Author:
ProCite
RefWorks
Reference Manager
BibTeX
Zotero
EndNote
-
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Liu L , Oza S , Hogan D , Chu Y , Perin J , Zhu J , Lawn JE , Cousens S , Mathers C , Black RE , 2016. Global, regional, and national causes of under-5 mortality in 2000–15: an updated systematic analysis with implications for the sustainable development goals. Lancet 388: 3027–3035.
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Prevalence of Pathogens in Young Children Presenting to Hospital with Diarrhea from Lambaréné, Gabon
Gédéon Prince Manouana
Gédéon Prince Manouana
Centre de Recherche Médicales de Lambaréné, Lambaréné, Gabon;
Institut für Tropenmedizin, Eberhad Karls Universität Tübingen, Tübingen, Germany;
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Institut für Tropenmedizin, Eberhad Karls Universität Tübingen, Tübingen, Germany;
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Natalie Byrne
Natalie Byrne
Institut für Tropenmedizin, Eberhad Karls Universität Tübingen, Tübingen, Germany;
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Mirabeau Mbong Ngwese
Mirabeau Mbong Ngwese
Centre de Recherche Médicales de Lambaréné, Lambaréné, Gabon;
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Alvyn Nguema Moure
Alvyn Nguema Moure
Centre de Recherche Médicales de Lambaréné, Lambaréné, Gabon;
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Philipp Hofmann
Philipp Hofmann
German Center for Infection Research (DZIF), Hamburg-Borstel-Lübeck-Riems, Greifswald - Insel Riems, Germany;
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Gedeon Bingoulou Matsougou
Gedeon Bingoulou Matsougou
Centre de Recherche Médicales de Lambaréné, Lambaréné, Gabon;
Département de Pédiatrie, Faculté de Médecine, Université des Sciences de la Santé (USS), Libreville, Gabon;
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Département de Pédiatrie, Faculté de Médecine, Université des Sciences de la Santé (USS), Libreville, Gabon;
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Fabrice Lotola Mougeni
Fabrice Lotola Mougeni
Centre de Recherche Médicales de Lambaréné, Lambaréné, Gabon;
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Elsy Nnoh Dansou
Elsy Nnoh Dansou
Centre de Recherche Médicales de Lambaréné, Lambaréné, Gabon;
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Maradona Daouda Agbanrin
Maradona Daouda Agbanrin
Centre de Recherche Médicales de Lambaréné, Lambaréné, Gabon;
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Christiane Sidonie Mapikou Gouleu
Christiane Sidonie Mapikou Gouleu
Centre de Recherche Médicales de Lambaréné, Lambaréné, Gabon;
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Simon Ategbo
Simon Ategbo
Département de Pédiatrie, Faculté de Médecine, Université des Sciences de la Santé (USS), Libreville, Gabon;
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Jeannot Fréjus Zinsou
Jeannot Fréjus Zinsou
Centre de Recherche Médicales de Lambaréné, Lambaréné, Gabon;
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Bayode Romeo Adegbite
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, The Netherlands;
Amsterdam Infection and Immunity, Amsterdam Public Health, University of Amsterdam, Amsterdam, The Netherlands;
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Department of Infectious Diseases, Center of Tropical Medicine and Travel Medicine, Amsterdam University Medical Centers, Location Amsterdam, Amsterdam, The Netherlands;
Amsterdam Infection and Immunity, Amsterdam Public Health, University of Amsterdam, Amsterdam, The Netherlands;
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Jean Ronald Edoa
Jean Ronald Edoa
Centre de Recherche Médicales de Lambaréné, Lambaréné, Gabon;
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Peter Gottfried Kremsner
Peter Gottfried Kremsner
Centre de Recherche Médicales de Lambaréné, Lambaréné, Gabon;
Institut für Tropenmedizin, Eberhad Karls Universität Tübingen, Tübingen, Germany;
German Center for Infection Research (DZIF), Tübingen, Germany;
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Institut für Tropenmedizin, Eberhad Karls Universität Tübingen, Tübingen, Germany;
German Center for Infection Research (DZIF), Tübingen, Germany;
