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Measles-associated diarrhea in hospitalized children in Lima, Peru: pathogenic agents and impact on growth
B L Greenberg1, R B Sack, E Salazar-Lindo
1Department of Immunology and Infectious Diseases, Johns Hopkins University School of Hygiene and Public Health, Baltimore, Maryland 21205.
Insights
Measles infection increases the risk of developing diarrhea in young children. This study found higher rates of Campylobacter jejuni and increased diarrhea episodes in children with measles-associated diarrhea.
Area of Science:
- Pediatrics
- Infectious Diseases
- Gastroenterology
Background:
- Measles is a common childhood illness, but its association with diarrhea is not fully understood.
- Diarrhea is a significant cause of morbidity and mortality in young children globally.
Purpose of the Study:
- To investigate the causes and impact of diarrhea in children with measles.
- To compare children with measles-associated diarrhea to those with acute diarrhea only.
Main Methods:
- A case-control study comparing 77 children aged 0-5 years with measles-associated diarrhea to 77 controls with acute diarrhea only.
- Evaluation of growth and diarrheal morbidity for one month post-illness.
- Bacteriologic and virologic testing of stool samples.
Main Results:
- Campylobacter jejuni was more frequently isolated from cases (31%) than controls (16%).
- Rotavirus was absent in cases but present in 28% of controls.
- Children with measles-associated diarrhea experienced a higher incidence density (6.5 vs. 4.1) and longer duration (3 vs. 2 days) of diarrhea episodes.
Conclusions:
- Measles is a significant risk factor for developing diarrhea in young children.
- Bacteriologic and virologic findings suggest measles infection may impact the host's immunologic response, contributing to diarrhea.
Abstract:
Because the causes of measles-associated diarrhea are not well known, 0- to 5-year-old children presenting to the hospital with measles-associated diarrhea (cases, n = 77) or acute diarrhea only (controls, n = 77) were compared. Growth and diarrheal morbidity were evaluated for 1 month after acute illness. Campylobacter jejuni was more frequently isolated from cases (31%) than controls (16%; P = .03). Rotavirus was absent in all cases versus 28% of controls (P less than .001). Incidence density for new episodes of diarrhea was significantly greater in cases (6.5 vs. 4.1; odds ratio, 1.6; confidence intervals, 1.09-2.34; P = .01), as was duration of episodes (3 vs. 2 days, P = .02). Both groups showed similar positive cumulative percentage weight gains throughout follow-up. These data support the theory of measles as a risk factor for developing diarrhea. The bacteriologic and virologic findings may reflect the immunologic response of the host to measles infection.