Aetiology, risk factors and microbiota composition in children with prolonged diarrhoea: A prospective
Andrea Lo Vecchio1, Paolo Quitadamo2, Marco Poeta1
1Department of Translational Medical Science-Section of Pediatrics, University of Naples Federico II, Naples, Italy.
Insights
Prolonged diarrhea in children is often caused by severe intestinal infections. While not linked to specific risk factors or microbiome changes, it typically resolves without special treatment.
Area of Science:
- Pediatric Gastroenterology
- Infectious Diseases
- Microbiome Research
Background:
- Prolonged diarrhea (ProD) is defined as acute-onset diarrhea lasting over one week.
- The etiology, risk factors, and management of ProD are not well-defined.
- Understanding ProD is crucial for pediatric healthcare.
Purpose of the Study:
- To assess the etiology, risk factors, and management of prolonged diarrhea in hospitalized children.
- To investigate the potential role of gut microbiota in ProD.
- To compare ProD cases with acute diarrhea (AD) controls.
Main Methods:
- Prospective enrollment of children aged 30 days to 14 years with diarrhea lasting 7-14 days (ProD) and controls with acute diarrhea (AD).
- High-throughput sequencing of 16S rRNA gene amplicons for stool sample analysis.
- Comparison of clinical presentation, etiology, and potential risk factors between ProD and AD groups.
Main Results:
- Sixty-eight children with ProD and 104 with AD were enrolled.
- Intestinal infections were the primary cause in both groups (ProD 92.9% vs. AD 97.8%).
- ProD was associated with a higher prevalence of bacterial infections (30.8% vs. 8.9%) and a more severe initial clinical presentation, but not specific age, host factors, or microbiome alterations.
Conclusions:
- Prolonged diarrhea in children typically results from severe intestinal infections with a longer-than-expected course.
- No specific risk factors or microbiome alterations were uniquely identified for ProD.
- In most cases, ProD resolves without specific management or therapies.
Aim:
Prolonged diarrhoea (ProD) refers to acute-onset diarrhoea that persists for longer than 1 week. As the aetiology, risk factors and management are poorly defined, we prospectively enrolled children hospitalised in a high-income setting to assess these outcomes and investigate the potential role of gut microbiota.
Methods:
All children aged 30 days to 14 years admitted for acute-onset diarrhoea lasting 7-14 days were included. Children consecutively admitted in the same period for acute diarrhoea (AD) served as controls. High-throughput sequencing of 16S rRNA gene amplicons was used to analyse stool samples from a subset of patients and healthy controls.
Results:
Sixty-eight with ProD and 104 with AD were enrolled. Intestinal infections were the main aetiology of diarrhoea in both groups (ProD 92.9% vs. AD 97.8%). ProD children showed a higher prevalence of bacterial infections compared to AD (30.8% vs. 8.9%, p = 0.024). Neither age, host-related factors, nor microbiome alterations were specifically linked to ProD. However, ProD children had a more severe initial clinical presentation than AD.
Conclusion:
ProD is often the result of an unusually severe intestinal infection that runs a course longer than expected but generally resolves without further problems. No specific management or therapies should be undertaken in most cases.
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