Etiology and severity of diarrheal diseases in infants at the semiarid region of Brazil: A case-control study

Lima, Aldo A. M.; Oliveira, Domingos B.; Quetz, Josiane Silva; Havt, Alexandre; Prata, Mara M. G.; Lima, Ila Fernanda Nunes; Soares, A; Filho, José Q.; Lima, Noélia L.; Medeiros, Pedro; Santos, Ana K. S.; Veras, Herlice N.; Gondim, Rafhaella N D G; Pankov, Rafaela Chemello; Bona, Mariana Duarte; Rodrigues, Francisco Adelvane de Paulo; Moreira, Renato A.; Moreira, Ariele C.; Bertolini, Marcelo; Bertolini, Luciana Relly; Freitas, V. J. F.; Houpt, Eric R.; Guerrant, Richard L.

doi:10.1371/journal.pntd.0007154

Cited by 34 publications

(37 citation statements)

References 27 publications

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“…The most prevalent agents associated with AGE in our study were norovirus, rotavirus, adenovirus, and astrovirus. Similar data was reported in the US and in Brazil [31,32]. In our study, norovirus surpassed rotavirus as a leading cause of AGE, in similar fashion as reported in several industrialized and middle-income countries, including US, Brazil and Peru [28,[33][34][35][36].…”

Section: Discussionsupporting

confidence: 90%

Etiology of acute gastroenteritis among children less than 5 years of age in Bucaramanga, Colombia: A case-control study

Farfán-García¹,

Imdad

Zhang

et al. 2020

PLoS Negl Trop Dis

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Background Acute gastroenteritis (AGE) is a major cause of morbidity and mortality in children aged less than 5 years in low-and middle-income countries where limited access to potable water, poor sanitation, deficient hygiene, and food product contamination are prevalent. Research on the changing etiology of AGE and associated risk factors in Latin America, including Colombia, is essential to understand the epidemiology of these infections. The primary objectives of this study were to describe etiology of moderate to severe AGE in children less than 5 years of age from Bucaramanga, Colombia, a middle-income country in Latin American, and to identify the presence of emerging E. coli pathotypes. Methodology/Principal findings This was a prospective, matched for age, case-control study to assess the etiology of moderate to severe AGE in children less than 5 years of age in Bucaramanga, Colombia, South America. We tested for 24 pathogens using locally available diagnostic testing, including stool culture, polymerase chain reaction, microscopy and enzyme-linked immunoassay. Adjusted attributable fractions were calculated to assess the association between AGE and each pathogen in this study population. The study included 861 participants, 431 cases and 430 controls. Enteric pathogens were detected in 71% of cases and in 54% of controls (p = <0.001). Co-infection was identified in 28% of cases and in 14% of controls (p = <0.001). The adjusted attributable fraction showed that Norovirus GII explained 14% (95% CI: 10-18%)

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Section: Discussionsupporting

confidence: 90%

Etiology of acute gastroenteritis among children less than 5 years of age in Bucaramanga, Colombia: A case-control study

Farfán-García¹,

Imdad

Zhang

et al. 2020

PLoS Negl Trop Dis

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“…We investigated EPEC genetics and suggested specific VRGs and coenteropathogens that may be responsible for clinical outcomes in both tEPEC and aEPEC infections in children from the Brazilian semiarid region, which is one of the poorest areas of Brazil, showing precarious sanitation and a population with a low socioeconomic status (25). In parallel, we described the most prevalent enteropathogens in this population and found tEPEC to be one of the major causes of diarrhea (16).…”

Section: Discussionmentioning

confidence: 95%

“…Geographic location, study design, and ethical approval. The present study originated from a previous cross-sectional case-control study of diarrhea (16), which was conducted in cities from the four states of the northeast region of Brazil: Cajazeiras (Paraiba), Crato (Ceará), Ouricuri (Pernambuco), Patos (Paraiba), Picos (Piauí), and Sousa (Paraiba). These cities were included in this study since they were representatives of the semiarid region of Brazil and had more than 50,000 inhabitants.…”

