Interactions between intestinal pathogens, enteropathy and malnutrition in developing countries.

Andrew J Prendergast,Paul Kelly

doi:10.1097/qco.0000000000000261

Abstract

Purpose of reviewThis review focuses on recent data highlighting the interactions between intestinal pathogens, enteropathy and malnutrition in developing countries, which drive morbidity and mortality and hinder the long-term developmental potential of children.Recent findingsDiarrhoea remains the second commonest cause of death in children below 5 years, and malnutrition underlies 45% of all child deaths. Even in the absence of diarrhoea, subclinical pathogen carriage and enteropathy are almost universal in developing countries. Here, we review recent studies addressing the causes and consequences of diarrhoea; emerging data on environmental influences that govern postnatal development of the gut and microbiota; current concepts of environmental enteric dysfunction; and recent intervention trials in the field. We highlight the interactions between these processes, whereby intestinal pathogens drive a cycle of gut damage, malabsorption, chronic inflammation and failed mucosal regeneration, leading to malnutrition and susceptibility to further enteric infections.SummaryEfforts to improve child survival and long-term developmental potential need to address the overlapping and interacting effects of diarrhoea, enteropathy and malnutrition. Recent insights from human and animal studies suggest potential targets for intervention.

Highlights

Malnutrition underlies 45% of child deaths globally
Controls 2–3 months after a single episode of moderate-severe diarrhoea (MSD), highlighting the neglected post-discharge mortality associated with diarrhoea, among malnourished children [2&&]
Leptin levels during acute cholera were low and stayed suppressed for at least 1 month after recovery; leptin concentrations on day 2 were related to immunoglobulin G antibody levels to cholera toxin 30 days later, indicating the impact of leptin on immune function [12]. These findings suggest that nutritional and immune convalescence need to be addressed to reduce postdiarrhoeal morbidity and mortality

Summary

INTRODUCTION

Malnutrition underlies 45% of child deaths globally. Stunting is the commonest presentation of malnutrition, affecting approximately one-third of children in developing countries, leading to increased mortality from infections such as diarrhoea. There have been huge reductions in diarrhoeal mortality over several decades, diarrhoea remains the second commonest cause of death among children below 5 years. Precise mortality estimates vary between 666 000 and 712 000 annually [1], with young children (

KEY POINTS

Dysbiosis

Findings

CONCLUSION