A Comparison of Diarrheal Severity Scores in the MAL‐ED Multisite Community‐Based Cohort Study

Lee, Gwenyth O.; Richard, Stephanie A; Kang, Gagandeep; Houpt, Eric R.; Seidman, Jessica C.; Pendergast, Laura L.; Bhutta, Zulfiqar A; Ahmed, Tahmeed; Mduma, Estomih; Lima, Aldo A. M.; Jennifer, Mats Steffi; Hossain, Md. Iqbal; Chandyo, Ram Krishna; Nyathi, Emanuel; Lima, Ila Fernanda Nunes; Pascal, John; Soofi, Sajid Bashir; Bodhidatta, Ladaporn; Guerrant, Richard L.; Caulfield, Laura E.; Black, Robert E.; Kosek, Margaret

doi:10.1097/mpg.0000000000001286

Cited by 32 publications

(25 citation statements)

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“…Others have also found that the Vesikari severity scoring system may overestimate disease severity to some degree . However, different clinical scoring systems have been found to be equally sensitive with regard to predicting clinical outcomes and the Vesikari score was effective in predicting clinical outcome, measured as the length of stay in our population as well as in a US population .…”

Section: Discussionmentioning

confidence: 47%

Hypoglycaemia was common in acute gastroenteritis in a prospective hospital‐based study, but electrolyte imbalances were not

et al. 2018

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Section: Discussionmentioning

confidence: 47%

Hypoglycaemia was common in acute gastroenteritis in a prospective hospital‐based study, but electrolyte imbalances were not

et al. 2018

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“…Diarrhea was defined as maternal report of three or more loose stools in a 24-hour period or at least 1 stool with visible blood present [ 12 ], and unique diarrheal episodes were separated by at least 2 days without diarrhea [ 10 ]. Dysentery was defined as diarrhea with visible blood reported by the child’s mother during the identified illness episode, and severe diarrhea as diarrhea samples with a modified Vesikari severity score (MAL-ED score) of ≥ 5 [ 13 , 14 ]. Control samples were non-diarrhea stools (i.e.…”

Section: Methodsmentioning

confidence: 99%

The other Campylobacters: Not innocent bystanders in endemic diarrhea and dysentery in children in low-income settings

et al. 2018

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BackgroundCampylobacter is one of the main causes of gastroenteritis worldwide. Most of the current knowledge about the epidemiology of this food-borne infection concerns two species, C. coli and C. jejuni. Recent studies conducted in developing countries and using novel diagnostic techniques have generated evidence of the increasing burden and importance of other Campylobacter species, i.e. non-C. coli/jejuni. We performed a nested case-control study to compare the prevalence of C. coli/jejuni and other Campylobacter in children with clinical dysentery and severe diarrhea as well as without diarrhea to better understand the clinical importance of infections with Campylobacter species other than C. coli/jejuni.Methodology/Principal findingsOur nested case-control study of 439 stool samples included dysenteric stools, stools collected during severe diarrhea episodes, and asymptomatic stools which were systematically selected to be representative of clinical phenotypes from 9,160 stools collected during a birth cohort study of 201 children followed until two years of age. Other Campylobacter accounted for 76.4% of the 216 Campylobacter detections by qPCR and were more prevalent than C. coli/jejuni across all clinical groups. Other Campylobacter were also more prevalent than C. coli/jejuni across all age groups, with older children bearing a higher burden of other Campylobacter. Biomarkers of intestinal inflammation and injury (methylene blue, fecal occult test, myeloperoxidase or MPO) showed a strong association with dysentery, but mixed results with infection. MPO levels were generally higher among children infected with C. coli/jejuni, but Shigella-infected children suffering from dysentery recorded the highest levels (26,224 ng/mL); the lowest levels (10,625 ng/mL) were among asymptomatic children infected with other Campylobacter. Adjusting for age, sex, and Shigella infection, dysentery was significantly associated with C. coli/jejuni but not with other Campylobacter, whereas severe diarrhea was significantly associated with both C. coli/jejuni and other Campylobacter. Compared to asymptomatic children, children suffering from dysentery had a 14.6 odds of C. coli/jejuni infection (p-value < 0.001, 95% CI 5.5–38.7) but were equally likely to have other Campylobacter infections–odds ratio of 1.3 (0.434, 0.7–2.4). Children suffering from severe diarrhea were more likely than asymptomatic children to test positive for both C. coli/jejuni and other Campylobacter–OR of 2.8 (0.034, 1.1–7.1) and 1.9 (0.018, 1.1–3.1), respectively. Compared to the Campylobacter-free group, the odds of all diarrhea given C. coli/jejuni infection and other Campylobacter infection were 8.8 (<0.001, 3.0–25.7) and 2.4 (0.002, 1.4–4.2), respectively. Eliminating other Campylobacter in this population would eliminate 24.9% of the diarrhea cases, which is almost twice the population attributable fraction of 15.1% due to C. coli/jejuni.Conclusions/SignificanceEighty-seven percent of the dysentery and 59.5% of the severe diarrhea samples were po...

