Enteroaggregative Escherichia coli Subclinical Infection and Coinfections and Impaired Child Growth in the MAL-ED Cohort Study

Aldo A.M. Lima; Alberto M. Soares; José Q.S. Filho; Alexandre Havt; Ila F.N. Lima; Noélia L. Lima; Cláudia B. Abreu; S. Francisco; Rosa M.S. Mota; William K.Y. Pan; Christopher Troeger; Pedro H.Q.S. Medeiros; Herlice N. Veras; Mara A. Prata; Ben J.J. McCormick; Monica McGrath; Elizabeth T. Rogawski; Eric R. Houpt; James A. Platts-Mills; Jean Gratz; Amidou Samie; Pascal Bessong; Sudhir Babji; Gangadeep Kang; Shahida Qureshi; Sadia Shakoor; Zulfigar A. Bhutta; Rashidul Haque; Tahmeed Ahmed; Estomih R. Mduma; Erling Svensen; Margaret Kosek; Pablo P. Yori; Ladaporn Bodhidatta; Shrestha Jasmin; Carl J. Mason; Dennis Lang; Michael Gottlieb; Richard L. Guerrant

doi:10.1097/MPG.0000000000001717

Enteroaggregative Escherichia coli Subclinical Infection and Coinfections and Impaired Child Growth in the MAL-ED Cohort Study

Aldo A.M. Lima^* (Corresponding Author), Alberto M. Soares, José Q.S. Filho, Alexandre Havt, Ila F.N. Lima, Noélia L. Lima, Cláudia B. Abreu, S. Francisco, Rosa M.S. Mota, William K.Y. Pan, Christopher Troeger, Pedro H.Q.S. Medeiros, Herlice N. Veras, Mara A. Prata, Ben J.J. McCormick, Monica McGrath, Elizabeth T. Rogawski, Eric R. Houpt, James A. Platts-Mills, Jean GratzAmidou Samie, Pascal Bessong, Sudhir Babji, Gangadeep Kang, Shahida Qureshi, Sadia Shakoor, Zulfigar A. Bhutta, Rashidul Haque, Tahmeed Ahmed, Estomih R. Mduma, Erling Svensen, Margaret Kosek, Pablo P. Yori, Ladaporn Bodhidatta, Shrestha Jasmin, Carl J. Mason, Dennis Lang, Michael Gottlieb, Richard L. Guerrant

^*Corresponding author for this work

The Rowett Institute of Nutrition and Health

Research output: Contribution to journal › Article › peer-review

26 Citations (Scopus)

Abstract

Objective: We evaluated the impact of subclinical enteroaggregative Escherichia coli (EAEC) infection alone and in combination with other pathogens in the first 6 months of life on child growth. Methods: Nondiarrheal samples from 1684 children across 8 Multisite Birth Cohort Study, Malnutrition and Enteric Diseases (MAL-ED) sites in Asia, Africa, and Latin America were tested monthly; more than 90% of children were followed-up twice weekly for the first 6 months of life. Results: Children with subclinical EAEC infection did not show altered growth between enrollment and 6 months. Conversely, EAEC coinfection with any other pathogen was negatively associated with delta weight-for-length (P < 0.05) and weight-for-age (P > 0.05) z scores between 0 and 6 months. The presence of 2 or more pathogens without EAEC was not significantly associated with delta weight-for-length and weight-for-age. The most frequent EAEC coinfections included Campylobacter spp, heat-labile toxin-producing enterotoxigenic E coli, Cryptosporidium spp, and atypical enteropathogenic E coli. Myeloperoxidase levels were increased with EAEC coinfection (P < 0.05). EAEC pathogen codetection was associated with lower neopterin levels compared to those of no-pathogen control children (P < 0.05). Mothers of children with EAEC coinfections had lower levels of education, poorer hygiene and sanitation, lower socioeconomic status, and lower breast-feeding rates compared to mothers of children in whom no pathogen was detected (P < 0.05). Conclusions: These data emphasize the public health importance of subclinical EAEC infection in early infancy in association with other pathogens and the need for improved maternal and child care, hygiene, sanitation, and socioeconomic factors.

