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Identifying Etiological Agents Causing Diarrhea in Low Income Ecuadorian Communities

Gabriela VascoMicrobiology Institute, Universidad San Francisco de Quito, Quito, Ecuador; Centro de Biomedicina, Universidad Central del Ecuador, Quito, Ecuador; Department of Epidemiology, University of Michigan, Ann Arbor, Michigan; Centro de Salud de Guamaní, Ministerio de Salud Pública, Quito, Ecuador

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Gabriel TruebaMicrobiology Institute, Universidad San Francisco de Quito, Quito, Ecuador; Centro de Biomedicina, Universidad Central del Ecuador, Quito, Ecuador; Department of Epidemiology, University of Michigan, Ann Arbor, Michigan; Centro de Salud de Guamaní, Ministerio de Salud Pública, Quito, Ecuador

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Richard AthertonMicrobiology Institute, Universidad San Francisco de Quito, Quito, Ecuador; Centro de Biomedicina, Universidad Central del Ecuador, Quito, Ecuador; Department of Epidemiology, University of Michigan, Ann Arbor, Michigan; Centro de Salud de Guamaní, Ministerio de Salud Pública, Quito, Ecuador

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Manuel CalvopiñaMicrobiology Institute, Universidad San Francisco de Quito, Quito, Ecuador; Centro de Biomedicina, Universidad Central del Ecuador, Quito, Ecuador; Department of Epidemiology, University of Michigan, Ann Arbor, Michigan; Centro de Salud de Guamaní, Ministerio de Salud Pública, Quito, Ecuador

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William CevallosMicrobiology Institute, Universidad San Francisco de Quito, Quito, Ecuador; Centro de Biomedicina, Universidad Central del Ecuador, Quito, Ecuador; Department of Epidemiology, University of Michigan, Ann Arbor, Michigan; Centro de Salud de Guamaní, Ministerio de Salud Pública, Quito, Ecuador

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Thamara AndradeMicrobiology Institute, Universidad San Francisco de Quito, Quito, Ecuador; Centro de Biomedicina, Universidad Central del Ecuador, Quito, Ecuador; Department of Epidemiology, University of Michigan, Ann Arbor, Michigan; Centro de Salud de Guamaní, Ministerio de Salud Pública, Quito, Ecuador

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Martha EguigurenMicrobiology Institute, Universidad San Francisco de Quito, Quito, Ecuador; Centro de Biomedicina, Universidad Central del Ecuador, Quito, Ecuador; Department of Epidemiology, University of Michigan, Ann Arbor, Michigan; Centro de Salud de Guamaní, Ministerio de Salud Pública, Quito, Ecuador

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Joseph N. S. EisenbergMicrobiology Institute, Universidad San Francisco de Quito, Quito, Ecuador; Centro de Biomedicina, Universidad Central del Ecuador, Quito, Ecuador; Department of Epidemiology, University of Michigan, Ann Arbor, Michigan; Centro de Salud de Guamaní, Ministerio de Salud Pública, Quito, Ecuador

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Continued success in decreasing diarrheal disease burden requires targeted interventions. To develop such interventions, it is crucial to understand which pathogens cause diarrhea. Using a case-control design we tested stool samples, collected in both rural and urban Ecuador, for 15 pathogenic microorganisms. Pathogens were present in 51% of case and 27% of control samples from the urban community, and 62% of case and 18% of control samples collected from the rural community. Rotavirus and Shigellae were associated with diarrhea in the urban community; co-infections were more pathogenic than single infection; Campylobacter and Entamoeba histolytica were found in large numbers in cases and controls; and non-typhi Salmonella and enteropathogenic Escherichia coli were not found in any samples. Consistent with the Global Enteric Multicenter Study, focused in south Asia and sub-Saharan Africa, we found that in Ecuador a small group of pathogens accounted for a significant amount of the diarrheal disease burden.

Author Notes

* Address correspondence to Joseph N. S. Eisenberg, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109. E-mail: jnse@umich.com

Financial support: This study was supported by grant No. RO1-AI050038 from the National Institute of Allergy and Infectious Diseases (NIAID) and the Center for Global Health at the University of Michigan.

Authors' addresses: Gabriela Vasco, Gabriel Trueba, and Thamara Andrade, Microbiology Institute, Universidad San Francisco de Quito, Quito, Ecuador, E-mails: piavas_rc@hotmail.com, gtrueba@usfq.edu.ec, and thamaraandrade@yahoo.com. Richard Atherton, Manuel Calvopiña, and William Cevallos, Centro de Biomedicina, Universidad Central del Ecuador, Quito, Ecuador, E-mails: richard.atherton@hotmail.co.uk, mcalvopina@gmail.com, and wcalvopina@gmail.com. Martha Eguiguren, Centro de Salud Guamaní, Ministerio de Salud Pública, Quito, Ecuador, E-mail: m._eguiguren@hotmail.com. Joseph N. S. Eisenberg, School of Public Health, University of Michigan, CA, E-mail: jnse@umich.edu.

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