Enteric pathogens, intestinal permeability and nitric oxide production in acute gastroenteritis

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Assessment of Intestinal Transcytosis of Neonatal Escherichia coli Bacteremia Isolates
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Renata Kukuruzovic1, Roy M Robins-Browne, Nicholas M Anstey

  • 1Northern Territory Clinical School, Flinders University, c/o Royal Darwin Hospital, Australia.

The Pediatric Infectious Disease Journal
|August 23, 2002
PubMed

Insights

Cryptosporidium, Strongyloides, rotavirus, and enteroaggregative E. coli cause severe gastroenteritis in Aboriginal children. These pathogens are linked to acidosis, hypokalemia, and abnormal gut permeability.

Area of Science:

  • Pediatric Infectious Diseases
  • Gastroenterology
  • Microbiology

Background:

  • Aboriginal children in northern Australia experience high rates of severe diarrheal disease.
  • Associated complications include acidosis, hypokalemia, osmotic diarrhea, abnormal small bowel permeability, and elevated nitric oxide (NO) production.

Purpose of the Study:

  • To investigate the relationship between specific enteric pathogens and diarrheal disease severity in Australian Aboriginal children.
  • To identify key pathogens contributing to severe gastroenteritis manifestations.

Main Methods:

  • Study included 291 diarrheal admissions and 84 controls.
  • Pathogen identification used standard microbiologic investigations and PCR.
  • Nitric oxide (NO) production measured via urine nitrate/nitrite excretion.
  • Small bowel permeability assessed using the lactulose:rhamnose ratio.

Main Results:

  • Diagnostic tests for diarrheagenic Escherichia coli increased specific diagnoses from 53% to 75%.
  • Common pathogens: enteroaggregative E. coli (28.9%), rotavirus (26.5%), enteropathogenic E. coli (17.2%), Salmonella spp. (10.7%), Cryptosporidium parvum (7.2%), and Strongyloides stercoralis (7.2%).
  • High small bowel permeability ratios were associated with rotavirus, enteroaggregative E. coli, and Cryptosporidium.
  • Elevated NO production was highest with Cryptosporidium.
  • Rotavirus linked to acidosis/osmotic diarrhea; Strongyloides to wasting/hypokalemia; Cryptosporidium to severe/prolonged diarrhea.

Conclusions:

  • Cryptosporidium, Strongyloides, rotavirus, and enteroaggregative E. coli are significant contributors to severe acute gastroenteritis.
  • These pathogens are associated with critical clinical outcomes in Australian Aboriginal children, highlighting the need for targeted diagnostics and management.
Abstract

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