Scientists Identify Pathogens Associated With Paediatric Diarrhoeal Disease

Pathogens associated with moderate-to-severe diarrhoea in infants have been discovered by scientists. The Global Enteric Multicenter Study (GEMS) was designed to identify the aetiology and population-based burden of paediatric diarrhoeal disease in sub-Saharan Africa and south Asia.

It is a 3-year, prospective, age-stratified, matched case-control study of moderate-to-severe diarrhoea in children aged 0-59 months residing in censused populations at four sites in Africa and three in Asia.

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The researchers said that recruited children with moderate-to-severe diarrhoea seeking care at health centres along with one to three randomly selected matched community control children without diarrhoea.

From patients with moderate-to-severe diarrhoea and controls, they said they obtained clinical and epidemiological data, anthropometric measurements, and a faecal sample to identify enteropathogens at enrolment.

One follow-up home visit was made about 60 days later to ascertain vital status, clinical outcome, and interval growth.

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They enrolled 9439 children with moderate-to-severe diarrhoea and 13 129 control children without diarrhoea.

By analysing adjusted population attributable fractions, they found that most attributable cases of moderate-to-severe diarrhoea were due to four pathogens: rotavirus, Cryptosporidium, enterotoxigenic Escherichia coli producing heat-stable toxin (ST-ETEC; with or without co-expression of heat-labile enterotoxin), and Shigella.

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Other pathogens were important in selected sites (eg, Aeromonas, Vibrio cholerae O1, Campylobacter jejuni).

They also found that odds of dying during follow-up were 8.5-fold higher in patients with moderate-to-severe diarrhoea than in controls.

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Pathogens associated with increased risk of case death were ST-ETEC and typical enteropathogenic E coli in infants aged 0-11 months, and Cryptosporidium in toddlers aged 12-23 months.

The researchers noted that interventions targeting five pathogens (rotavirus, Shigella, ST-ETEC, Cryptosporidium, typical enteropathogenic E coli) could substantially reduce the burden of moderate-to-severe diarrhoea.

New methods and accelerated implementation of existing interventions (rotavirus vaccine and zinc) are needed to prevent disease and improve outcomes, they added.

The research was published in Lancet.

Source-ANI