Pathogens Associated With Linear Growth Faltering in Children With Diarrhea and Impact of Antibiotic Treatment: The Global Enteric Multicenter Study

Dilruba Nasrin; William C. Blackwelder; Halvor Sommerfelt; Yukun Wu; Tamer H. Farag; Sandra Panchalingam; Kousick Biswas; Debasish Saha; M. Jahangir Hossain; Samba O. Sow; Robert F.B. Reiman; Dipika Sur; Abu S.G. Faruque; Anita K.M. Zaidi; Doh Sanogo; Boubou Tamboura; Uma Onwuchekwa; Byomkesh Manna; Thandavarayan Ramamurthy; Suman Kanungo; Richard Omore; John B. Ochieng; Joseph O. Oundo; Sumon K. Das; Shahnawaz Ahmed; Shahida Qureshi; Farheen Quadri; Richard A. Adegbola; Martin Antonio; Inacio Mandomando; Tacilta Nhampossa; Quique Bassat; Anna Roose; Ciara E. O'Reilly; Eric D. Mintz; Usha Ramakrishnan; Helen Powell; Yuanyuan Liang; James P. Nataro; Myron M. Levine; Karen L. Kotloff

doi:10.1093/infdis/jiab434

Pathogens Associated With Linear Growth Faltering in Children With Diarrhea and Impact of Antibiotic Treatment: The Global Enteric Multicenter Study

Dilruba Nasrin, William C. Blackwelder, Halvor Sommerfelt, Yukun Wu, Tamer H. Farag, Sandra Panchalingam, Kousick Biswas, Debasish Saha, M. Jahangir Hossain, Samba O. Sow, Robert F.B. Reiman, Dipika Sur, Abu S.G. Faruque, Anita K.M. Zaidi, Doh Sanogo, Boubou Tamboura, Uma Onwuchekwa, Byomkesh Manna, Thandavarayan Ramamurthy, Suman KanungoRichard Omore, John B. Ochieng, Joseph O. Oundo, Sumon K. Das, Shahnawaz Ahmed, Shahida Qureshi, Farheen Quadri, Richard A. Adegbola, Martin Antonio, Inacio Mandomando, Tacilta Nhampossa, Quique Bassat, Anna Roose, Ciara E. O'Reilly, Eric D. Mintz, Usha Ramakrishnan, Helen Powell, Yuanyuan Liang, James P. Nataro, Myron M. Levine, Karen L. Kotloff

Division of Woman and Child Health, Medical College, Pakistan

Research output: Contribution to journal › Article › peer-review

54 Citations (Scopus)

Abstract

Background: The association between childhood diarrheal disease and linear growth faltering in developing countries is well described. However, the impact attributed to specific pathogens has not been elucidated, nor has the impact of recommended antibiotic treatment. Methods: The Global Enteric Multicenter Study enrolled children with moderate to severe diarrhea (MSD) seeking healthcare at 7 sites in sub-Saharan Africa and South Asia. At enrollment, we collected stool samples to identify enteropathogens. Length/height was measured at enrollment and follow-up, approximately 60 days later, to calculate change in height-for-age z scores (ΔHAZ). The association of pathogens with ΔHAZ was tested using linear mixed effects regression models. Results: Among 8077 MSD cases analyzed, the proportion with stunting (HAZ below-1) increased from 59% at enrollment to 65% at follow-up (P <. 0001). Pathogens significantly associated with linear growth decline included Cryptosporidium (P <. 001), typical enteropathogenic Escherichia coli (P =. 01), and untreated Shigella (P =. 009) among infants (aged 0-11 months) and enterotoxigenic E. coli encoding heat-stable toxin (P <. 001) and Cryptosporidium (P =. 03) among toddlers (aged 12-23 months). Shigella-infected toddlers given antibiotics had improved linear growth (P =. 02). Conclusions: Linear growth faltering among children aged 0-23 months with MSD is associated with specific pathogens and can be mitigated with targeted treatment strategies, as demonstrated for Shigella.

Original language	English
Pages (from-to)	S848-S855
Journal	Journal of Infectious Diseases
Volume	224
DOIs	https://doi.org/10.1093/infdis/jiab434
Publication status	Published - 15 Dec 2021

Keywords

Diarrhea
antibiotics
children
growth faltering
pathogens
stunting

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Access to Document

10.1093/infdis/jiab434

Cite this

Nasrin, D., Blackwelder, W. C., Sommerfelt, H., Wu, Y., Farag, T. H., Panchalingam, S., Biswas, K., Saha, D., Jahangir Hossain, M., Sow, S. O., Reiman, R. F. B., Sur, D., Faruque, A. S. G., Zaidi, A. K. M., Sanogo, D., Tamboura, B., Onwuchekwa, U., Manna, B., Ramamurthy, T., ... Kotloff, K. L. (2021). Pathogens Associated With Linear Growth Faltering in Children With Diarrhea and Impact of Antibiotic Treatment: The Global Enteric Multicenter Study. Journal of Infectious Diseases, 224, S848-S855. https://doi.org/10.1093/infdis/jiab434

