Aeromonas-Associated Diarrhea in Children Under 5 Years: The GEMS Experience

Area of Science:

• Pediatric infectious diseases
• Microbiology
• Global health

Background:

• Diarrheal diseases remain a leading cause of mortality in children under five globally.
• Aeromonas species are increasingly recognized as potential enteric pathogens, particularly in low-resource settings.
• Understanding the epidemiology and risk factors for Aeromonas-associated diarrhea is crucial for targeted interventions.

Purpose of the Study:

• To investigate the clinical findings, epidemiology, and risk factors for moderate-to-severe diarrhea (MSD) associated with Aeromonas species in children aged 0-59 months.
• To determine the significance of Aeromonas as a pathogen in MSD, controlling for other infections and sociodemographic factors.

Main Methods:

• The study utilized data from the Global Enteric Multicenter Study, enrolling 12,110 MSD cases and 17,291 matched controls across South Asia and Sub-Saharan Africa.
• Pooled, age-stratified conditional logistic regression models were applied to assess the association of Aeromonas infection.
• Multivariate logistic regression analysis identified risk factors for Aeromonas positivity in MSD cases.

Main Results:

• Aeromonas was identified as a significant pathogen in 22.2% of MSD cases in Pakistan and Bangladesh.
• Aeromonas remained significant after adjusting for coinfecting pathogens and sociodemographic variables.
• Increased odds of Aeromonas infection were associated with dysentery (especially in younger children), co-infection with Shigella, and severe stunting.

Conclusions:

• Aeromonas species are a significant cause of MSD in Pakistan and Bangladesh.
• The presence of dysentery and co-occurrence with other pathogens, particularly Shigella, are key features of Aeromonas-associated diarrhea.
• Stunting is a significant risk factor for Aeromonas infection in young children.