Original language	English
Pages (from-to)	325-333
Number of pages	9
Journal	Journal of pediatric gastroenterology and nutrition
Volume	66
Issue number	2
DOIs	https://doi.org/10.1097/MPG.0000000000001717
Publication status	Published - 1 Feb 2018

Bibliographical note

Funding Information:
Universidade Federal do Ceara, Fortaleza, Ceará, Brazil, the †Duke Global Health Institute, Duke University, Durham, NC, the zInstitute for Health Metrics and Evaluation, Seattle, WA, the §National Institutes of Health, Fogarty International Center, Bethesda, MD, the ||Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA, the ôDepartment of Microbiology, University of Venda, the #Division of Gastrointestinal Sciences, Christian Medical College and Hospital Vellore, Vellore, India, the **Department of Gastrointestinal Sciences Christian Medical College, the ††Aga Khan University, the zzDepartment of Pediatrics, Aga Khan University, Naush-ahro Feroze, Pakistan, the §§International Centre for Diarrhoeal Disease Research, ICDDR-B, Dhaka, Bangladesh, the ||||Haydom Lutheran Hospital, Moshi, Tanzania, the ôôHaukeland University Hospital, Haydom, Tanzania, the ##Johns Hopkins University, Baltimore, MD, the

Funding Information:
Research Institute of Medical Sciences, Kathmandu, Nepal, and the zzzFoundation for the National Institutes of Health, Baltimore, MD.

Acknowledgments: The Etiology, Risk Factors, and Interactions of Enteric Infections and Malnutrition and the Consequences for Child Health and Development Project (MAL-ED) is carried out as a collaborative project supported by the Bill & Melinda Gates Foundation, the Foundation for the NIH, and the National Institutes of Health/Fogarty International Center. The authors thank the staff and participants of the MAL-ED Network for their important contributions.

Publisher Copyright:
Copyright © 2017 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition.

Data Availability Statement

Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal's Web site (www.jpgn.org).

Keywords

enteroaggregative Escherichia coli
gut inflammation
intestinal immune responses
nutritional status
pathogen enteroaggregative Escherichia coli coinfection

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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Cite this

Lima, A. A. M., Soares, A. M., Filho, J. Q. S., Havt, A., Lima, I. F. N., Lima, N. L., Abreu, C. B., Francisco, S., Mota, R. M. S., Pan, W. K. Y., Troeger, C., Medeiros, P. H. Q. S., Veras, H. N., Prata, M. A., McCormick, B. J. J., McGrath, M., Rogawski, E. T., Houpt, E. R., Platts-Mills, J. A., ... Guerrant, R. L. (2018). Enteroaggregative Escherichia coli Subclinical Infection and Coinfections and Impaired Child Growth in the MAL-ED Cohort Study. Journal of pediatric gastroenterology and nutrition, 66(2), 325-333. https://doi.org/10.1097/MPG.0000000000001717

Enteroaggregative Escherichia coli Subclinical Infection and Coinfections and Impaired Child Growth in the MAL-ED Cohort Study. / Lima, Aldo A.M. (Corresponding Author); Soares, Alberto M.; Filho, José Q.S. et al.
In: Journal of pediatric gastroenterology and nutrition, Vol. 66, No. 2, 01.02.2018, p. 325-333.

