Impact of co-infections with enteric pathogens on children suffering from acute diarrhea in southwest China

Abstract

BackgroundAcute diarrhea is a global health problem, resulting in high morbidity and mortality in children. It has been suggested that enteric pathogen co-infections play an important role in gastroenteritis, but most research efforts have only focused on a small range of species belonging to a few pathogen groups. This study aimed to assess the impact of co-infections with a broad range of enteric pathogens on children aged below five years who suffer from acute diarrhea in southwest China.MethodA total of 1020 subjects (850 diarrhea cases and 170 healthy controls) were selected from four sentinel hospitals in Kunming, Yunnan province, southwest China, from June 2014 to July 2015. Stool specimens were collected to detect five virus (rotavirus group A, RVA; norovirus, NoV; Sapovirus, SaV; astrovirus, As; and adenovirus, Ad), seven bacterial (diarrheagenic Escherichia coli, DEC; non-typhoidal Salmonella, NTS; Shigella spp.; Vibrio cholera; Vibrio parahaemolyticus; Aeromonas spp.; and Plesiomonas spp.), and three protozoan (Cryptosporidium spp., Giardia lamblia, and Blastocystis hominis, B. hominis) species using standard microbiologic and molecular methods. Data were analyzed using the partial least square regression technique and chi-square test.ResultsAt least one enteric pathogen was detected in 46.7 % (n = 397) of acute gastroenteritis cases and 13.5 % (n = 23) of healthy controls (χ2 = 64.4, P < 0.05). Single infection with RVA was associated with acute diarrhea (26.5 % vs. 5.8 %, P < 0.05). The prevalence of a single infection with B. hominis in diarrhea cases was higher than in healthy controls (3.1 % vs. 0.5 %, OR = 4.7, 95 % CI: 1.01–112.0). Single infection with NoV GII was not associated with diarrhea (4.4 % vs. 3.5 %, OR = 1.2, 95 % CI: 0.5–3.3). Single infections with bacterial species were not observed. The prevalence of co-infections with two enteric pathogens in diarrhea cases was higher than in asymptomatic children (20.1 % vs. 5.3 %, P < 0.05). RVA-NoV GII was the most common co-infection in symptomatic children (4.4 %), with it aggravating the severity of diarrhea.ConclusionsAlthough it is clear that RVA has an overwhelming impact on diarrhea illnesses in children, co-infection with other enteric pathogens appears to also aggravate diarrhea severity. These findings should serve as evidence for public health services when planning and developing intervention programs.Electronic supplementary materialThe online version of this article (doi:10.1186/s40249-016-0157-2) contains supplementary material, which is available to authorized users.

Antibiotic Susceptibility Profile of Escherichia coli and Salmonella Causing Childhood Diarrhoea in Awka Municipality, South-eastern Nigeria

“…The possible reasons are: (i) that when one intestinal pathogen infects the body, the infection rate of other pathogens increases [21]; (ii), these are foodborne pathogens and can be found in the same contaminated foods increasing the likelihood of mixed infections in risk populations. It has been reported that co-infections with multiple enteric pathogens occur mainly in zones with poor quality of food, drinking water and poor sanitary conditions in the environment [20,22]. Co-infection among children with diarrhoea may cause more severe diarrhoea than infection with a single pathogen and can also increase treatment costs [20,23].Thus we suggest that it is important to consider enteric pathogens rather than just single pathogen in every epidemiological study evaluating diarrhoea-causing agents in poor countries.…”

“…Co-infection by multiple groups of enteric pathogens has been demonstrated to be the norm in diarrhoea cases [20]. The possible reasons are: (i) that when one intestinal pathogen infects the body, the infection rate of other pathogens increases [21]; (ii), these are foodborne pathogens and can be found in the same contaminated foods increasing the likelihood of mixed infections in risk populations.…”

Case–control study of diarrheal disease etiology in individuals over 5 years in southwest China

“…However, co-infection is a common prevalence in diarrhea cases in such communities with poor food hygiene, low sanitation and contaminated water (35.0, 20.1, 13.0%, respectively) [6, 12, 13]. Co-infection, however, are also common in healthy patients (8.0, 5.3, 0.8%, respectively) [6, 12, 13]. Co-infection is of particular human health importance because pathogen species can interact within the host.…”

Etiological Agents of Pediatric Diarrhea in Ardebil, Northwestern Iran

“…Non-typhoidal Salmonella spp. annually causes 93,800,000 cases of gastroenteritis and 155,000 deaths globally (12,13). Protozoan diarrhea is also distributed around the globe.…”

“…Giardia lamblia, Entamoeba histolytica, and Cryptosporidium parvum are the mostly reported protozoan pathogens that cause gastroenteritis (4,5). Studies showed that approximately 100,000 deaths followed by gastroenteritis are related to protozoan species (12). Asymptomatic amebiasis is one of the most common complications of E. histolytica, but it is life threatening if parasite invades the intestinal mucosa.…”