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Persistent diarrhea: a persistent infection with enteropathogens or a gut commensal dysbiosis?
Shafiqul A Sarker1, Tahmeed Ahmed1, Harald Brüssow2
1Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh.
Insights
Persistent diarrhea (PD) in children, often linked to antibiotic misuse, may stem from gut microbiota imbalances rather than persistent infections. Nutritional interventions show promise in managing this significant childhood health burden.
Area of Science:
- Pediatrics
- Microbiology
- Public Health
Background:
- Persistent diarrhea (PD) affects 5-10% of acute diarrhea (AD) episodes in developing countries, causing growth faltering and contributing to half of all diarrhea-related mortality.
- The exact pathogenesis of PD remains unclear, with varying enteropathogen associations reported across different regions.
- Antibiotic misuse during AD is a significant risk factor for developing PD.
Purpose of the Study:
- To investigate the potential role of commensal gut microbiota dysbiosis in the pathogenesis of persistent diarrhea.
- To understand the impact of nutritional interventions on gut microbiota development in children with PD.
Main Methods:
- Analysis of commensal gut microbiota composition in children experiencing persistent diarrhea.
- Evaluation of microbiota changes during nutritional interventions, including lactose-reduced diets and complex plant polysaccharides.
Main Results:
- Enteroaggregative *Escherichia coli* (EAEC) have been identified in some PD cases, but their role may be influenced by prior antibiotic use.
- Effectiveness of nutritional interventions suggests a potential link between gut dysbiosis and PD.
- Further analysis of gut microbiota during nutritional interventions is needed to elucidate PD pathogenesis.
Conclusions:
- Commensal gut microbiota dysbiosis, rather than persistent enteropathogen infection, is increasingly suspected as a key factor in many PD cases.
- Nutritional interventions, particularly those involving complex plant polysaccharides, show promise in managing PD.
- Understanding gut microbiota dynamics in PD is crucial for developing targeted and effective interventions.
Abstract:
In children from developing countries 5-10% of acute diarrhea (AD) episodes develop into persistent diarrhea (PD) defined by > 14 days of diarrhea duration. PD represents a major health burden leading to growth faltering. It is also associated with half of all diarrhea mortality. A rational intervention is thus crucial, but depends on an understanding of the pathogenesis of PD, which is still lacking. Many surveys were conducted in Latin America and in South Asia; they differ, however, with respect to enteropathogens associated with PD. Enteroaggregative strains of Escherichia coli (EAEC) were identified by several studies, but they may reflect selection by the frequent antibiotic use during the preceding AD episode. Epidemiologists have in fact identified antibiotic misuse as a major risk factor for PD. Together with the effectiveness of empirical treatment based on nutritional interventions with lactose-reduced and lactose-free diets and particularly complex plant polysaccharides from green banana, one might suspect a role of commensal gut microbiota dysbiosis instead of a persistent infection with enteropathogens in many PD cases. An analysis of the commensal gut microbiota development in persistent diarrhea during nutritional interventions is likely to increase our understanding of PD pathogenesis.
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