Research output: Contribution to journal › Article › peer-review

Lima, AAM, Soares, AM, Filho, JQS, Havt, A, Lima, IFN, Lima, NL, Abreu, CB, Francisco, S, Mota, RMS, Pan, WKY, Troeger, C, Medeiros, PHQS, Veras, HN, Prata, MA, McCormick, BJJ, McGrath, M, Rogawski, ET, Houpt, ER, Platts-Mills, JA, Gratz, J, Samie, A, Bessong, P, Babji, S, Kang, G, Qureshi, S, Shakoor, S, Bhutta, ZA, Haque, R, Ahmed, T, Mduma, ER, Svensen, E, Kosek, M, Yori, PP, Bodhidatta, L, Jasmin, S, Mason, CJ, Lang, D, Gottlieb, M & Guerrant, RL 2018, 'Enteroaggregative Escherichia coli Subclinical Infection and Coinfections and Impaired Child Growth in the MAL-ED Cohort Study', Journal of pediatric gastroenterology and nutrition, vol. 66, no. 2, pp. 325-333. https://doi.org/10.1097/MPG.0000000000001717

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title = "Enteroaggregative Escherichia coli Subclinical Infection and Coinfections and Impaired Child Growth in the MAL-ED Cohort Study",

abstract = "Objective: We evaluated the impact of subclinical enteroaggregative Escherichia coli (EAEC) infection alone and in combination with other pathogens in the first 6 months of life on child growth. Methods: Nondiarrheal samples from 1684 children across 8 Multisite Birth Cohort Study, Malnutrition and Enteric Diseases (MAL-ED) sites in Asia, Africa, and Latin America were tested monthly; more than 90% of children were followed-up twice weekly for the first 6 months of life. Results: Children with subclinical EAEC infection did not show altered growth between enrollment and 6 months. Conversely, EAEC coinfection with any other pathogen was negatively associated with delta weight-for-length (P < 0.05) and weight-for-age (P > 0.05) z scores between 0 and 6 months. The presence of 2 or more pathogens without EAEC was not significantly associated with delta weight-for-length and weight-for-age. The most frequent EAEC coinfections included Campylobacter spp, heat-labile toxin-producing enterotoxigenic E coli, Cryptosporidium spp, and atypical enteropathogenic E coli. Myeloperoxidase levels were increased with EAEC coinfection (P < 0.05). EAEC pathogen codetection was associated with lower neopterin levels compared to those of no-pathogen control children (P < 0.05). Mothers of children with EAEC coinfections had lower levels of education, poorer hygiene and sanitation, lower socioeconomic status, and lower breast-feeding rates compared to mothers of children in whom no pathogen was detected (P < 0.05). Conclusions: These data emphasize the public health importance of subclinical EAEC infection in early infancy in association with other pathogens and the need for improved maternal and child care, hygiene, sanitation, and socioeconomic factors.",

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note = "Funding Information: Universidade Federal do Ceara, Fortaleza, Cear{\'a}, Brazil, the †Duke Global Health Institute, Duke University, Durham, NC, the zInstitute for Health Metrics and Evaluation, Seattle, WA, the §National Institutes of Health, Fogarty International Center, Bethesda, MD, the ||Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA, the {\^o}Department of Microbiology, University of Venda, the #Division of Gastrointestinal Sciences, Christian Medical College and Hospital Vellore, Vellore, India, the **Department of Gastrointestinal Sciences Christian Medical College, the ††Aga Khan University, the zzDepartment of Pediatrics, Aga Khan University, Naush-ahro Feroze, Pakistan, the §§International Centre for Diarrhoeal Disease Research, ICDDR-B, Dhaka, Bangladesh, the ||||Haydom Lutheran Hospital, Moshi, Tanzania, the {\^o}{\^o}Haukeland University Hospital, Haydom, Tanzania, the ##Johns Hopkins University, Baltimore, MD, the Funding Information: Research Institute of Medical Sciences, Kathmandu, Nepal, and the zzzFoundation for the National Institutes of Health, Baltimore, MD. Acknowledgments: The Etiology, Risk Factors, and Interactions of Enteric Infections and Malnutrition and the Consequences for Child Health and Development Project (MAL-ED) is carried out as a collaborative project supported by the Bill & Melinda Gates Foundation, the Foundation for the NIH, and the National Institutes of Health/Fogarty International Center. The authors thank the staff and participants of the MAL-ED Network for their important contributions. Publisher Copyright: Copyright {\textcopyright} 2017 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition.",

