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Published on: November 7, 2018
Pathogens Associated With Linear Growth Faltering in Children With Diarrhea and Impact of Antibiotic Treatment: The
Dilruba Nasrin1,2, William C Blackwelder1,2, Halvor Sommerfelt3,4
1Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA.
Insights
Childhood diarrhea linked to specific pathogens causes linear growth faltering. Targeted antibiotic treatment for Shigella infections in toddlers improved growth, showing potential for intervention.
Area of Science:
- Global Health
- Pediatric Infectious Diseases
- Nutritional Epidemiology
Background:
- Childhood diarrheal disease is a known contributor to linear growth faltering in developing nations.
- The specific roles of individual enteropathogens and the impact of antibiotic treatments on growth faltering remain unclear.
Purpose of the Study:
- To investigate the association between specific enteropathogens and linear growth faltering in children with moderate to severe diarrhea (MSD).
- To evaluate the impact of antibiotic treatment on linear growth in children with MSD.
Main Methods:
- The Global Enteric Multicenter Study enrolled 8077 children with MSD across 7 sites in sub-Saharan Africa and South Asia.
- Stool samples identified enteropathogens, and height-for-age z scores (HAZ) were measured at enrollment and ~60 days later to assess change (ΔHAZ).
- Linear mixed effects regression models analyzed the association between pathogens and ΔHAZ.
Main Results:
- Stunting prevalence increased from 59% to 65% among children with MSD from enrollment to follow-up.
- Pathogens associated with growth decline included Cryptosporidium, typical enteropathogenic E. coli (infants), and heat-stable enterotoxigenic E. coli (toddlers).
- Untreated Shigella was linked to growth decline in infants, but Shigella-infected toddlers receiving antibiotics showed improved linear growth.
Conclusions:
- Specific enteropathogens are significantly associated with linear growth faltering in young children (0-23 months) with MSD.
- Targeted antibiotic treatment strategies, such as for Shigella infections, can mitigate linear growth faltering.
Background:
The association between childhood diarrheal disease and linear growth faltering in developing countries is well described. However, the impact attributed to specific pathogens has not been elucidated, nor has the impact of recommended antibiotic treatment.
Methods:
The Global Enteric Multicenter Study enrolled children with moderate to severe diarrhea (MSD) seeking healthcare at 7 sites in sub-Saharan Africa and South Asia. At enrollment, we collected stool samples to identify enteropathogens. Length/height was measured at enrollment and follow-up, approximately 60 days later, to calculate change in height-for-age z scores (ΔHAZ). The association of pathogens with ΔHAZ was tested using linear mixed effects regression models.
Results:
Among 8077 MSD cases analyzed, the proportion with stunting (HAZ below -1) increased from 59% at enrollment to 65% at follow-up (P < .0001). Pathogens significantly associated with linear growth decline included Cryptosporidium (P < .001), typical enteropathogenic Escherichia coli (P = .01), and untreated Shigella (P = .009) among infants (aged 0-11 months) and enterotoxigenic E. coli encoding heat-stable toxin (P < .001) and Cryptosporidium (P = .03) among toddlers (aged 12-23 months). Shigella-infected toddlers given antibiotics had improved linear growth (P = .02).
Conclusions:
Linear growth faltering among children aged 0-23 months with MSD is associated with specific pathogens and can be mitigated with targeted treatment strategies, as demonstrated for Shigella.
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