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Multicenter Study
. 2021 Dec 20;224(12 Suppl 2):S848-S855.
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  1   2 , William C Blackwelder  1   2 , Halvor Sommerfelt  3   4 , Yukun Wu  1   2 , Tamer H Farag  1   2 , Sandra Panchalingam  1   2 , Kousick Biswas  5 , Debasish Saha  6 , M Jahangir Hossain  6 , Samba O Sow  7 , Robert F B Reiman  8 , Dipika Sur  9 , Abu S G Faruque  10 , Anita K M Zaidi  11 , Doh Sanogo  7 , Boubou Tamboura  7 , Uma Onwuchekwa  7 , Byomkesh Manna  9 , Thandavarayan Ramamurthy  9 , Suman Kanungo  9 , Richard Omore  12 , John B Ochieng  12 , Joseph O Oundo  12 , Sumon K Das  10 , Shahnawaz Ahmed  10 , Shahida Qureshi  11 , Farheen Quadri  11 , Richard A Adegbola  6 , Martin Antonio  6 , Inacio Mandomando  13   14 , Tacilta Nhampossa  13   14 , Quique Bassat  13   14   15 , Anna Roose  1   16 , Ciara E O'Reilly  17 , Eric D Mintz  17 , Usha Ramakrishnan  18 , Helen Powell  1   2 , Yuanyuan Liang  19 , James P Nataro  1   2   16 , Myron M Levine  1   2   16 , Karen L Kotloff  1   2   16
Affiliations
Multicenter Study

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

Dilruba Nasrin et al. J Infect Dis. .

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.

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Figures

Figure 1.
Figure 1.
Distribution of diarrhea episodes included in the analysis according to the presence of dysentery, Shigella isolation, and antibiotic treatment. Abbreviation: MSD, moderate to severe diarrhea; WHO, World Health Organization.
See this image and copyright information in PMC

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