Aeromonas-associated diarrhea in children under 5 years: The gems experience

Farah Naz Qamar, Muhammad Imran Nisar, Farheen Quadri, Sadia Shakoor, Samba O. Sow, Dilruba Nasrin, William C. Blackwelder, Yukun Wu, Tamer Farag, Sandra Panchalingham, Dipika Sur, Shahida Qureshi, Abu S.G. Faruque, Debasish Saha, Pedro L. Alonso, Robert F. Breiman, Quique Bassat, B. Tamboura, Thandavarayan Ramamurthy, Suman KanungoShahnawaz Ahmed, Anowar Hossain, Sumon K. Das, Martin Antonio, M. Jahangir Hossain, Inacio Mandomando, Sharon M. Tennant, Karen L. Kotloff, Myron M. Levine, Anita K.M. Zaidi, Eric D. Mintz

Research output: Contribution to journalArticlepeer-review

24 Citations (Scopus)


We report the clinical findings, epidemiology, and risk factors for moderate-to-severe diarrhea (MSD) associated with Aeromonas species in children 0-59 months of age, from the Global Enteric Multicenter Study, conducted at three sites in south Asia and four sites in sub-Saharan Africa. Children with MSD were enrolled along with controls matched for age, gender, and neighborhood. Pooled, age-stratified conditional logistic regression models were applied to evaluate the association of Aeromonas infection controlling for coinfecting pathogens and sociodemographic variables. A pooled, age-stratified, multivariate logistic regression analysis was done to identify risk factors associated with Aeromonas positivity in MSD cases. A total of 12,110 cases and 17,291 matched controls were enrolled over a period of 48 months. Aeromonas was identified as a significant pathogen in 736 cases of MSD in Pakistan and Bangladesh (22.2%). Aeromonas remained a significant pathogen even after adjustment for the presence of other pathogens and sociodemographic factors. Odds ratio (OR) for Aeromonas were higher in the presence of Shigella (matched OR: 6.2, 95% confidence interval [CI]: 1.9-20.2). Cases of Aeromonas were likely to present with dysentery, particularly in the 0-11 months (OR: 1.4, 95% CI 1.0-2.0) and 12-23 months (OR: 1.8, 95% CI: 1.3-2.5) age group. The odds of Aeromonas increased with increasing degree of stunting, being highest for severe stunting (OR: 10.1, 95% CI: 3.6-28.9). Aeromonas is a significant pathogen for MSD in Pakistan and Bangladesh. Presence of dysentery and co-occurrence with other pathogens, notably Shigella spp. are significant features of Aeromonas-associated diarrhea.

Original languageEnglish
Pages (from-to)774-780
Number of pages7
JournalAmerican Journal of Tropical Medicine and Hygiene
Issue number4
Publication statusPublished - Oct 2016


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