@article{a03d1eebb4794bbe89f13f079af42249,

title = "Pathogens Associated With Linear Growth Faltering in Children With Diarrhea and Impact of Antibiotic Treatment: The Global Enteric Multicenter Study",

abstract = "Background: The association between childhood diarrheal disease and linear growth faltering in developing countries is well described. However, the impact attributed to specific pathogens has not been elucidated, nor has the impact of recommended antibiotic treatment. Methods: The Global Enteric Multicenter Study enrolled children with moderate to severe diarrhea (MSD) seeking healthcare at 7 sites in sub-Saharan Africa and South Asia. At enrollment, we collected stool samples to identify enteropathogens. Length/height was measured at enrollment and follow-up, approximately 60 days later, to calculate change in height-for-age z scores (ΔHAZ). The association of pathogens with ΔHAZ was tested using linear mixed effects regression models. Results: Among 8077 MSD cases analyzed, the proportion with stunting (HAZ below-1) increased from 59% at enrollment to 65% at follow-up (P <. 0001). Pathogens significantly associated with linear growth decline included Cryptosporidium (P <. 001), typical enteropathogenic Escherichia coli (P =. 01), and untreated Shigella (P =. 009) among infants (aged 0-11 months) and enterotoxigenic E. coli encoding heat-stable toxin (P <. 001) and Cryptosporidium (P =. 03) among toddlers (aged 12-23 months). Shigella-infected toddlers given antibiotics had improved linear growth (P =. 02). Conclusions: Linear growth faltering among children aged 0-23 months with MSD is associated with specific pathogens and can be mitigated with targeted treatment strategies, as demonstrated for Shigella.",

keywords = "Diarrhea, antibiotics, children, growth faltering, pathogens, stunting",

author = "Dilruba Nasrin and Blackwelder, {William C.} and Halvor Sommerfelt and Yukun Wu and Farag, {Tamer H.} and Sandra Panchalingam and Kousick Biswas and Debasish Saha and {Jahangir Hossain}, M. and Sow, {Samba O.} and Reiman, {Robert F.B.} and Dipika Sur and Faruque, {Abu S.G.} and Zaidi, {Anita K.M.} and Doh Sanogo and Boubou Tamboura and Uma Onwuchekwa and Byomkesh Manna and Thandavarayan Ramamurthy and Suman Kanungo and Richard Omore and Ochieng, {John B.} and Oundo, {Joseph O.} and Das, {Sumon K.} and Shahnawaz Ahmed and Shahida Qureshi and Farheen Quadri and Adegbola, {Richard A.} and Martin Antonio and Inacio Mandomando and Tacilta Nhampossa and Quique Bassat and Anna Roose and O'Reilly, {Ciara E.} and Mintz, {Eric D.} and Usha Ramakrishnan and Helen Powell and Yuanyuan Liang and Nataro, {James P.} and Levine, {Myron M.} and Kotloff, {Karen L.}",

note = "Publisher Copyright: {\textcopyright} 2021 The Author(s). Published by Oxford University Press for the Infectious Diseases Society of America.",

year = "2021",

month = dec,

day = "15",

doi = "10.1093/infdis/jiab434",

language = "English",

volume = "224",

pages = "S848--S855",

journal = "Journal of Infectious Diseases",

issn = "0022-1899",

publisher = "Oxford University Press",

}

Nasrin, D, Blackwelder, WC, Sommerfelt, H, Wu, Y, Farag, TH, Panchalingam, S, Biswas, K, Saha, D, Jahangir Hossain, M, Sow, SO, Reiman, RFB, Sur, D, Faruque, ASG, Zaidi, AKM, Sanogo, D, Tamboura, B, Onwuchekwa, U, Manna, B, Ramamurthy, T, Kanungo, S, Omore, R, Ochieng, JB, Oundo, JO, Das, SK, Ahmed, S, Qureshi, S, Quadri, F, Adegbola, RA, Antonio, M, Mandomando, I, Nhampossa, T, Bassat, Q, Roose, A, O'Reilly, CE, Mintz, ED, Ramakrishnan, U, Powell, H, Liang, Y, Nataro, JP, Levine, MM & Kotloff, KL 2021, 'Pathogens Associated With Linear Growth Faltering in Children With Diarrhea and Impact of Antibiotic Treatment: The Global Enteric Multicenter Study', Journal of Infectious Diseases, vol. 224, pp. S848-S855. https://doi.org/10.1093/infdis/jiab434

TY - JOUR

T1 - Pathogens Associated With Linear Growth Faltering in Children With Diarrhea and Impact of Antibiotic Treatment

T2 - The Global Enteric Multicenter Study

AU - Nasrin, Dilruba

AU - Blackwelder, William C.

AU - Sommerfelt, Halvor

AU - Wu, Yukun

AU - Farag, Tamer H.

