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Pathogen-specific risk of seizure in children with moderate-to-severe diarrhoea: Case control study with follow-up
Farzana Afroze1, Sumon Kumar Das2,3, Shahnawaz Ahmed4
1Nutrition & Clinical Services Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh.
Objective:
To determine the pathogen-specific risk of seizure in under-five children hospitalised with moderate-to-severe diarrhoea (MSD) in rural settings.
Method:
This was a prospective case-control study with follow-up, conducted in a sentinel facility of Global Enteric Multicenter Study in Mirzapur, a rural community of Bangladesh between 2007 and 2010. Children aged 0-59 months who presented with MSD and seizure constituted the cases whereas those who did not have seizure comprised the controls. MSD was defined if the episodes were associated with dehydration or dysentery or required hospitalisation with diarrhoea or dysentery. All enrolled children were followed up at home within 50-90 days of enrolment. A total of 64 cases and 128 randomly selected controls formed the analysable dataset.
Results:
The result of logistic regression analysis after adjusting for potential confounders revealed that shigellosis (Shigella species, OR = 5.34, 95% CI = 2.37-12.04) particularly S. flexneri (OR = 3.34, 95% CI = 1.48-7.57), S. flexneri 6 (OR = 23.24, 95% CI = 2.79-193.85), S. sonnei (OR = 6.90, 95% CI = 2.34-19.85); norovirus (OR = 6.77, 95% CI = 1.69-27.11), fever (OR = 16.75, 95% CI = 1.81-154.70) and loss of consciousness (OR = 35.25, 95% CI = 1.71-726.20) were the independent risk factors for seizure in MSD children. At enrolment, cases had lower WHZ (P = 0.006) compared to their peers, follow-up anthropometrics showed significant improvement in WHZ (P < 0.001) and WAZ (P < 0.05), whereas deterioration in HAZ (P < 0.001) in both cases and controls.
Conclusion:
Childhood MSD episodes particularly due to Shigella and norovirus are often associated with seizure. Prompt identification and appropriate management of children with shigellosis may reduce occurrence and adverse consequences of seizure linked with MSD.
Insights
Shigellosis and norovirus infections significantly increase seizure risk in children with moderate-to-severe diarrhea (MSD). Early diagnosis and treatment of shigellosis can prevent seizure complications in MSD cases.
Area of Science:
- Infectious Diseases
- Pediatrics
- Epidemiology
Background:
- Moderate-to-severe diarrhea (MSD) is a significant health concern in children under five.
- Seizures are a serious complication of diarrheal illnesses in young children.
- Identifying specific pathogens linked to seizures in MSD is crucial for targeted interventions.
Purpose of the Study:
- To determine the pathogen-specific risk factors for seizures in hospitalized children under five with moderate-to-severe diarrhea (MSD).
- To investigate the association between specific enteric pathogens and seizure occurrence in pediatric MSD cases.
Main Methods:
- A prospective case-control study was conducted in a rural Bangladeshi setting.
- Cases were children aged 0-59 months with MSD and seizure; controls were children with MSD but no seizure.
- Logistic regression analysis was used to identify independent risk factors for seizure.
Main Results:
- Shigellosis (particularly S. flexneri and S. sonnei), norovirus, fever, and loss of consciousness were identified as independent risk factors for seizure in MSD children.
- Shigellosis showed a significantly elevated odds ratio (OR=5.34) for seizure.
- Cases exhibited lower Weight-for-Height Z-score (WHZ) at enrollment compared to controls.
Conclusions:
- Childhood MSD episodes, especially those caused by Shigella and norovirus, are frequently associated with seizures.
- Prompt identification and management of shigellosis in children with MSD can potentially reduce the incidence and severity of associated seizures.
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