Abstract
Introduction Acute diarrheal disease (ADD) is a common cause of morbidity and mortality in children under 5 years of age. Understanding of the etiology of ADD is lacking in most low and middle income countries because reference laboratories detect limited number of pathogens. The objective of this study was to determine the feasibility to conduct a comprehensive case-control study to survey diarrheal pathogens among children with and without moderate-to-severe ADD. Materials and Methods Microbiology and molecular-based techniques were used to detect viral, bacterial, and parasitic enteropathogens. The study was conducted in Bucaramanga, Colombia, after Institutional Review Board approval was obtained. Results Ninety children less than 5 years of age were recruited after a written informed consent was obtained from parents or guardians. Forty-five subjects served as cases with ADD and 45 as controls. Thirty-six subjects out of 90 (40.0%) were positive for at least one enteropathogen, that is, 20 (44.4%) cases and 16 (35.5%) controls. Conclusions The three most common enteric pathogens were enteroaggregative E. coli (10.0%), Norovirus (6.7%), and Salmonella spp. (5.6%). The E. coli pathogens were 18.8% of all infections making them the most frequent pathogens. Half of ADD cases were negative for any pathogens.
Highlights
Acute diarrheal disease (ADD) is a common cause of morbidity and mortality in children under 5 years of age
One explanation for the low Rotavirus incidence among ADD cases may be the introduction of Rotavirus vaccine in Colombia in 2009 that might have contributed to a decline in Rotavirus infections and disease severity [24, 25]
35.5% of the control subjects were identified as enteropathogen-positive. This information is relevant because Colombia, a middle income, is expected to have lower risk factors for infection compared to low income countries, yet our results show high proportion of infections in controls as previously reported by case-control studies conducted in low income countries [8]
Summary
Acute diarrheal disease (ADD) is a common cause of morbidity and mortality in children under 5 years of age. Acute diarrheal disease (ADD) is the most frequent cause of childhood illness and a leading cause of death in children less than 5 years of age [1]. Most episodes of ADD are relatively mild to moderate; about 2% of cases lead to severe diarrhea that is a risk factor for significant morbidity and mortality [2]. A recent study showed that odds of stunting increase by 1.13 times for every 5 episodes of diarrhea in children less 2 years of age [3]. Selective enteropathogens like E. coli and Campylobacter can lead to severe morbidities (irrespective of severity of diarrhea), like hemolytic uremic syndrome and Guillain-Barre syndrome, among other conditions [5, 6]
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