biofilm formation and HA is likely due to inhibition of fimbrial assembly. Antimicrobial agents that inhibit the assembly or function of fimbrial filaments should be good candidates for the prevention of infection.

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“…Other evidence was provided by authors in a previous study [33], which described 47.6% prevalence of stunting among children which was significantly associated with diarrhea.…”

Section: Discussionmentioning

confidence: 71%

Assessing Stunting and Predisposing Factors Among Children

Gupta

2017

Asian J Pharm Clin Res

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Objective: The present study was aimed at "assessing stunting and predisposing factors among children."Methods: Prospective, descriptive, observational and cross-sectional study was conducted comprising children between 2 years and below 5 years age group in the city Fazilka in Punjab, India. Random, two-stage cluster sampling method was adopted. Direct observation and interview methods were used to assess physical appearance, demographic characteristics, habit of soil eating, and episodes of diarrhea (diarrheal episodes 2 weeks before investigation). Inspection method was used to assess nail beds of children to ascertain pallor.Results: Prospective, descriptive, observational and cross-sectional study was conducted comprising children between 2 years and below 5 years age group in the city Fazilka in Punjab, India. Study population was made up of total 440 children which were differentiated into 240/440, 127/440, and 73/440 children representing about 54.5%, 28.9%, and 16.6% of proportions from schools, child care, and slums, respectively. Children 55/240, 36/127, and 35/73 from schools, childcare centers, and slums suffered from stunting which amounted to about 23%, 28%, and 48% prevalence of stunting in school, childcare center, and slum children. Gender-wise characterization of study population depicted boys (260/440) and girls (180/440) with a proportion of 59% boys and 41% girls. Among the participants, about 20.5% (90/440) and 79.5% (350/440) of children belonged to illiterate and literate parents. The odds for stunting were nearly 1.6 times higher among anemic children in comparison to children in non-anemic group represented by odds 0.575 and 0.348 in former and latter groups of children with odds ratio (OR=1.65). Children (n=41) out of total children (n=80) those belonged to income (<2000 INR) per month in family, were stunted and contributed to 51% prevalence of stunting. Another group of children (n=85/360) who belonged to income (>2000 INR) per month in family, suffered from 23.6% prevalence of stunting.Conclusion: National policies should be reformed to generate employment, Maintain minimum support price for Agricultural products, Sustain food security and contribute and promote community sanitation and hygiene.

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Reducing stunting among children: the potential contribution of diagnostics

Cited by 43 publications

References 37 publications

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

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

Nitazoxanide Inhibits Biofilm Production and Hemagglutination by Enteroaggregative Escherichia coli Strains by Blocking Assembly of AafA Fimbriae

Assessing Stunting and Predisposing Factors Among Children

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