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J Infect Dis. Etiology of Diarrhea in Bangladeshi Infants in the First Year of Life Using Molecular Methods

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  • J Infect Dis. Etiology of Diarrhea in Bangladeshi Infants in the First Year of Life Using Molecular Methods

    [Source: The Journal of Infectious Diseases, full page: (LINK). Abstract, edited.]


    Etiology of Diarrhea in Bangladeshi Infants in the First Year of Life Using Molecular Methods

    Mami Taniuchi 1, Shihab U. Sobuz 2, Sharmin Begum 2, James A. Platts-Mills 1, Jie Liu 1, Zhengyu Yang 3, Xin-Qun Wang 3, William A. Petri Jr. 1, Rashidul Haque 2 and Eric R. Houpt 1


    Author Affiliations: <SUP>1</SUP>Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia, Charlottesville, USA 22908; <SUP>2</SUP>Parasitology Lab, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka-1212, Bangladesh; <SUP>3</SUP>Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA 22908

    Corresponding Author: Eric Houpt fax number 434-925-7500, phone number 434-243-9326, and email erh6k@virginia.edu.


    Abstract

    Background.

    Diarrhea causes enormous morbidity and mortality in developing countries yet the relative importance of multiple potential enteropathogens has been difficult to ascertain.


    Methods.

    We performed a longitudinal cohort study from birth to 1 year of age of 147 urban slum children in Bangladesh. Four-hundred twenty episodes of diarrhea and 1385 monthly surveillance stool specimens were analyzed with multiplex PCR for 32 enteropathogen gene targets. For each child we examined enteropathogen quantities over time to ascribe each positive target as a probable or less likely contributor to diarrhea.


    Results.

    Multiple enteropathogens were detected by the first month of life. Diarrhea was associated with a state of overall pathogen excess (mean±SE: 5.6±0.1 enteropathogen gene targets vs. 4.3±0.1 in surveillance stools, P<0.05). After applying a longitudinal, quantitative approach to filter out less likely contributors, each diarrheal episode still had an average of 3.3 probable or dominant targets. Enteroaggregative Escherichia coli, Campylobacter, enteropathogenic E. coli, rotavirus, and Entamoeba histolytica were the most frequent probable contributors to diarrhea. Rotavirus was enriched in moderate to severe diarrheal episodes.


    Conclusions.

    In this community-based study diarrhea appeared to be a multi-pathogen event and a state of enteropathogen excess above a high carriage baseline.


    Received March 15, 2013. Revision received May 13, 2013. Accepted May 15, 2013.

    © The Author 2013. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved.

    For Permissions, please e-mail: journals.permissions@oup.com.


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