Impact of Asymptomatic Enteroaggregative Escherichia coli Infection and Co-Pathogen Burden on Intestinal Barrier Function, Linear Growth, and Cognitive Development in Early Childhood: Insights from a Birth Cohort Study

Enteroaggregative Escherichia coli (EAEC) is a major enteric pathogen in low-resource settings. The aim for the present study is to reanalyze the effects of subclinical EAEC infection, alone or in combination with other pathogens, on intestinal function, growth, and cognition in children aged 0–6 months through molecular diagnosis. A total of 1,659 non-diarrheal stool samples from the Etiology, Risk Factors and Interactions of Enteric Infections and Malnutrition and the Consequences for Child Health and Development cohort were analyzed using quantitative polymerase chain reaction testing for 29 enteropathogens. Children were grouped by infection status: EAEC alone or with 1, 2, or $3 co-pathogens. Enteroaggregative Escherichia coli and a higher pathogen burden were associated with lower socioeconomic status and greater antibiotic use (P ,0.001). Enteroaggregative Escherichia coli with $3 co-pathogens was linked to elevated neopterin (b 5 687.5; CI: 129.7–1,245.3), increased intestinal permeability (b 5 0.41; CI: 0.058–0.77), and a lower length-for-age z-score (b 5 –0.44; CI: –0.76 to –0.12), and EAEC alone reduced cognitive scores at 15 and 24 months of age (b 5 –2.82 and –5.02, respectively; CI: –5.15 to –0.48 and –9.81 to –0.22, respectively). Subclinical EAEC infection is associated with inflammation, gut dysfunction, growth failure, and cognitive delay.