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Mechanisms and impact of enteric infections
R L Guerrant1, A A Lima, M Barboza
1Division of Geographic and International Medicine, University of Virginia, Charlottesville, USA.
Insights
Understanding enteric pathogens is crucial for child health. Early childhood diarrhea and infections cause long-term growth issues, impacting human development and global security.
Area of Science:
- Gastroenterology and Infectious Diseases
- Pediatric Health and Nutrition
- Global Public Health
Background:
- Diarrheal diseases cause over 3 million child deaths annually.
- Enteric infections, even without diarrhea, are linked to childhood growth shortfalls and malnutrition.
- The long-term consequences of enteric infections are increasingly recognized as a significant public health concern.
Purpose of the Study:
- To improve understanding of enteric pathogen pathogenesis and effective interventions.
- To quantify the extended impact of enteric infections on child development.
- To identify physiological derangements associated with persistent diarrheal illnesses.
Main Methods:
- Utilizing lactulose/mannitol permeability tests to assess intestinal barrier function.
- Employing fecal lactoferrin measurements to quantify sub-mucosal inflammation.
- Investigating common themes in persistent diarrheal illnesses, such as blunted villi.
Main Results:
- Persistent diarrheal illnesses are characterized by blunted villi and disrupted intestinal barrier function.
- Sub-mucosal inflammation is a common feature, quantifiable by fecal lactoferrin levels.
- Enteric infections are increasingly identified as a cause of growth shortfalls, independent of overt diarrhea.
Conclusions:
- Improved understanding of enteric infection physiology is essential for developing targeted interventions.
- Addressing enteric infections can mitigate long-term impacts on child development and reduce global health disparities.
- Effective interventions for enteric diseases are critical for improving human development and global security.
Abstract:
The increased recognition of both old and new enteric pathogens and their potential impact requires an improved understanding of pathogenesis and effective interventions. While the overwhelming mortality (> 3 million children per year) due to diarrheal diseases is well-recognized, the potential long-term impacts of enteric infections and early childhood diarrhea morbidity are just beginning to be appreciated. Furthermore, several enteric infections are now being recognized as causes of growth shortfalls with or without diarrhea; i.e., malnutrition may be one of the greatest yet of the "emerging infectious diseases." The increased appreciation of this extended impact calls for further quantification and improved understanding of the deranged physiology. In particular, persistent diarrheal illnesses exhibit common themes of blunted villi, disruption of intestinal barrier function and varying degrees of sub-mucosal inflammation for which lactulose/mannitol permeability and fecal lactoferrin provide respective quantification. Finally, such improved understanding will allow targeted interventions among those most vulnerable, which will enable further documentation of cost effectiveness and the potential for improved human development which is critical to reducing the widening disparity and population overgrowth which increasingly threaten our global security.