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Research Article

Clinico-Epidemiological Characteristics of Symptomatic and Asymptomatic Enterotoxigenic and Enteropathogenic Escherichia Coli Diarrhea and Impact on Child Growth

Al-Afroza Sultana Nutrition Research Division, International Centre for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh;

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Rina Das Nutrition Research Division, International Centre for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh;
Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia;

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Md Nasif Hossain Environmental Institute, University of Virginia, Charlottesville, Virginia;
Division of Infectious Diseases and International Health, University of Virginia School of Medicine, Charlottesville, Virginia;

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Rukaeya Amin Sobi Nutrition Research Division, International Centre for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh;

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Farina Naz Nutrition Research Division, International Centre for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh;

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Soroar Hossain Khan Nutrition Research Division, International Centre for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh;

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Sabiha Nasrin Nutrition Research Division, International Centre for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh;
Department of Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts, Amherst, Massachusetts;

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Sharika Nuzhat Nutrition Research Division, International Centre for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh;

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Mohammod Jobayer Chisti Nutrition Research Division, International Centre for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh;

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Pradip K. Bardhan Nutrition Research Division, International Centre for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh;

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Protim Sarker Nutrition Research Division, International Centre for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh;

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Tahmeed Ahmed Nutrition Research Division, International Centre for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh;
James P. Grant School of Public Health, BRAC University, Dhaka, Bangladesh;
Department of Global Health, University of Washington, Seattle, Washington;

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Subhra Chakraborty Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland

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ASG Faruque Nutrition Research Division, International Centre for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh;

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DOI:
https://doi.org/10.4269/ajtmh.24-0347
Volume/Issue:
Ahead of Print
Open access
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Enterotoxigenic Escherichia (E.) coli (ETEC) and enteropathogenic E. coli (EPEC) are major bacterial causes of childhood diarrhea. We explored the clinico-epidemiological characteristics of children aged <5 years associated with moderate-to-severe diarrhea (MSD), asymptomatic ETEC or EPEC infections, and subsequent impact on growth reflected by z-score. Data from 9,439 MSD and 13,128 asymptomatic children were extracted from Global Enteric Multicenter Study, conducted between 2007 and 2011. Epidemiological risk factors and clinical characteristics of ETEC and EPEC infection were explored using multivariable logistic regression, and a paired t-test was used to investigate the impact of infection on nutritional status. Children aged 12–23 months were more affected by ETEC-positive MSD compared with 0–11 months, whereas children aged 0–11 months were more vulnerable to EPEC-positive MSD. ETEC- and EPEC-positive MSD children showed more characteristics of clinical dehydration like sunken eyes and loss of skin turgor preservation, and needed more intravenous rehydration than ETEC- and EPEC-negative MSD children. Among the other identified co-pathogen, presence of Campylobacter in the analyzed stool sample had higher likelihood to be associated with symptomatic MSD (adjusted odds ratio [aOR] 1.42, 95% CI 1.17–1.71) and asymptomatic children with ETEC infection (aOR 1.42, 95% CI 1.16–1.73) and asymptomatic EPEC infection (aOR 1.22, 95% CI 1.04–1.43). Significant growth faltering was noted in MSD children with ETEC (mean difference 0.22, 95% CI 0.10–0.34) and EPEC (mean difference 0.15, 95% CI 0.03–0.27) from baseline to ∼60 days (50–90 days). Our findings highlight the need to implement preventative strategies to reduce the risk of diarrheal illnesses.

Author Notes

Financial support: This work was supported, in whole or in part, by the Bill and Melinda Gates Foundation to ASG Faruque and by the core donors who provide unrestricted support to the International Centre for Diarrheal Disease Research, Bangladesh for its operations and research. Current donors providing unrestricted support include the governments of Bangladesh and Canada. Under the grant conditions of the foundation, a Creative Commons Attribution 4.0 Generic License has already been assigned to the author’s accepted manuscript version that might arise from this submission. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Data availability: A publicly available GEMS dataset was analyzed in this study. These data can be obtained here: Clinical Epidemiology Database Resources (ClinEpiDB) (https://clinepidb.org/ce/app/record/dataset/DS_841a9f5259). After the thorough review and approval process by the ClinEpiDB study team, we have obtained official data access from ClinEpiDB, the responsible entity for managing the GEMS data repository.

Authors’ contributions: A. A. Sultana, A. Faruque, T. Ahmed, and R. Das conceptualized and designed the study; S. H. Khan managed the dataset and gave technical support; A. A. Sultana and M. N. H. conducted the statistical analysis of data; A. A. Sultana prepared the original draft; T. Ahmed gave final approval to the version to be published; and all authors contributed to the review and editing of the manuscript to the final version, and have read and agreed to the published version of the manuscript.

Current contact information: Al-Afroza Sultana, Rina Das, Rukaeya Amin Sobi, Soroar Hossain Khan, Sabiha Nasrin, Sharika Nuzhat, Mohammod Jobayer Chisti, Pradip K. Bardhan, Protim Sarker, Tahmeed Ahmed, and ASG Faruque, Nutrition Research Division, International Center for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh, E-mails: afroza.akhi@icddrb.org, rina.das@icddrb.org, rukaeya.amin@icddrb.org, soroar@icddrb.org, sabiha.nasrin@icddrb.org, sharika.nuzhat@icddrb.org, chisti@icddrb.org, pradip.bardhan@gmail.com, protim@icddrb.org, tahmeed@icddrb.org, and gfaruque@icddrb.org. Md Nasif Hossain, Environmental Institute, University of Virginia, Charlottesville, Virginia, and Division of Infectious Diseases and International Health, University of Virginia School of Medicine, Charlottesville, Virginia, E-mail: nasif.stat.iu@gmail.com. Farina Naz, Health System and Population Studies Division, International Center for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh, E-mail: farina.naz@icddrb.org. Subhra Chakraborty, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, E-mail: schakr11@jhu.edu.

Address correspondence to Rina Das, Nutrition Research Division, International Center for Diarrheal Disease Research, Bangladesh, 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka-1212, Bangladesh. E-mail: rina.das@icddrb.org
Copyright:
© The author(s) 2025
Received:
23 May 2024
|
Accepted:
12 Jan 2025
|
Published Online:
13 May 2025
Cover The American Journal of Tropical Medicine and Hygiene
The American Journal of Tropical Medicine and Hygiene
Print ISSN:
0002-9637
Online ISSN:
1476-1645

Leprosy

By Sir Leonard Rogers and Ernest Muir. Pp. i–xii, 1–260. Second Edition, Williams & Wilkins Co., Baltimore, Md., 1940

Goldberger on Pellagra

ed. by Milton Terris, Professor of Preventive Medicine, New York Medical College. xii + 395 pages. Louisiana State University Press, Baton Rouge, Louisiana. 1964. $12.50

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