Microsporidiosis and malnutrition in children with persistent diarrhea, Uganda

Abstract

We show that the microsporidian fungus Enterocytozoon bieneusi is associated with lower rates of weight gain in children in Uganda with persistent diarrhea. This relationship remained after controlling for HIV and concurrent cryptosporidiosis. Children with microsporidiosis were predicted to weigh 1.3 kg less than children without microsporidiosis at 5 years of age.

Figure 1

Nutritional status of children in Uganda with microsporidiosis with or without HIV or concurrent cryptosporidiosis. The infection status and number of children in each infection category are shown. Outliers are indicated with dots (1.5–3 interquartile ranges [IQRs]) or the asterisk (>3 IQR). The dashed horizontal line indicates conventional cut-off for malnutrition (z-score <2), horizontal lines in each column indicate the median score, and error bars indicate the highest and lowest z-scores excluding outliers.

Figure 2

Weight-for-age growth curves of study children (as modeled by multiple linear regression) and reference populations in Uganda (11). Curves represent the median weight-for-age, averaged between boys and girls and controlling for concurrent Cryptosporidium spp. infection. The difference, 95% confidence interval, and significance of the interaction term between Enterocytozoon bieneusi and age reflect the difference in growth rates of children with and without microsporidiosis in ln(kg)/ln(age). R² = 0.42, difference = –0.133, 95% confidence interval –0.23 to –0.03, p = 0.009.