Etiology and severity of diarrheal diseases in infants at the semiarid region of Brazil: A case-control study

Eric R. Houpt,Rafaela Chemello Pankov ,Noélia L. Lima,Marcelo Bertolini,Pedro Medeiros ,Mara M. G. Prata,Ila Fernanda Nunes Lima ,Josiane Silva Quetz ,Alexandre Havt,Ariele C. Moreira ,Aldo A. M. Lima,Rafhaella N D G Gondim ,A Soares ,Renato A. Moreira,Mariana Duarte Bona ,José Q. Filho,V. J. F. Freitas ,Francisco Adelvane De Paulo Rodrigues ,Ana K. S. Santos,Domingos B. Oliveira,Luciana Relly Bertolini ,Herlice N. Veras,Richard L. Guerrant

doi:10.1371/journal.pntd.0007154

Abstract

BackgroundDiarrheal diseases are an important cause of morbidity and mortality among children in developing countries. We aimed to study the etiology and severity of diarrhea in children living in the low-income semiarid region of Brazil.MethodologyThis is a cross-sectional, age-matched case-control study of diarrhea in children aged 2–36 months from six cities in Brazil’s semiarid region. Clinical, epidemiological, and anthropometric data were matched with fecal samples collected for the identification of enteropathogens.ResultsWe enrolled 1,200 children, 596 cases and 604 controls. By univariate analysis, eight enteropathogens were associated with diarrhea: Norovirus GII (OR 5.08, 95% CI 2.10, 12.30), Adenovirus (OR 3.79, 95% CI 1.41, 10.23), typical enteropathogenic Escherichia coli (tEPEC), (OR 3.28, 95% CI 1.39, 7.73), enterotoxigenic E. coli (ETEC LT and ST producing toxins), (OR 2.58, 95% CI 0.99, 6.69), rotavirus (OR 1.91, 95% CI 1.20, 3.02), shiga toxin-producing E. coli (STEC; OR 1.77, 95% CI 1.16, 2.69), enteroaggregative E. coli (EAEC), (OR 1.45, 95% CI 1.16, 1.83) and Giardia spp. (OR 1.39, 95% CI 1.05, 1.84). By logistic regression of all enteropathogens, the best predictors of diarrhea were norovirus, adenovirus, rotavirus, STEC, Giardia spp. and EAEC. A high diarrhea severity score was associated with EAEC.ConclusionsSix enteropathogens: Norovirus, Adenovirus, Rotavirus, STEC, Giardia spp., and EAEC were associated with diarrhea in children from Brazil’s semiarid region. EAEC was associated with increased diarrhea severity.

Highlights

Diarrheal diseases remain a prominent cause of morbidity and mortality in developing countries as the second most common cause of death in children under five years old [1,2]
Eight enteropathogens were associated with diarrhea: Norovirus GII, Adenovirus, typical enteropathogenic Escherichia coli, enterotoxigenic E. coli (ETEC LT and ST producing toxins), rotavirus, shiga toxinproducing E. coli (STEC; Odds ratios (OR) 1.77, 95% confidence intervals (95% CI) 1.16, 2.69), enteroaggregative E. coli (EAEC), and Giardia spp
Six enteropathogens: Norovirus, Adenovirus, Rotavirus, STEC, Giardia spp., and EAEC were associated with diarrhea in children from Brazil’s semiarid region

Summary

Introduction

Diarrheal diseases remain a prominent cause of morbidity and mortality in developing countries as the second most common cause of death in children under five years old [1,2]. Studies of diarrheal illness among children in Brazil and other developing countries has focused on health centers or emergency hospitals that primarily treat patients with moderate-to-severe diarrhea and have the ability to identify enteropathogens [3,4,5]. This approach captures only a small subset of Brazil’s diarrheal diseases burden and limits accurate understanding about pathogen prevalence in the poorest semiarid region of Brazil.

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