Journal Article

Epidemiology of enteroaggregative Escherichia coli infections and associated outcomes in the MAL-ED birth cohort

Yori, Pablo Peñataro, Mahfuz, Mustafa, Anania, Japhat, Havt, Alexandre, Bessong, Pascal O., Ahmed, Tahmeed, Lima, Ila F. N., Gottlieb, Michael, McCormick, Benjamin J. J., Kosek, Margaret N., Seidman, Jessica C., Bodhidatta, Ladaporn, Medeiros, Pedro H. Q. S., Rogawski, Elizabeth T., Lang, Dennis R., Babji, Sudhir, Qureshi, Shahida, Lima, Aldo A. M., Houpt, Eric R., Shrestha, Jasmin, Guerrant, Richard L., Bhutta, Zulfiqar A., Maro, Athanasia, Hariraju, Dinesh, Samie, Amidou

2017

Overview

Enteroaggregative E. coli (EAEC) have been associated with mildly inflammatory diarrhea in outbreaks and in travelers and have been increasingly recognized as enteric pathogens in young children with and without overt diarrhea. We examined the risk factors for EAEC infections and their associations with environmental enteropathy biomarkers and growth outcomes over the first two years of life in eight low-resource settings of the MAL-ED study. EAEC infections were detected by PCR gene probes for aatA and aaiC virulence traits in 27,094 non-diarrheal surveillance stools and 7,692 diarrheal stools from 2,092 children in the MAL-ED birth cohort. We identified risk factors for EAEC and estimated the associations of EAEC with diarrhea, enteropathy biomarker concentrations, and both short-term (one to three months) and long-term (to two years of age) growth. Overall, 9,581 samples (27.5%) were positive for EAEC, and almost all children had at least one detection (94.8%) by two years of age. Exclusive breastfeeding, higher enrollment weight, and macrolide use within the preceding 15 days were protective. Although not associated with diarrhea, EAEC infections were weakly associated with biomarkers of intestinal inflammation and more strongly with reduced length at two years of age (LAZ difference associated with high frequency of EAEC detections: -0.30, 95% CI: -0.44, -0.16). Asymptomatic EAEC infections were common early in life and were associated with linear growth shortfalls. Associations with intestinal inflammation were small in magnitude, but suggest a pathway for the growth impact. Increasing the duration of exclusive breastfeeding may help prevent these potentially inflammatory infections and reduce the long-term impact of early exposure to EAEC.

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Age / Age Distribution / Bioindicators / Biology and Life Sciences / Biomarkers / Breast feeding / Breastfeeding & lactation / Care and treatment / Child Health / Children / Children & youth / Childrens health / Cohort Studies / Cohorts / Detection / Diarrhea / Diarrhea - epidemiology / Diarrhea - microbiology / Disease Outbreaks / DNA / Duration / E coli / Epidemiology / Escherichia coli - pathogenicity / Escherichia coli infections / Escherichia coli Infections - epidemiology / Feces - microbiology / Female / Growth / Health aspects / High frequency / Humans / Infant / Infant, Newborn / Infections / Infectious diseases / Inflammation / International Cooperation / Intestine / Linear Models / Male / Malnutrition / Medical research / Medicine and Health Sciences / Multivariate Analysis / Nucleotide sequence / Outbreaks / Parturition / PCR / People and Places / Polymerase chain reaction / Probes / Public health / Risk analysis / Risk Factors / Social Sciences / Studies / Supervision / Tropical diseases / Virulence