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Common diarrhea pathogens and the risk of dehydration in young children with acute watery diarrhea: a case-control
A S Faruque1, D Mahalanabis, A Islam
1International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh.
Insights
Vibrio cholerae O1 significantly increases dehydration risk in children with acute watery diarrhea. Other common pathogens like E. coli and rotavirus showed no significant link to dehydration in this study.
Area of Science:
- Pediatrics
- Infectious Diseases
- Public Health
Background:
- Acute watery diarrhea is a major cause of dehydration in children globally.
- Identifying specific pathogens linked to severe dehydration is crucial for targeted interventions.
- The International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B) conducts vital research in this area.
Purpose of the Study:
- To investigate the association between common diarrheal pathogens and dehydration in children.
- To determine the specific role of Vibrio cholerae O1 and other enteropathogens in causing dehydration.
Main Methods:
- A case-control study was conducted with 269 children with moderate/severe dehydration and 700 controls without dehydration.
- Children attended a treatment center in Dhaka, Bangladesh.
- Statistical analysis controlled for multiple confounding factors including age, nutritional status, and home care practices.
Main Results:
- Vibrio cholerae O1 infection was significantly associated with dehydration (odds ratio 5.5).
- No significant association was found between dehydration and infections with enterotoxigenic Escherichia coli, Campylobacter jejuni, or rotavirus.
- Vibrio cholerae O1 accounted for a small proportion of dehydration cases (4.5% isolation rate).
Conclusions:
- Vibrio cholerae O1 is a key pathogen contributing to dehydration in children with acute watery diarrhea.
- While cholera is a significant factor, other common pathogens are not strongly linked to dehydration in this context.
- Preventive strategies focusing on correct oral rehydration therapy (ORT) at home, prompt referral, and timely antibiotic use for suspected cholera are essential in endemic areas.
Abstract:
The role of common diarrheal pathogens in dehydration was examined in children with acute watery diarrhea who attended the treatment center of the International Centre for Diarrhoeal Disease Research, Bangladesh, in Dhaka. Two hundred sixty-nine children with moderate or severe dehydration were matched with 700 children with no dehydration. Vibrio cholerae O1 infections were 5.5 times more likely to be associated with dehydration than in cases without this agent. No significant association could be found between the presence of enterotoxigenic Escherichia coli. Campylobacter jejuni, or rotavirus infection and dehydration. These results were obtained after simultaneously controlling for age, lack of oral rehydration therapy (ORT) at home, protein energy malnutrition, withdrawal of breast-feeding during diarrhea at home, poor housing, longer duration of diarrhea at home, and delay in reaching the treatment center. The cholera isolation rate was only 4.5% and thus explains only a small proportion of the cases of dehydration. In cholera-endemic areas, a strategy to prevent dehydration in small children is needed to ensure correct use of ORT at home, prompt referral, and the use of a suitable antibiotic when cholera is clinically suspected.