Prevalence of Pathogens in Young Children Presenting to Hospital with Diarrhea from Lambaréné, Gabon

Abstract

Abstract.Diarrheal disease is the second most frequent cause of mortality in children younger than 5 years worldwide, causing more than half a million deaths each year. Our knowledge of the epidemiology of potentially pathogenic agents found in children suffering from diarrhea in sub-Saharan African countries is still patchy, and thereby hinders implementation of effective preventative interventions. The lack of cheap, easy-to-use diagnostic tools leads to mostly symptomatic and empirical case management. An observational study with a total of 241 participants was conducted from February 2017 to August 2018 among children younger than 5 years with diarrhea in Lambaréné, Gabon. Clinical and demographic data were recorded, and a stool sample was collected. The samples were examined using a commercial rapid immunoassay to detect Rotavirus/adenovirus, conventional bacterial culture for Salmonella spp., and multiplex real-time PCR for Cryptosporidium spp., Giardia lamblia, Cyclospora cayetanensis, enterotoxigenic Escherichia coli (ETEC), and enteroinvasive Escherichia coli (EIEC)/Shigella. At least one infectious agent was present in 121 of 241 (50%) samples. The most frequently isolated pathogens were EIEC/Shigella and ETEC (54/179; 30.2% and 44/179; 24.6%, respectively), followed by G. lamblia (33/241; 13.7%), Cryptosporidium spp. (31/241; 12.9%), and Rotavirus (23/241; 9.5%). Coinfection with multiple pathogens was observed in 33% (40/121) of the positive cases with EIEC/Shigella, ETEC, and Cryptosporidium spp. most frequently identified. Our results provide new insight into the possible causes of diarrheal disease in the Moyen-Ogooué region of Gabon and motivate further research on possible modes of infection and targeted preventive measures.

Knowledge and perception on antimicrobial resistance and antibiotics prescribing attitude among physicians and nurses in Lambaréné region, Gabon: a call for setting-up an antimicrobial stewardship program

“…(30.2%), enterotoxigenic Escherichia coli (24.6%), followed by G. lamblia (13.7%), Cryptosporidium spp. (12.9%), and rotavirus (9.5%) [ 36 ].…”

Molecular Prevalence of Diarrheal Pathogens in Children with Acute Diarrhea in Southeastern Gabon

“…This rate is less than the one found in children by a previous study that used real-time PCR. 9 In contrast, a lower rate was reported in another study. 11 These differences may be explained by age distribution and the methods used.…”

“…These rates were significantly greater than those described recently in Lambar en e (50% and 33%, respectively). 9 Geographic distribution, age distribution, and the methods used for detection and diagnosis (microscopy, culture, ELISA, and molecular methods) may contribute to differences in the epidemiology of enteric pathogens that induce diarrheal diseases in children. 1,8 The most prevalent pathogens in our study were adenovirus, EIEC, EPEC, rotavirus, Shigella, and Giardia.…”

“…This rate was greater than those found in previous studies in Gabon. 9,11 In a systematic review and meta-analysis 8 of enteric pathogens associated with gastroenteritis in children younger than 5 years in sub-Saharan Africa, adenovirus was the most common cause of acute diarrhea, resulting in 10.8% of cases. Moreover, adenovirus types 40/41 were, to a lesser extent, important pathogens associated with moderate-to-severe diarrhea in GEMS.…”

“…8 In Gabon, comprehensive studies on the etiology of childhood diarrheal diseases are rare. Recently, a study on the etiology of childhood diarrhea conducted at Lambar en e 9 found that enteroinvasive E. coli/Shigella (30.2%), ETEC (24.6%), G. duodenalis (13.7%), Cryptosporidium (12.9%), and rotavirus (9.5%) were the most common enteric pathogens detected in this low-income Gabonese setting. Other publications in the literature are isolated studies of viral, bacterial, or parasitic agents.…”