Symptomatic and Asymptomatic Campylobacter Infections Associated with Reduced Growth in Peruvian Children

Abstract

BackgroundAlthough diarrheal illnesses are recognized as both a cause and effect of undernutrition, evidence for the effect of specific enteropathogens on early childhood growth remains limited. We estimated the effects of undernutrition as a risk factor for campylobacteriosis, as well as associations between symptomatic and asymptomatic Campylobacter infections and growth.Methodology/Principal FindingsUsing data from a prospective cohort of 442 children aged 0–72 months, the effect of nutritional status on the incidence of Campylobacter infection was estimated using uni- and multivariate Poisson models. Multivariate regression models were developed to evaluate the effect of Campylobacter infection on weight gain and linear growth. Overall, 8.3% of diarrheal episodes were associated with Campylobacter (crude incidence rate = 0.37 episodes/year) and 4.9% of quarterly asymptomatic samples were Campylobacter positive. In univariate models, the incidence of Campylobacter infection was marginally higher in stunted than non-stunted children (IRR 1.270, 95% CI (0.960, 1.681)(p = 0.095). When recent diarrheal burdens were included in the analysis, there was no difference in risk between stunted and unstunted children. Asymptomatic and symptomatic Campylobacter infections were associated with reduced weight gain over a three-month period (65.5 g (95% CI: −128.0, −3.0)(p = 0.040) and 43.9 g (95% CI:−87.6, −1.0)(p = 0.049) less weight gain, respectively). Symptomatic Campylobacter infections were only marginally associated with reduced linear growth over a nine month period (−0.059 cm per episode, 95% CI: −0.118, 0.001)(p = 0.054), however relatively severe episodes were associated with reduced linear growth (−0.169 cm/episode, 95% CI −0.310, −0.028)(p = 0.019).Conclusions/SignificanceOur findings suggest that Campylobacter is not as benign as commonly assumed, and that there is evidence to support expanding the indications for antibiotic therapy in campylobacteriosis in children.

Risk Factors for Diarrhea in Children Under Five Years of Age Residing in Peri-urban Communities in Cochabamba, Bolivia

“…[4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21]41 These risk factors were on water, sanitation, hygiene, and knowledge of the causes of childhood diarrheal disease and prevention. All of these variables were obtained from the baseline KPC survey administered to the primary caregiver in each household.…”

“…For Campylobacter, maternal education and household water connection were found to be significant risk factors for this age group. 12 In Blake and others, where five enteric pathogens were compared differences were observed in risk factors between pathogens for children 5 years of age. For example exclusive breastfeeding was protective for shigella, however not for rotavirus or enterotoxigenic Escherichia coli.…”

“…In Cochabamba, Bolivia, the site of this study, the most recent government survey from 2008 reported a diarrhea prevalence of 36.2% for children 5 years of age for the department. 2 Previous studies have identified risk factors for diarrhea such as younger age, 3,4 male gender, 4,5 early weaning, 5-8 seasonal patterns, 5,7,9 low maternal education, 5,9,10 lack of piped water supply, 9,[11][12][13][14][15] poor water-storage practices, 9,14-18 younger maternal age, 11,12 lack of hand washing with soap by caregiver, 18,19 poor sanitation, 9,16,18,20,21 visible feces in the yard, 4 indiscriminate disposal of child feces, 17 unsatisfactory garbage disposal, 11 shorter boiling time, 13 using water from cistern trucks, 13 and not treating water in the home. 13 In a recent multisite study it was found that rotavirus was the most common cause of moderate to severe diarrhea in children 0-23 months of age, and shigellosis for the age group 24-59 months of age.…”

Fecal Markers of Environmental Enteropathy are Associated with Animal Exposure and Caregiver Hygiene in Bangladesh

“…19 This is also consistent with findings from Lee and others who reported that asymptomatic Campylobacter infections were associated with significant reductions in weight gain over a 3-month period. 20 In rural Gambia infants had diarrhea 7.3% of the time, however, elevated lactulose:mannitol (L:M) ratios in urine, a measure of impaired intestinal barrier function, were observed in infants 76% of the time. Furthermore, it was estimated that L:M ratios in this population could predict 43% of observed variation in length growth and 39% of weight growth.…”

Detection of Campylobacter in Stool and Determination of Significance by Culture, Enzyme Immunoassay, and PCR in Developing Countries

“…Campylobacter is often shed for extended periods following such episodes, and asymptomatic excretion is common (11). The prevalence and consequences of these infections on childhood development are unclear, though recently, not only symptomatic Campylobacter infection but also asymptomatic Campylobacter infection has been associated with poor early-childhood weight gain in Peru (12).…”