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Intestinal pathogen clearance in children with severe acute malnutrition is unrelated to inpatient morbidity
Christian J Versloot1, Suzanna Attia2, Céline Bourdon3
1Physiology and Experimental Medicine, Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, ON, Canada; University of Groningen, University Medical Center Groningen, Department of Pediatric Gastroenterology, Hepatology, and Nutrition, Groningen, The Netherlands.
Insights
Most children with severe acute malnutrition (SAM) clear intestinal pathogens with antibiotic treatment. While pathogen clearance reduces intestinal inflammation, it does not significantly impact clinical outcomes like diarrhea in SAM patients.
Area of Science:
- Pediatric infectious diseases
- Gastroenterology
- Nutritional science
Background:
- Severe acute malnutrition (SAM) in children is frequently complicated by diarrhea, a condition linked to increased mortality.
- The specific roles of intestinal bacteria, parasites, and viruses in causing diarrhea among SAM patients are not well understood.
- Investigating these pathogens is crucial for improving treatment and outcomes for children with SAM.
Purpose of the Study:
- To detect and analyze stool pathogens in children with SAM at hospital admission and after treatment.
- To evaluate the association between the presence of intestinal pathogens and clinical outcomes, including diarrhea.
- To assess changes in intestinal inflammation markers (fecal calprotectin and CRP) in relation to pathogen presence and clearance.
Main Methods:
- A cohort of 47 children aged 8-59 months with complicated SAM in Malawi was studied.
- Stool samples were analyzed for 15 intestinal pathogens, and fecal calprotectin and C-reactive protein (CRP) levels were measured at admission and post-stabilization.
- Statistical analyses, including Wilcoxon tests, were used to compare pathogen prevalence, inflammation markers, and clinical outcomes between the two time points.
Main Results:
- Pathogens were detected in almost all children upon admission, with clearance observed in 55% after treatment (89% vs. 55%, p=0.001).
- Giardia lamblia and Shigella spp. were the most persistent pathogens.
- Higher fecal calprotectin levels were noted in children with persistent pathogens post-stabilization (p=0.03), indicating increased intestinal inflammation, but CRP levels did not correlate.
- The presence of stool pathogens was not significantly associated with clinical outcomes such as diarrhea.
Conclusions:
- Intestinal pathogens are highly prevalent in children with complicated SAM and are largely cleared with antibiotic therapy.
- Persistent pathogens after treatment are linked to heightened intestinal inflammation but do not appear to influence clinical outcomes like diarrhea.
- Further research may be needed to fully elucidate the complex interplay between gut microbiota, inflammation, and clinical outcomes in SAM.
Background & Aims:
Children with Severe Acute Malnutrition (SAM) often suffer from diarrhea, which is associated with increased mortality. The contribution of intestinal bacteria, parasites and viruses to morbidity such as diarrhea in SAM remains poorly understood. To evaluate their association with clinical outcomes, we detected stool pathogens in children with SAM at hospital admission and after clinical stabilization prior to discharge.
Methods:
15 intestinal pathogens, fecal calprotectin and C-reactive protein (CRP) were determined at admission and after clinical stabilization in children aged 8-59 months (n = 47) hospitalized in Malawi for complicated SAM. Differences in fecal pathogens, intestinal and systemic inflammation, and clinical outcomes between time points were evaluated using the Wilcoxon Signed-Rank test or Wilcoxon rank-sum test.
Results:
On admission pathogens were present in nearly all children and after clinical stabilization many were cleared with only 55% of children still harboring a pathogen (89% vs. 55%, p = 0.001). Nosocomial infections were infrequent. The pathogens Giardia lamblia and Shigella spp. were most likely to persist. After clinical stabilization, fecal calprotectin was higher in children harboring a pathogen (median (IQR): 383 mg/kg (903-149 mg/kg) vs 140 mg/kg (300-71 mg/kg), p = 0.03). CRP did not correlate with fecal calprotectin levels nor was it associated with pathogen detection. Presence of stool pathogens was not associated with clinical outcomes such as diarrhea.
Conclusions:
Fecal pathogens were very common and cleared in most children with complicated SAM treated with antibiotics. The presence of stool pathogens after stabilization was associated with increased intestinal inflammation but not with clinical outcomes. (http://www.isrctn.com/ISRCTN13916953).
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