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Benjamin Mordmüller
Benjamin Mordmüller
Centre de Recherche Médicales de Lambaréné, Lambaréné, Gabon;
Institut für Tropenmedizin, Eberhad Karls Universität Tübingen, Tübingen, Germany;
German Center for Infection Research (DZIF), Tübingen, Germany;
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Institut für Tropenmedizin, Eberhad Karls Universität Tübingen, Tübingen, Germany;
German Center for Infection Research (DZIF), Tübingen, Germany;
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Daniel Eibach
Daniel Eibach
German Center for Infection Research (DZIF), Hamburg-Borstel-Lübeck-Riems, Greifswald - Insel Riems, Germany;
Infectious Disease Epidemiology, Bernhard Nocht Insitute for Tropical Medicine, Hamburg, Germany;
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Infectious Disease Epidemiology, Bernhard Nocht Insitute for Tropical Medicine, Hamburg, Germany;
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Matthew McCall
Matthew McCall
Centre de Recherche Médicales de Lambaréné, Lambaréné, Gabon;
Institut für Tropenmedizin, Eberhad Karls Universität Tübingen, Tübingen, Germany;
Department of Medical Microbiology, Radboudumc, Nijmegen, The Netherlands;
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Institut für Tropenmedizin, Eberhad Karls Universität Tübingen, Tübingen, Germany;
Department of Medical Microbiology, Radboudumc, Nijmegen, The Netherlands;
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Alabi Abraham
Alabi Abraham
Centre de Recherche Médicales de Lambaréné, Lambaréné, Gabon;
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Steffen Borrmann
Steffen Borrmann
Centre de Recherche Médicales de Lambaréné, Lambaréné, Gabon;
Institut für Tropenmedizin, Eberhad Karls Universität Tübingen, Tübingen, Germany;
German Center for Infection Research (DZIF), Tübingen, Germany;
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Institut für Tropenmedizin, Eberhad Karls Universität Tübingen, Tübingen, Germany;
German Center for Infection Research (DZIF), Tübingen, Germany;
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Ayola Akim Adegnika
Ayola Akim Adegnika
Centre de Recherche Médicales de Lambaréné, Lambaréné, Gabon;
Institut für Tropenmedizin, Eberhad Karls Universität Tübingen, Tübingen, Germany;
German Center for Infection Research (DZIF), Tübingen, Germany;
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Institut für Tropenmedizin, Eberhad Karls Universität Tübingen, Tübingen, Germany;
German Center for Infection Research (DZIF), Tübingen, Germany;
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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.
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Author Notes
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.
ProCite
RefWorks
Reference Manager
BibTeX
Zotero
EndNote
-
1.
Troeger C et al. 2017. Estimates of global, regional, and national morbidity, mortality, and aetiologies of diarrhoeal diseases: a systematic analysis for the Global Burden of Disease Study 2015. Lancet Infect Dis 17: 909–948.
-
2.
Liu L , Oza S , Hogan D , Chu Y , Perin J , Zhu J , Lawn JE , Cousens S , Mathers C , Black RE , 2016. Global, regional, and national causes of under-5 mortality in 2000–15: an updated systematic analysis with implications for the sustainable development goals. Lancet 388: 3027–3035.
-
3.
United Nations , 2015. Transforming Our World: The 2030 Agenda for Sustainable Development. United Nations General Assembly 1–35.
-
4.
World Health Organization , 2005. The Treatment of Diarrhoea: A Manual for Physicians and Other Senior Health Workers. Geneva, Switzerland: WHO.
-
5.
Kotloff KL et al. 2013. Burden and aetiology of diarrhoeal disease in infants and young children in developing countries (the global enteric multicenter study, GEMS): a prospective, case-control study. Lancet 382: 209–222.
-
6.
Striepen B , 2013. Parasitic infections: time to tackle cryptosporidiosis. Nature 503: 189–191.
-
7.
Rossle NF , Latif B , 2013. Cryptosporidiosis as threatening health problem: a review. Asian Pac J Trop Biomed 3: 916–924.
-
8.
Koko J , Ambara JP , Ategbo S , Gahouma D , 2013. Épidémiologie des diarrhées aiguës bactériennes de l’enfant à Libreville. Gabon Arch Pédiatrie 20: 432–433.
-
9.