year = "2018",

month = feb,

day = "1",

doi = "10.1097/MPG.0000000000001717",

language = "English",

volume = "66",

pages = "325--333",

journal = "Journal of pediatric gastroenterology and nutrition",

issn = "0277-2116",

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TY - JOUR

T1 - Enteroaggregative Escherichia coli Subclinical Infection and Coinfections and Impaired Child Growth in the MAL-ED Cohort Study

AU - Lima, Aldo A.M.

AU - Soares, Alberto M.

AU - Filho, José Q.S.

AU - Havt, Alexandre

AU - Lima, Ila F.N.

AU - Lima, Noélia L.

AU - Abreu, Cláudia B.

AU - Francisco, S.

AU - Mota, Rosa M.S.

AU - Pan, William K.Y.

AU - Troeger, Christopher

AU - Medeiros, Pedro H.Q.S.

AU - Veras, Herlice N.

AU - Prata, Mara A.

AU - McCormick, Ben J.J.

AU - McGrath, Monica

AU - Rogawski, Elizabeth T.

AU - Houpt, Eric R.

AU - Platts-Mills, James A.

AU - Gratz, Jean

AU - Samie, Amidou

AU - Bessong, Pascal

AU - Babji, Sudhir

AU - Kang, Gangadeep

AU - Qureshi, Shahida

AU - Shakoor, Sadia

AU - Bhutta, Zulfigar A.

AU - Haque, Rashidul

AU - Ahmed, Tahmeed

AU - Mduma, Estomih R.

AU - Svensen, Erling

AU - Kosek, Margaret

AU - Yori, Pablo P.

AU - Bodhidatta, Ladaporn

AU - Jasmin, Shrestha

AU - Mason, Carl J.

AU - Lang, Dennis

AU - Gottlieb, Michael

AU - Guerrant, Richard L.

N1 - Funding Information: Universidade Federal do Ceara, Fortaleza, Ceará, Brazil, the †Duke Global Health Institute, Duke University, Durham, NC, the zInstitute for Health Metrics and Evaluation, Seattle, WA, the §National Institutes of Health, Fogarty International Center, Bethesda, MD, the ||Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA, the ôDepartment of Microbiology, University of Venda, the #Division of Gastrointestinal Sciences, Christian Medical College and Hospital Vellore, Vellore, India, the **Department of Gastrointestinal Sciences Christian Medical College, the ††Aga Khan University, the zzDepartment of Pediatrics, Aga Khan University, Naush-ahro Feroze, Pakistan, the §§International Centre for Diarrhoeal Disease Research, ICDDR-B, Dhaka, Bangladesh, the ||||Haydom Lutheran Hospital, Moshi, Tanzania, the ôôHaukeland University Hospital, Haydom, Tanzania, the ##Johns Hopkins University, Baltimore, MD, the Funding Information: Research Institute of Medical Sciences, Kathmandu, Nepal, and the zzzFoundation for the National Institutes of Health, Baltimore, MD. Acknowledgments: The Etiology, Risk Factors, and Interactions of Enteric Infections and Malnutrition and the Consequences for Child Health and Development Project (MAL-ED) is carried out as a collaborative project supported by the Bill & Melinda Gates Foundation, the Foundation for the NIH, and the National Institutes of Health/Fogarty International Center. The authors thank the staff and participants of the MAL-ED Network for their important contributions. Publisher Copyright: Copyright © 2017 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition.

