Mortality in children with complicated severe acute malnutrition is related to intestinal and systemic inflammation: an observational cohort study

Attia, Suzanna; Versloot, Christian J.; Voskuijl, Wieger; Vliet, Sara J. van; Giovanni, Valeria Di; Zhang, Ling; Richardson, Susan E.; Bourdon, Céline; Netea, Mihai G.; Berkley, James A.; Rheenen, Patrick F. van; Bandsma, Robert

doi:10.3945/ajcn.116.130518

Cited by 125 publications

(167 citation statements)

References 40 publications

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“…Two studies among children with SAM, using PCR, reported a prevalence of Giardia of 33% and 38%, respectively [14,15], which is in line with our findings. The lack of association between Giardia and diarrhoea in our study might be due to lack of power, but our finding is in line with several studies, some of which reported higher detection rates of Giardia among non-diarrhoeal controls than among children with diarrhoea [16,30].…”

Section: Discussionsupporting

confidence: 92%

“…The lack of association between Giardia and diarrhoea in our study might be due to lack of power, but our finding is in line with several studies, some of which reported higher detection rates of Giardia among non-diarrhoeal controls than among children with diarrhoea [16,30]. Previous studies also failed to find an association between G. duodenalis and clinical outcome among children with SAM [14,15]. This questions the relevance of diagnosing children with SAM for G. duodenalis.…”

Section: Discussionsupporting

confidence: 78%

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Metronidazole-sensitive organisms in children with severe acute malnutrition: an evaluation of the indication for empiric metronidazole treatment

Zangenberg

Abdissa

Johansen

et al. 2020

Clinical Microbiology and Infection

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a b s t r a c tObjectives: Children with severe acute malnutrition (SAM) are treated with empiric amoxicillin or penicillin and gentamicin because of the high risk of severe infections. Experts have suggested, based on available evidence, adding metronidazole to cover anaerobic bacteraemia and diarrhoea caused by Giardia duodenalis or Clostridium difficile. The objective of this study was to assess the importance of these infections in children with SAM. Methods: Children from 6 months to 15 years with SAM were enrolled and followed clinically. Aerobic and, when patient weight permitted, anaerobic blood cultures were done using Bactec® system, and isolates identified with matrix-assisted laser desorption ionizationetime of flight mass spectrometry. Stool samples were tested for C. difficile, G. duodenalis and Entamoeba histolytica by PCR. Results: A total of 334 children were enrolled and 174 out of 331 (53%) for which data on this was available had diarrhoea. Of 273 patients tested by blood culture, 11 had bacteraemia (4.0%, 95% CI 2.3 e7.1%) but none with strict anaerobic bacteria (0/153, 95% CI 0e2.4%). There was no difference in the prevalence of C. difficile between children with (5/128, 4%) and without (7/87, 8%) diarrhoea (OR 0.47, 95% CI 0.14e1.53), and no difference in the prevalence of Giardia between these groups (78/138, 60% vs. 46/87, 53%; OR 1.34, 95% CI 0.77e2.32). Children with C. difficile had higher mortality than those without this infection (3/11,27%, vs. 7/186,4%; OR 43, 95% CI 3.9e483). Conclusion: Our results do not provide support for empiric metronidazole to cover for anaerobic bacteraemia. Trials evaluating the effect of empiric treatment and its effect on G. duodenalis and C. difficile are warranted. M. Zangenberg, Clin Microbiol Infect 2020;26:255.e7e255.e11

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Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 78%

Metronidazole-sensitive organisms in children with severe acute malnutrition: an evaluation of the indication for empiric metronidazole treatment

Zangenberg

Abdissa

Johansen

et al. 2020

Clinical Microbiology and Infection

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“…In severe malnutrition, the lack of antioxidants and nutrients necessary for endogenous antioxidants and a major liver peroxisomal and mitochondrial dysfunction results in a major oxidative stress [10][11][12] . In children with severe acute malnutrition, we have shown a major depletion of anaerobic microbes (or intolerant to reactive oxidative species) 12 , consistent with the collapse of fecal butyrate in those who die 13 . This led us to found that antioxidants allow most anaerobes, including methanogenic archaea, to thrive in an oxidative environment (aerobic) [14][15][16] .…”

Section: Introductionsupporting

confidence: 61%

Antioxidants maintain Butyrate production by Human GutClostridiain the presence of Oxygen