AU - Panchalingam, Sandra

AU - Biswas, Kousick

AU - Saha, Debasish

AU - Jahangir Hossain, M.

AU - Sow, Samba O.

AU - Reiman, Robert F.B.

AU - Sur, Dipika

AU - Faruque, Abu S.G.

AU - Zaidi, Anita K.M.

AU - Sanogo, Doh

AU - Tamboura, Boubou

AU - Onwuchekwa, Uma

AU - Manna, Byomkesh

AU - Ramamurthy, Thandavarayan

AU - Kanungo, Suman

AU - Omore, Richard

AU - Ochieng, John B.

AU - Oundo, Joseph O.

AU - Das, Sumon K.

AU - Ahmed, Shahnawaz

AU - Qureshi, Shahida

AU - Quadri, Farheen

AU - Adegbola, Richard A.

AU - Antonio, Martin

AU - Mandomando, Inacio

AU - Nhampossa, Tacilta

AU - Bassat, Quique

AU - Roose, Anna

AU - O'Reilly, Ciara E.

AU - Mintz, Eric D.

AU - Ramakrishnan, Usha

AU - Powell, Helen

AU - Liang, Yuanyuan

AU - Nataro, James P.

AU - Levine, Myron M.

AU - Kotloff, Karen L.

PY - 2021/12/15

Y1 - 2021/12/15

N2 - Background: The association between childhood diarrheal disease and linear growth faltering in developing countries is well described. However, the impact attributed to specific pathogens has not been elucidated, nor has the impact of recommended antibiotic treatment. Methods: The Global Enteric Multicenter Study enrolled children with moderate to severe diarrhea (MSD) seeking healthcare at 7 sites in sub-Saharan Africa and South Asia. At enrollment, we collected stool samples to identify enteropathogens. Length/height was measured at enrollment and follow-up, approximately 60 days later, to calculate change in height-for-age z scores (ΔHAZ). The association of pathogens with ΔHAZ was tested using linear mixed effects regression models. Results: Among 8077 MSD cases analyzed, the proportion with stunting (HAZ below-1) increased from 59% at enrollment to 65% at follow-up (P <. 0001). Pathogens significantly associated with linear growth decline included Cryptosporidium (P <. 001), typical enteropathogenic Escherichia coli (P =. 01), and untreated Shigella (P =. 009) among infants (aged 0-11 months) and enterotoxigenic E. coli encoding heat-stable toxin (P <. 001) and Cryptosporidium (P =. 03) among toddlers (aged 12-23 months). Shigella-infected toddlers given antibiotics had improved linear growth (P =. 02). Conclusions: Linear growth faltering among children aged 0-23 months with MSD is associated with specific pathogens and can be mitigated with targeted treatment strategies, as demonstrated for Shigella.

AB - Background: The association between childhood diarrheal disease and linear growth faltering in developing countries is well described. However, the impact attributed to specific pathogens has not been elucidated, nor has the impact of recommended antibiotic treatment. Methods: The Global Enteric Multicenter Study enrolled children with moderate to severe diarrhea (MSD) seeking healthcare at 7 sites in sub-Saharan Africa and South Asia. At enrollment, we collected stool samples to identify enteropathogens. Length/height was measured at enrollment and follow-up, approximately 60 days later, to calculate change in height-for-age z scores (ΔHAZ). The association of pathogens with ΔHAZ was tested using linear mixed effects regression models. Results: Among 8077 MSD cases analyzed, the proportion with stunting (HAZ below-1) increased from 59% at enrollment to 65% at follow-up (P <. 0001). Pathogens significantly associated with linear growth decline included Cryptosporidium (P <. 001), typical enteropathogenic Escherichia coli (P =. 01), and untreated Shigella (P =. 009) among infants (aged 0-11 months) and enterotoxigenic E. coli encoding heat-stable toxin (P <. 001) and Cryptosporidium (P =. 03) among toddlers (aged 12-23 months). Shigella-infected toddlers given antibiotics had improved linear growth (P =. 02). Conclusions: Linear growth faltering among children aged 0-23 months with MSD is associated with specific pathogens and can be mitigated with targeted treatment strategies, as demonstrated for Shigella.

KW - Diarrhea

KW - antibiotics

KW - children

KW - growth faltering

KW - pathogens

KW - stunting

UR - http://www.scopus.com/inward/record.url?scp=85122900824&partnerID=8YFLogxK

U2 - 10.1093/infdis/jiab434

DO - 10.1093/infdis/jiab434

M3 - Article

C2 - 34528677

AN - SCOPUS:85122900824

SN - 0022-1899

VL - 224

SP - S848-S855

JO - Journal of Infectious Diseases

JF - Journal of Infectious Diseases

ER -

Pathogens Associated With Linear Growth Faltering in Children With Diarrhea and Impact of Antibiotic Treatment: The Global Enteric Multicenter Study

Abstract

Keywords

UN SDGs

Access to Document

Other files and links

Fingerprint

Cite this