Prevalence of diarrhoeal pathogens among children under five years of age with and without diarrhoea in Guinea-Bissau.

Sointu Mero,Anu Kantele,Johan Ursing,Sandra Løfberg,Juha Kirveskari,Tinja Lääveri,Suvi Timonen,Poul-Erik Kofoed,Lars Rombo,Matthew C Freeman

doi:10.1371/journal.pntd.0009709

Abstract

BackgroundChildhood diarrhoea, a major cause of morbidity and mortality in low-income regions, remains scarcely studied in many countries, such as Guinea-Bissau. Stool sample drying enables later qPCR analyses of pathogens without concern about electricity shortages.MethodsDried stool samples of children under five years treated at the Bandim Health Centre in Bissau, Guinea-Bissau were screened by qPCR for nine enteric bacteria, five viruses, and four parasites. The findings of children having and not having diarrhoea were compared in age groups 0–11 and 12–59 months.ResultsOf the 429 children– 228 with and 201 without diarrhoea– 96.9% and 93.5% had bacterial, 62.7% and 44.3% viral, and 52.6% and 48.3% parasitic pathogen findings, respectively. Enteroaggregarive Escherichia coli (EAEC; 60.5% versus 66.7%), enteropathogenic E. coli (EPEC; 61.4% versus 62.7%), Campylobacter (53.2% versus 51.8%), and enterotoxigenic E. coli (ETEC; 54.4% versus 44.3%) were the most common bacterial pathogens. Diarrhoea was associated with enteroinvasive E. coli (EIEC)/Shigella (63.3%), ETEC (54.4%), astrovirus (75.0%), norovirus GII (72.6%) and Cryptosporidium (71.2%). The only pathogen associated with severe diarrhoea was EIEC/Shigella (p<0.001). EAEC was found more frequent among the infants, and EIEC/Shigella, Giardia duodenalis and Dientamoeba fragilis among the older children.ConclusionsStool pathogens proved common among all the children regardless of them having diarrhoea or not.

Highlights

Diarrhoeal diseases rank second as cause of childhood mortality and morbidity in low-income countries (LICs) worldwide
Dried stool samples of children under five years treated at the Bandim Health Centre in Bissau, Guinea-Bissau were screened by quantitative polymerase chain reaction (qPCR) for nine enteric bacteria, five viruses, and four parasites
Diarrhoea was associated with enteroinvasive E. coli (EIEC)/Shigella (63.3%), enterotoxigenic E. coli (ETEC) (54.4%), astrovirus (75.0%), norovirus GII (72.6%) and Cryptosporidium (71.2%)

Summary

Introduction

Diarrhoeal diseases rank second as cause of childhood mortality and morbidity in low-income countries (LICs) worldwide. In the African region, diarrhoea accounts for more than 10% of deaths among children under five years of age [1,2,3]. The aetiological agents for childhood diarrhoea comprise a variety of bacteria, viruses and parasites [4] which mostly spread through unclean water and food, a consequence of poor overall hygiene [4,5]. In only a few instances are bacterial, viral, and parasitic pathogens scrutinized using the same study setting [4,9,10]. A major cause of morbidity and mortality in low-income regions, remains scarcely studied in many countries, such as Guinea-Bissau. Stool sample drying enables later qPCR analyses of pathogens without concern about electricity shortages

Methods

Results

Conclusion