Million

Armstrong

Khelaifia

et al. 2019

Preprint

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BackgroundOxygen diffused from the human gut mucosa and shape the microbiota with a radial gradient of microbes according to their oxygen tolerance, while microbial and chemical oxygen consumption maintains the lumen in a deeply anaerobic state. Uncontrolled oxidative stress and hyperoxygenation have been reported as a pathogenic mechanism in Salmonella or Citrobacter rodentium infection, in patients with HIV and in severe acute malnutrition. We recently found that antioxidants allow strict anaerobes, including methanogenic archaea, to thrive in an oxidative environment (aerobic). Here, we tested the metabolomics switching of the 3 most odorous anaerobic microbes isolated from human gut when grown in aerobiosis with antioxidants. MethodsThree human gut Clostridia, Clostridium sporogenes, Clostridium lituseburense and Clostridium subterminale, isolated by culturomics, were grown in anaerobiosis or in aerobiosis with antioxidants. Gaz and liquid chromatography-Mass spectrometry (GC/MS and LC/MS) were used for metabolomics analysis. ResultsAn unexpected global dichotomic metabolomic switching from thiols, alcohols and shortchain fatty acid esters to a specific aerobic metabolic repertoire with the production of alkanes, cycloheptatriene and, paradoxically, increased butyrate production, was observed.Analysis of polar metabolites confirmed the discovery of an unexplored aerobic metabolic repertoire, including the production of specific dipeptides and several lysophospholipids, thus unraveling unsuspected human gut microbiome capacities. Conclusions 3Antioxidants unraveled an unexplored aerobic metabolic repertoire of human gut Clostridia.The increased production of butyrate suggests that antioxidants contribute to the maintenance and the active resilience of the human gut microbiome against oxidative aggression, as during Salmonella infection.

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“…Retarded growth is a condition that directly affects morbidity and mortality in childhood (8,9). According to World Health Organization data, pneumonia, diarrhea, malaria, measles and AIDs represent the cause of death in more than half of children under 5, and inadequate nutrition is present in one in three of these patients (10).…”

Section: Discussionmentioning

confidence: 99%

Determination of the frequency of growth retardation in pediatric out patients with growth retardation complaints

Bucak¹,

Almış²,

Benli³

et al. 2017

J Turgut Ozal Med Cent

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Aim: Having a healthy child is the most basic concern for parents, and their children being ill or showing signs of illness therefore causes them anxiety. Parents cannot generally be objective in assessing the growth of their own children. Children's growth must be evaluated solely with appropriate measurements and assessment criteria. The purpose of this study is to investigate the growth of patients with suspected retarded growth presenting to the children's health and diseases clinic. Material and Methods: One hundred patients presenting with retarded growth to the Adıyaman University Training and Research Hospital children's health and diseases clinic were included in this study. Patients were evaluated for retarded growth through measurement of weight, height and head circumference. Results: One hundred patients, 49 boys (49%) and 51 girls (51%) presenting with retarded growth were enrolled in the study. Patients' mean age was 47.62 ± 43.1 (3-192) months. The mean weight was 14.51 ± 7.9 (4.5-46.9) kg and mean height was 95.61 ± 23.14 (57-164) cm. Mean head circumference was 43.97 ± 2.6 (37-49) cm. In our observed population, the following measurements fell below the third percentile: Weight: 4 patients (4%); Weight and Height: 12 patients (12%); and Weight, Height and Head Circumference: 4 Patients (4%). Conclusion: An increasing number of concerned parents does not necessarily indicate any actual problem, or any abnormally high incidence of actual retarded growth and development than that might be expected from the literature. Well child visits must be performed and parents provided sufficient information on normal development.

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Mortality in children with complicated severe acute malnutrition is related to intestinal and systemic inflammation: an observational cohort study

Cited by 125 publications

References 40 publications

Metronidazole-sensitive organisms in children with severe acute malnutrition: an evaluation of the indication for empiric metronidazole treatment

Metronidazole-sensitive organisms in children with severe acute malnutrition: an evaluation of the indication for empiric metronidazole treatment

Antioxidants maintain Butyrate production by Human GutClostridiain the presence of Oxygen

Determination of the frequency of growth retardation in pediatric out patients with growth retardation complaints

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