Prevalence and diversity of enteric pathogens among cholera treatment centre patients with acute diarrhea in Uvira, Democratic Republic of Congo

Abstract

Background Cholera remains a major global health challenge. Uvira, in the Democratic Republic of the Congo (DRC), has had endemic cholera since the 1970’s and has been implicated as a possible point of origin for national outbreaks. A previous study among this population, reported a case confirmation rate of 40% by rapid diagnostic test (RDT) among patients at the Uvira Cholera Treatment Centre (CTC). This study considers the prevalence and diversity of 15 enteric pathogens in suspected cholera cases seeking treatment at the Uvira CTC. Methods We used the Luminex xTAG® multiplex PCR to test for 15 enteric pathogens, including toxigenic strains of V. cholerae in rectal swabs preserved on Whatman FTA Elute cards. Results were interpreted on MAGPIX® and analyzed on the xTAG® Data Analysis Software. Prevalence of enteric pathogens were calculated and pathogen diversity was modelled with a Poisson regression. Results Among 269 enrolled CTC patients, PCR detected the presence of toxigenic Vibrio cholerae in 38% (103/269) of the patients, which were considered to be cholera cases. These strains were detected as the sole pathogen in 36% (37/103) of these cases. Almost half (45%) of all study participants carried multiple enteric pathogens (two or more). Enterotoxigenic Escherichia coli (36%) and Cryptosporidium (28%) were the other most common pathogens identified amongst all participants. No pathogen was detected in 16.4% of study participants. Mean number of pathogens was highest amongst boys and girls aged 1–15 years and lowest in women aged 16–81 years. Ninety-three percent of toxigenic V. cholerae strains detected by PCR were found in patients having tested positive for V. cholerae O1 by RDT. Conclusions Our study supports previous results from DRC and other cholera endemic areas in sub-Sahara Africa with less than half of CTC admissions positive for cholera by PCR. More research is required to determine the causes of severe acute diarrhea in these low-resource, endemic areas to optimize treatment measures. Trial registration This study is part of the impact evaluation study entitled: “Impact Evaluation of Urban Water Supply Improvements on Cholera and Other Diarrheal Diseases in Uvira, Democratic Republic of Congo” registered on 10 October 2016 at clinicaltrials.gov Identification number: NCT02928341.

How does handwashing behaviour change in response to a cholera outbreak? A qualitative case study in the Democratic Republic of the Congo

“…Our sampling was guided by case lists from the CTC, however in this region cholera case admission is not always laboratory confirmed. Other research from DRC has shown that only a minority of those admitted to CTCs actually had cholera [ 57 ] and therefore this may skew some of our research findings in relation to experiences of the disease. As noted, cholera was often used by research participants to be a catch all term for diarrhoeal diseases, this emic construction may have therefore also distorted the way people described their experiences and perceptions in relation to the disease.…”

Ethnomedicinal survey of antidiarrheal plants of the Nyamwezi people of Nsenda ward in Urambo District, central western Tanzania

“…Diarrhea is a major public health burden in low-and middle-income countries, particularly in Sub-Saharan Africa and South Asia (Kotloff et al 2013, Troeger et al 2018. The disease affects all age groups, but it is more critical in children under the age of five as it causes malnutrition, growth retardation, and reduced cognitive development (Samie et al 2009, Williams et al 2020. Diarrhea is the second leading cause of global child mortality and morbidity, and it is responsible for 0.525 million children's deaths under the age of five annually out of 1.7 billion episodes (WHO 2017).…”

Ethnobotany, Ethnopharmacology, and Phytochemistry of Medicinal Plants Used for Treating Human Diarrheal Cases in Rwanda: A Review

“…Diarrheal diseases are among the major etiologies of morbidity and mortality worldwide, with most of the cases occurring in low-and middle-income countries (LMICs), particularly in Sub-Saharan Africa (SSA) and South Asia [1][2][3]. Although diarrhea affects people of all ages, it leads to complications in children under five years of age, including malnutrition, growth retardation, and reduced cognitive development [4][5][6]. Diarrhea, often defined as "the passing per day of three or more loose or watery stools" [7][8][9], is associated with various risk factors, including unsafe water, poor sanitation, and childhood wasting, which are common in LMICs [3].…”