Lekana-Douki SE , Kombila-Koumavor C , Nkoghe D , Drosten C , Drexler JF , Leroy EM , 2015. Molecular epidemiology of enteric viruses and genotyping of rotavirus A, adenovirus and astrovirus among children under 5 years old in Gabon. Int J Infect Dis 34: 90–95.
-
10.
Duong TH , Kombila M , Dufillot D , Richard-Lenoble D , Owono Medang M , Martz M , Gendrel D , Engohan E , Moreno JL , 1991. Role of cryptosporidiosis in infants in Gabon. Results of two prospective studies. Bull Soc Pathol Exot 84: 635–644.
-
11.
Duong TH , Dufillot D , Koko J , Nze-Eyo’o R , Thuilliez V , Richard-Lenoble D , Kombila M , 1995. Cryptosporidiose digestive chez le jeune enfant en zone urbaine au Gabon. Santé 5: 185–188.
-
12.
Breurec S et al. 2016. Etiology and epidemiology of diarrhea in hospitalized children from low income country: a matched case-control study in Central African Republic. PLoS Negl Trop Dis 10: e0004283.
-
13.
Gasparinho C , Mirante MC , Centeno-Lima S , Istrate C , Mayer AC , Tavira L , Nery SV , Brito M , 2016. Etiology of diarrhea in children younger than 5 years attending the bengo general hospital in Angola. Pediatr Infect Dis J 35: e28–e34.
-
14.
Goldman RD , Friedman JN , Parkin PC , 2008. Validation of the clinical dehydration scale for children with acute gastroenteritis. Pediatrics 122: 545–549.
-
15.
Savin C , Carniel E , 2009. Diagnostic des infections. Bactériol Méd 2016: 149–161.
-
16.
Dekker JP , Frank KM , 2015. Salmonella, Shigella, and yersinia. Clin Lab Med 35: 225–246.
-
17.
Verweij JJ , Blangé RA , Templeton K , Schinkel J , Brienen EA , van Rooyen MA , van Lieshout L , Polderman AM , 2004. Cryptosporidium parvum in fecal samples by using multiplex real-time PCR. J Clin Microbiol 42: 1220–1223.
-
18.
Liu J et al. 2016. Use of quantitative molecular diagnostic methods to identify causes of diarrhoea in children: a reanalysis of the GEMS case-control study. Lancet 388: 1291–1301.
-
19.
Presterl E , Zwick RH , Reichmann S , Aichelburg A , Winkler S , Kremsner PG , Graninger W , 2003. Frequency and virulence properties of diarrheagenic Escherichia coli in children with diarrhea in Gabon. Am J Trop Med Hyg 69: 406–410.
-
20.
Manouana GP et al. 2020. Performance of a rapid diagnostic test for the detection of Cryptosporidium spp. in African children admitted to hospital with diarrhea. PLoS Negl Trop Dis 14: e0008448.
-
21.
Checkley W et al. 2015. A review of the global burden, novel diagnostics, therapeutics, and vaccine targets for Cryptosporidium. Lancet Infect Dis 15: 85–94.
-
22.
Gatei W , Wamae CN , Mbae C , Waruru A , Mulinge E , Waithera T , Gatika SM , Kamwati SK , Revathi G , Hart CA , 2006. Cryptosporidiosis: prevalence, genotype analysis, and symptoms associated with infections in children in Kenya. Am J Trop Med Hyg 75: 78–82.
-
23.
Mandomando IM et al. 2007. Etiology of diarrhea in children younger than 5 years of age admitted in a rural hospital of Southern Mozambique. Am J Trop Med Hyg 76: 522–527.
-
24.
Chen SY , Tsai CN , Chao HC , Lai MW , Lin TY , Ko TY , Chiu CH , 2009. Acute gastroenteritis caused by multiple enteric pathogens in children. Epidemiol Infect 137: 932–935.
-
25.
Li LL , Liu N , Humphries EM , Yu JM , Li S , Lindsay BR , Stine OC , Duan ZJ , 2016. Aetiology of diarrhoeal disease and evaluation of viral-bacterial coinfection in children under 5 years old in China: a matched case-control study. Clin Microbiol Infect 22: 381.e9–381.e16.
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