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Prevalence of Pathogens in Young Children Presenting to Hospital with Diarrhea from Lambaréné, Gabon

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  • 1 Centre de Recherche Médicales de Lambaréné, Lambaréné, Gabon;
  • 2 Institut für Tropenmedizin, Eberhad Karls Universität Tübingen, Tübingen, Germany;
  • 3 German Center for Infection Research (DZIF), Hamburg-Borstel-Lübeck-Riems, Greifswald - Insel Riems, Germany;
  • 4 Département de Pédiatrie, Faculté de Médecine, Université des Sciences de la Santé (USS), Libreville, Gabon;
  • 5 Department of Infectious Diseases, Center of Tropical Medicine and Travel Medicine, Amsterdam University Medical Centers, Location Amsterdam, Amsterdam, The Netherlands;
  • 6 Amsterdam Infection and Immunity, Amsterdam Public Health, University of Amsterdam, Amsterdam, The Netherlands;
  • 7 German Center for Infection Research (DZIF), Tübingen, Germany;
  • 8 Infectious Disease Epidemiology, Bernhard Nocht Insitute for Tropical Medicine, Hamburg, Germany;
  • 9 Department of Medical Microbiology, Radboudumc, Nijmegen, The Netherlands;
  • 10 Charité Universitätsmedizin Berlin, Berlin, Germany;

Abstract.

Diarrheal disease is the second most frequent cause of mortality in children younger than 5 years worldwide, causing more than half a million deaths each year. Our knowledge of the epidemiology of potentially pathogenic agents found in children suffering from diarrhea in sub-Saharan African countries is still patchy, and thereby hinders implementation of effective preventative interventions. The lack of cheap, easy-to-use diagnostic tools leads to mostly symptomatic and empirical case management. An observational study with a total of 241 participants was conducted from February 2017 to August 2018 among children younger than 5 years with diarrhea in Lambaréné, Gabon. Clinical and demographic data were recorded, and a stool sample was collected. The samples were examined using a commercial rapid immunoassay to detect Rotavirus/adenovirus, conventional bacterial culture for Salmonella spp., and multiplex real-time PCR for Cryptosporidium spp., Giardia lamblia, Cyclospora cayetanensis, enterotoxigenic Escherichia coli (ETEC), and enteroinvasive Escherichia coli (EIEC)/Shigella. At least one infectious agent was present in 121 of 241 (50%) samples. The most frequently isolated pathogens were EIEC/Shigella and ETEC (54/179; 30.2% and 44/179; 24.6%, respectively), followed by G. lamblia (33/241; 13.7%), Cryptosporidium spp. (31/241; 12.9%), and Rotavirus (23/241; 9.5%). Coinfection with multiple pathogens was observed in 33% (40/121) of the positive cases with EIEC/Shigella, ETEC, and Cryptosporidium spp. most frequently identified. Our results provide new insight into the possible causes of diarrheal disease in the Moyen-Ogooué region of Gabon and motivate further research on possible modes of infection and targeted preventive measures.

    • Supplementary Materials
    • Supplementary Materials

Author Notes

Address correspondence to Steffen Borrmann or Ayola akim Adegnika, Institut für Tropenmedizin, Eberhard-Karls-Universität Tübingen, Wilhelmstrasse 27, Tübingen, D-72074, Germany. E-mails: steffen.borrmann@uni-tuebingen.de or aadegnika@cermel.org.

Financial support: This study is part of the EDCTP program supported by the European Union. A. A. A. and M. G. P. are members of CANTAM (EDCTP-RegNet2015-1045) and PANDORA-ID-Net (EDCTP Grant Agreement RIA2016E-1609) networks. MGP is supported by CANTAM (EDCTP-RegNet2015-1045). The project is part of DFG funded grant GZ EI 1044/1–1 AOBJ.

Authors’ addresses: Gédéon Prince Mnouana, Centre de Recherche Médicales de Lambaréné, Lambaréné, Gabon, and Institut für Tropenmedizin, Eberhad Karls Universität Tübingen, E-mail: manouanacermel@gmail.com. Natalie Byrne, Institut für Tropenmedizin, Eberhad Karls Universität Tübingen, E-mail: natalie.byrne@student.uni-tuebingen.de. Mirabeau Mbong Ngwese, Alvyn Nguema Moure, Fabrice Lotola Mougeni, Elsy Nnoh Dansou, Maradona Daouda Agbanrin, Christiane Sidonie Mapikou Gouleu, Jeannot Fréjus Zinsou, Jean Ronald Edoa, Alabi Abraham, Centre de Recherche Médicales de Lambaréné, Lambaréné, Gabon, E-mails: mngwese@gmail.com, alvynhyou@gmail.com, fabrice.mougeni@gmail.com, elsydansou@gmail.com, daouda_agbanrin@yahoo.fr, gouschrist@yahoo.fr, jeannot.zinsou@cermel.org, jronaldedoa@gmail.com, and aalabi02@yahoo.co.uk. Philipp Hofmann, Charité- Universitätsmedizin Berlin, Berlin, Germany, E-mail: philipp.hofmann@charite.de. Gedeon Bingoulou Matsougou, Centre de Recherche Médicales de Lambaréné, Lambaréné, Gabon, and Département de Pédiatrie, Faculté de Médecine, Université des Sciences de la Santé (USS), Libreville, Gabon, E-mail: gede.bangs10@gmail.com. Simon Ategbo, Simon Ategbo, Département de Pédiatrie, Faculté de Médecine, Université des Sciences de la Santé (USS), Libreville, Gabon, E-mail: sategbo@yahoo.fr. Bayode Romeo Adegbite, Centre de Recherche Médicales de Lambaréné, Lambaréné, Gabon, Department of Infectious Diseases, Center of Tropical Medicine and Travel Medicine, Amsterdam University Medical Centers, Location Amsterdam, Amsterdam Infection and Immunity, Amsterdam, The Netherlands, and Amsterdam Public Health, University of Amsterdam, Amsterdam, The Netherlands, E-mail: aromakobs@yahoo.fr. Peter Gottfried Kremsner, Benjamin Mordmüller, Steffen Borrmann and Ayola Akim Adegnika, Centre de Recherche Médicales de Lambaréné, Lambaréné, Gabon, Institut für Tropenmedizin, Eberhad Karls Universität Tübingen, Tübingen, Germany, and German Center for Infection Research (DZIF), Tübingen, Germany, E-mails: peter.kremsner@uni-tuebingen.de, benjamin.mordmueller@uni-tuebingen.de, steffen.borrmann@uni-tuebingen.de, and ayola-akim.adegnika@medizin.uni-tuebingen.de. Daniel Eibach, German Center for Infection Research (DZIF), Hamburg-Borstel-Lübeck-Riems, Germany, and Infectious Disease Epidemiology, Bernhard Nocht Insitute for Tropical Medicine, Hamburg, Germany, E-mail: eibach@bnitm.de. Matthew McCall, Centre de Recherche Médicales de Lambaréné, Lambaréné, Gabon, Institut für Tropenmedizin, Eberhad Karls, Tübingen, Germany, and Department of Medical Microbiology, Radboudumc, Nijmegen, The Netherlands, E-mail: matthew.mccall@cermel.org.

These authors contributed equally to this work.

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