Recent Advances in Understanding the Long-Term Sequelae of Childhood Infectious Diarrhea

Abstract

Worldwide, early childhood infectious diarrhea continues to be a significant concern. Diarrheal illness affects the world’s youngest and most vulnerable citizens disproportionately. Estimates are that over 70% of the deaths from diarrhea occur in people younger than 24 months of age. Diarrhea and environmental enteropathy have been associated with growth failure and stunting. In addition, the burden of enteric disease also leads to cognitive and academic losses, thus resulting in loss of human capital and economic productivity. While considerable progress has been made on preventing and treating childhood diarrheal illness, the mortality and morbidity still remain unacceptably high. This paper seeks to review the recent (mainly from 2013) publications surrounding the global burden of childhood diarrhea and the implications for long-term sequelae.

Improving the detection of environmental enteric dysfunction: a lactulose, rhamnose assay of intestinal permeability in children aged under 5 years exposed to poor sanitation and hygiene

“…Poor nutrition is associated with cognitive stunting with implications for future socioeconomic status. 2 EED may also explain the reduced efficacy of oral vaccines in low income and middle income countries and the increased risk of serious infection in children with undernutrition. 3 4 Thus, there is a critical need for a reliable, simple, non-invasive and sensitive biomarker of disease activity to potentially identify in the field high-risk individuals who are candidates for interventional trials.…”

Diet and specific microbial exposure trigger features of environmental enteropathy in a novel murine model

“…A number of epidemiological and microbiological studies indicate that increased oral bacterial exposure early in life (due to poor environmental sanitation) is behind the aetiology of EE 17 33 34 , and in a number of these cases, children exhibit small intestinal bacterial overgrowth 35 36 . Notably, contamination of the household environment with E. coli and Bacteroidales species was common and correlated with increased intestinal permeability, as well as growth rate deficiencies in rural areas of Zimbabwe and Bangladesh 17 33 .…”

Animal-related factors associated with moderate-to-severe diarrhea in children younger than five years in western Kenya: A matched case-control study

“…While mortality rates have decreased, the incidence of diarrheal disease in young children in low- and middle-income countries has shown little change, from 3.4 episodes/child year in 1990 to 2.9 episodes/child year in 2010 [ 3 ]. Persistently high incidence rates in these countries are concerning because early childhood diarrhea may have long-term effects on child growth and development [ 4 , 5 ]. Data characterising risk factors and etiologies of diarrheal disease in children in these settings are important for focusing interventions to decrease associated morbidity and mortality rates.…”