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Published on: March 10, 2020
Prevalence of Pathogens in Young Children Presenting to Hospital with Diarrhea from Lambaréné, Gabon
Gédéon Prince Manouana1,2, Natalie Byrne2, Mirabeau Mbong Ngwese1
11Centre de Recherche Médicales de Lambaréné, Lambaréné, Gabon.
Insights
Diarrheal disease in Gabonese children is often caused by enteroinvasive Escherichia coli (EIEC)/Shigella and enterotoxigenic E. coli (ETEC). This study highlights key pathogens contributing to childhood diarrhea in sub-Saharan Africa, informing targeted interventions.
Area of Science:
- Pediatrics
- Infectious Diseases
- Public Health
Background:
- Diarrheal disease is a leading cause of mortality in children under five globally, particularly in sub-Saharan Africa.
- Limited epidemiological data on diarrheal pathogens in this region hinders effective prevention strategies.
- Lack of accessible diagnostics leads to empirical treatment, underscoring the need for etiological studies.
Purpose of the Study:
- To investigate the prevalence and types of infectious agents causing diarrhea in young children in Lambaréné, Gabon.
- To identify the most common pathogens responsible for diarrheal episodes in the Moyen-Ogooué region.
- To provide data for developing targeted preventive measures against childhood diarrhea.
Main Methods:
- An observational study involving 241 children under five with diarrhea in Gabon.
- Stool sample analysis using rapid immunoassay for Rotavirus/adenovirus, bacterial culture for Salmonella spp., and multiplex real-time PCR for other pathogens.
- Detection of Cryptosporidium spp., Giardia lamblia, Cyclospora cayetanensis, enterotoxigenic Escherichia coli (ETEC), and enteroinvasive Escherichia coli (EIEC)/Shigella.
Main Results:
- 50% of participants (121/241) had at least one infectious agent identified.
- Enteroinvasive E. coli (EIEC)/Shigella (30.2%) and enterotoxigenic E. coli (ETEC) (24.6%) were the most prevalent pathogens.
- Giardia lamblia (13.7%), Cryptosporidium spp. (12.9%), and Rotavirus (9.5%) were also frequently detected.
- Coinfections were present in 33% of positive cases, with EIEC/Shigella, ETEC, and Cryptosporidium spp. being common in mixed infections.
Conclusions:
- This study provides crucial etiological insights into childhood diarrhea in Gabon.
- EIEC/Shigella and ETEC are significant contributors to diarrheal disease in this population.
- Further research into infection routes and targeted interventions is warranted to reduce childhood mortality from diarrhea.
Abstract:
Diarrheal disease is the second most frequent cause of mortality in children younger than 5 years worldwide, causing more than half a million deaths each year. Our knowledge of the epidemiology of potentially pathogenic agents found in children suffering from diarrhea in sub-Saharan African countries is still patchy, and thereby hinders implementation of effective preventative interventions. The lack of cheap, easy-to-use diagnostic tools leads to mostly symptomatic and empirical case management. An observational study with a total of 241 participants was conducted from February 2017 to August 2018 among children younger than 5 years with diarrhea in Lambaréné, Gabon. Clinical and demographic data were recorded, and a stool sample was collected. The samples were examined using a commercial rapid immunoassay to detect Rotavirus/adenovirus, conventional bacterial culture for Salmonella spp., and multiplex real-time PCR for Cryptosporidium spp., Giardia lamblia, Cyclospora cayetanensis, enterotoxigenic Escherichia coli (ETEC), and enteroinvasive Escherichia coli (EIEC)/Shigella. At least one infectious agent was present in 121 of 241 (50%) samples. The most frequently isolated pathogens were EIEC/Shigella and ETEC (54/179; 30.2% and 44/179; 24.6%, respectively), followed by G. lamblia (33/241; 13.7%), Cryptosporidium spp. (31/241; 12.9%), and Rotavirus (23/241; 9.5%). Coinfection with multiple pathogens was observed in 33% (40/121) of the positive cases with EIEC/Shigella, ETEC, and Cryptosporidium spp. most frequently identified. Our results provide new insight into the possible causes of diarrheal disease in the Moyen-Ogooué region of Gabon and motivate further research on possible modes of infection and targeted preventive measures.
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