Section: Methodsmentioning

confidence: 99%

Virulence-Related Genes and Coenteropathogens Associated with Clinical Outcomes of Enteropathogenic Escherichia coli Infections in Children from the Brazilian Semiarid Region: a Case-Control Study of Diarrhea

et al. 2019

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Enteropathogenic Escherichia coli (EPEC) is a major cause of diarrhea in children from developing countries and presents high genetic variability. We aimed to characterize the EPEC virulence-related gene (VRG) distribution and copathogens associated with diarrhea and nutrition-related outcomes in children from the lowincome Brazilian semiarid region. A cross-sectional case-control study of diarrhea was conducted in 1,191 children aged 2 to 36 months from the northeast region of Brazil. Stool samples were collected and clinical, epidemiological, and anthropometric data were identified from each child. A broad molecular evaluation of enteropathogens was performed, and EPEC-positive samples were further investigated for 18 VRGs using five multiplex PCRs. EPEC was detected in 28.2% of the study population, with similar proportions among cases and controls. Typical EPEC (tEPEC) infections were more often associated with diarrhea than atypical EPEC (aEPEC) infections, while aEPEC infections presented a higher prevalence. The VRG ler, a negative regulator of the locus of enterocyte effacement, was associated with the absence of diarrhea in aEPEC-positive children; espB, a major component of the type 3 secretion system, was associated with diarrhea in tEPEC-positive children; the presence of procolonization VRGs-the combination of cesT positivity, espP negativity, and the presence of the map gene-was associated with undernutrition; and Campylobacter spp., norovirus, and enteroaggregative E. coli (EAEC) coinfections were associated with increased clinical severity in EPEC-infected children. These data identified tEPEC strains associated with diarrhea and specific VRGs of EPEC (ler, espB, cesT, and map genes) and Campylobacter spp., norovirus, and EAEC to be major contributors to diarrhea and undernutrition in children from a low-income Brazilian region.

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“…Several studies using health information system data from China within case-crossover or interrupted time series (ITS) analyses have quantified significant increases in diarrheal disease and bacillary dysentery following floods in Anhui and Hunan provinces, respectively [22][23][24]. However, new diagnostic methods applied in multi-site, population-based studies now make it possible to characterize pathogen-specific trends in both diarrheal and asymptomatic enteric infections [25][26][27]. Using information from one such study, which happened to coincide with a La Niña-related flooding disaster, the objective of the analysis presented here was to use a comparative ITS analysis to derive causal inferences about the species-specific impacts of this event on enteric pathogen infections.…”

Section: Introductionmentioning

confidence: 99%

Pathogen-Specific Impacts of the 2011–2012 La Niña-Associated Floods on Enteric Infections in the MAL-ED Peru Cohort: A Comparative Interrupted Time Series Analysis

Colston

Olórtegui

Zaitchik

et al. 2020

IJERPH

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Extreme floods pose multiple direct and indirect health risks. These risks include contamination of water, food, and the environment, often causing outbreaks of diarrheal disease. Evidence regarding the effects of flooding on individual diarrhea-causing pathogens is limited, but is urgently needed in order to plan and implement interventions and prioritize resources before climate-related disasters strike. This study applied a causal inference approach to data from a multisite study that deployed broadly inclusive diagnostics for numerous high-burden common enteropathogens. Relative risks (RRs) of infection with each pathogen during a flooding disaster that occurred at one of the sites—Loreto, Peru—were calculated from generalized linear models using a comparative interrupted time series framework with the other sites as a comparison group and adjusting for background seasonality. During the early period of the flood, increased risk of heat-stable enterotoxigenic E. coli (ST-ETEC) was identified (RR = 1.73 [1.10, 2.71]) along with a decreased risk of enteric adenovirus (RR = 0.36 [0.23, 0.58]). During the later period of the flood, sharp increases in the risk of rotavirus (RR = 5.30 [2.70, 10.40]) and sapovirus (RR = 2.47 [1.79, 3.41]) were observed, in addition to increases in transmission of Shigella spp. (RR = 2.86 [1.81, 4.52]) and Campylobacter spp. (RR = 1.41 (1.01, 1.07). Genotype-specific exploratory analysis reveals that the rise in rotavirus transmission during the flood was likely due to the introduction of a locally atypical, non-vaccine (G2P[4]) strain of the virus. Policy-makers should target interventions towards these pathogens—including vaccines as they become available—in settings where vulnerability to flooding is high as part of disaster preparedness strategies, while investments in radical, transformative, community-wide, and locally-tailored water and sanitation interventions are also needed.

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Etiology and severity of diarrheal diseases in infants at the semiarid region of Brazil: A case-control study

Cited by 34 publications

References 27 publications

Etiology of acute gastroenteritis among children less than 5 years of age in Bucaramanga, Colombia: A case-control study

Etiology of acute gastroenteritis among children less than 5 years of age in Bucaramanga, Colombia: A case-control study

Virulence-Related Genes and Coenteropathogens Associated with Clinical Outcomes of Enteropathogenic Escherichia coli Infections in Children from the Brazilian Semiarid Region: a Case-Control Study of Diarrhea

Pathogen-Specific Impacts of the 2011–2012 La Niña-Associated Floods on Enteric Infections in the MAL-ED Peru Cohort: A Comparative Interrupted Time Series Analysis

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