PY - 2018/2/1

Y1 - 2018/2/1

N2 - Objective: We evaluated the impact of subclinical enteroaggregative Escherichia coli (EAEC) infection alone and in combination with other pathogens in the first 6 months of life on child growth. Methods: Nondiarrheal samples from 1684 children across 8 Multisite Birth Cohort Study, Malnutrition and Enteric Diseases (MAL-ED) sites in Asia, Africa, and Latin America were tested monthly; more than 90% of children were followed-up twice weekly for the first 6 months of life. Results: Children with subclinical EAEC infection did not show altered growth between enrollment and 6 months. Conversely, EAEC coinfection with any other pathogen was negatively associated with delta weight-for-length (P < 0.05) and weight-for-age (P > 0.05) z scores between 0 and 6 months. The presence of 2 or more pathogens without EAEC was not significantly associated with delta weight-for-length and weight-for-age. The most frequent EAEC coinfections included Campylobacter spp, heat-labile toxin-producing enterotoxigenic E coli, Cryptosporidium spp, and atypical enteropathogenic E coli. Myeloperoxidase levels were increased with EAEC coinfection (P < 0.05). EAEC pathogen codetection was associated with lower neopterin levels compared to those of no-pathogen control children (P < 0.05). Mothers of children with EAEC coinfections had lower levels of education, poorer hygiene and sanitation, lower socioeconomic status, and lower breast-feeding rates compared to mothers of children in whom no pathogen was detected (P < 0.05). Conclusions: These data emphasize the public health importance of subclinical EAEC infection in early infancy in association with other pathogens and the need for improved maternal and child care, hygiene, sanitation, and socioeconomic factors.

AB - Objective: We evaluated the impact of subclinical enteroaggregative Escherichia coli (EAEC) infection alone and in combination with other pathogens in the first 6 months of life on child growth. Methods: Nondiarrheal samples from 1684 children across 8 Multisite Birth Cohort Study, Malnutrition and Enteric Diseases (MAL-ED) sites in Asia, Africa, and Latin America were tested monthly; more than 90% of children were followed-up twice weekly for the first 6 months of life. Results: Children with subclinical EAEC infection did not show altered growth between enrollment and 6 months. Conversely, EAEC coinfection with any other pathogen was negatively associated with delta weight-for-length (P < 0.05) and weight-for-age (P > 0.05) z scores between 0 and 6 months. The presence of 2 or more pathogens without EAEC was not significantly associated with delta weight-for-length and weight-for-age. The most frequent EAEC coinfections included Campylobacter spp, heat-labile toxin-producing enterotoxigenic E coli, Cryptosporidium spp, and atypical enteropathogenic E coli. Myeloperoxidase levels were increased with EAEC coinfection (P < 0.05). EAEC pathogen codetection was associated with lower neopterin levels compared to those of no-pathogen control children (P < 0.05). Mothers of children with EAEC coinfections had lower levels of education, poorer hygiene and sanitation, lower socioeconomic status, and lower breast-feeding rates compared to mothers of children in whom no pathogen was detected (P < 0.05). Conclusions: These data emphasize the public health importance of subclinical EAEC infection in early infancy in association with other pathogens and the need for improved maternal and child care, hygiene, sanitation, and socioeconomic factors.

KW - enteroaggregative Escherichia coli

KW - gut inflammation

KW - intestinal immune responses

KW - nutritional status

KW - pathogen enteroaggregative Escherichia coli coinfection

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U2 - 10.1097/MPG.0000000000001717

DO - 10.1097/MPG.0000000000001717

M3 - Article

C2 - 29356769

AN - SCOPUS:85041555976

SN - 0277-2116

VL - 66

SP - 325

EP - 333

JO - Journal of pediatric gastroenterology and nutrition

JF - Journal of pediatric gastroenterology and nutrition

IS - 2

ER -

Enteroaggregative Escherichia coli Subclinical Infection and Coinfections and Impaired Child Growth in the MAL-ED Cohort Study

Abstract

Bibliographical note

Data Availability Statement

Keywords

UN SDGs

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