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“…Environmental exposures, such as toxins, stress, nutrition, and infection during pregnancy have all been linked with behavioral, cognitive and neurodevelopmental impairments in offspring (Lee et al, 2016). Emerging evidence suggests that some of these exposures exert their influence via maternal immune regulation (Calderon-Garciduenas et al, 2009; Wright et al, 2010; Gilman et al, 2017).…”

Section: Introductionmentioning

confidence: 99%

Associations between maternal cytokine levels during gestation and measures of child cognitive abilities and executive functioning

Dozmorov

Bilbo

Kollins

et al. 2018

Brain, Behavior, and Immunity

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Preclinical studies demonstrate that environmentally-induced alterations in inflammatory cytokines generated by the maternal and fetal immune system can significantly impact fetal brain development. Yet, the relationship between maternal cytokines during gestation and later cognitive ability and executive function remains understudied. Children (n = 246) were born of mothers enrolled in the Newborn Epigenetic Study - a prospective pre-birth cohort in the Southeastern US. We characterized seven cytokines [IL-1β, IL-4,IL-6, IL-12p70, IL-17A, tumor necrosis factor-α (TNFα), and interferon-γ (IFNγ)] and one chemokine (IL-8) from maternal plasma collected during pregnancy. We assessed children's cognitive abilities and executive functioning at a mean age of 4.5 (SD = 1.1) years. Children's DAS-II and NIH toolbox scores were regressed on cytokines and the chemokine, controlling for maternal age, race, education, body mass index, IQ, parity, smoking status, delivery type, gestational weeks, and child birth weight and sex. Higher IL-12p70 (β = 4.26, p = 0.023) and IL-17A (β = 3.70, p = 0.042) levels were related to higher DAS-II GCA score, whereas higher IL-1β (β = -6.07, p = 0.003) was related to lower GCA score. Higher IL-12p70 was related to higher performance on NIH toolbox measures of executive functions related to inhibitory control and attention (β = 5.20, p = 0.046) and cognitive flexibility (β = 5.10, p = 0.047). Results suggest that dysregulation in gestational immune activity are associated with child cognitive ability and executive functioning.

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A Comparison of Diarrheal Severity Scores in the MAL‐ED Multisite Community‐Based Cohort Study

Abstract: Supplemental Digital Content is available in the text

Cited by 32 publications

References 24 publications

Hypoglycaemia was common in acute gastroenteritis in a prospective hospital‐based study, but electrolyte imbalances were not

Hypoglycaemia was common in acute gastroenteritis in a prospective hospital‐based study, but electrolyte imbalances were not

The other Campylobacters: Not innocent bystanders in endemic diarrhea and dysentery in children in low-income settings

Associations between maternal cytokine levels during gestation and measures of child cognitive abilities and executive functioning

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