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Published on: February 17, 2023
Polymicrobial enteric infections in African infants with diarrhoea-results from a longitudinal prospective
Melina Heinemann1, Cornelia Strauchs2, Marc Lütgehetmann3
1Division of Infectious Diseases, I. Department of Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany; Department of Tropical Medicine, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany.
Insights
Polymicrobial enteric infections are common in Ghanaian infants, with more pathogens linked to increased diarrhea risk. Many infants acquire new pathogens without developing illness, highlighting complex infection dynamics.
Area of Science:
- Pediatric infectious diseases
- Microbiology
- Public health in developing nations
Background:
- Enteric infections pose a significant health burden in infants globally.
- Understanding pathogen prevalence and co-detection is crucial for effective treatment and prevention strategies.
- Ghanaian infants experience high rates of diarrheal diseases, necessitating research into causative agents.
Purpose of the Study:
- To investigate the frequency of polymicrobial enteric pathogen detection in Ghanaian infants.
- To compare pathogen detection rates between infants with and without diarrhea.
- To assess the association between the number of detected pathogens and diarrhea severity.
Main Methods:
- A longitudinal case-control study involving infants aged 1-12 months.
- Prospective assessment of infants with and without diarrhea from a peri-urban Ghanaian hospital.
- Stool sample analysis using PCR for 18 enteric pathogens on days 0, 6, and 28.
Main Results:
- High detection rates of at least one enteric pathogen: 93% in cases and 85% in controls.
- Significantly higher median pathogen counts in infants with diarrhea (three) compared to controls (two).
- Enterotoxigenic Escherichia coli, rotavirus, Giardia lamblia, and astrovirus showed the highest attributable fractions for diarrhea.
Conclusions:
- The majority of Ghanaian infants harbor enteric pathogens, often acquired asymptomatically.
- A higher number of co-occurring enteric pathogens may elevate the risk and severity of diarrhea.
- Further research into asymptomatic pathogen acquisition and its implications is warranted.
Objectives:
This longitudinal case-control study aimed to determine the frequency of polymicrobial enteric detections in Ghanaian infants with and without diarrhoea.
Methods:
Infants aged 1-12 months with and without diarrhoea attending the outpatient department of a peri-urban Ghanaian hospital were prospectively assessed and stool samples were collected on days 0, 6 and 28 and analysed for 18 enteric pathogens with PCR.
Results:
At least one enteric pathogen was detected in 100 of 107 cases with diarrhoea (93%) and in 82 of 97 controls (85%). The number of pathogens was higher in cases than in controls (median three versus two pathogens, p 0.001). The adjusted attributable fraction (AF) for diarrhoea was highest for enterotoxigenic Escherichia coli (7.2%, 95% CI -2.0% to 16.3%), rotavirus (4.1%, 95% CI 0.6%-7.5%), Giardia lamblia (2.3%, 95% CI -0.7 to 5.3%) and astrovirus (2.3%, 95% CI -2.9 to 7.5%). In cases, a higher pathogen number was significantly associated with watery stool consistency (median 3, interquartile range (IQR) 2-5 versus median 2.5, IQR 1-4, p 0.014), stool frequency five or more per day (median 4, IQR 3-5 versus median 3, IQR 2-4, p 0.048) and vomiting (median 4, IQR 3-5 versus median 3, IQR 2-4, p 0.025). During follow-up, 94% (78/83) of cases and 85% (67/79) of controls had acquired at least one new pathogen without developing a new episode of diarrhoea.
Conclusion:
Enteric pathogens could be identified in the stool of the vast majority of Ghanaian infants, whereby pathogens were very frequently acquired without resulting in new episodes of diarrhoea during follow-up. A higher number of co-occurring pathogens may increase the risk of diarrhoea and disease severity.
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