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Impact of co-infections with enteric pathogens on children suffering from acute diarrhea in southwest China

BACKGROUND: Acute diarrhea is a global health problem, resulting in high morbidity and mortality in children. It has been suggested that enteric pathogen co-infections play an important role in gastroenteritis, but most research efforts have only focused on a small range of species belonging to a fe...

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Autores principales: Zhang, Shun-Xian, Zhou, Yong-Ming, Xu, Wen, Tian, Li-Guang, Chen, Jia-Xu, Chen, Shao-Hong, Dang, Zhi-Sheng, Gu, Wen-Peng, Yin, Jian-Wen, Serrano, Emmanuel, Zhou, Xiao-Nong
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4922062/
https://www.ncbi.nlm.nih.gov/pubmed/27349521
http://dx.doi.org/10.1186/s40249-016-0157-2
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author Zhang, Shun-Xian
Zhou, Yong-Ming
Xu, Wen
Tian, Li-Guang
Chen, Jia-Xu
Chen, Shao-Hong
Dang, Zhi-Sheng
Gu, Wen-Peng
Yin, Jian-Wen
Serrano, Emmanuel
Zhou, Xiao-Nong
author_facet Zhang, Shun-Xian
Zhou, Yong-Ming
Xu, Wen
Tian, Li-Guang
Chen, Jia-Xu
Chen, Shao-Hong
Dang, Zhi-Sheng
Gu, Wen-Peng
Yin, Jian-Wen
Serrano, Emmanuel
Zhou, Xiao-Nong
author_sort Zhang, Shun-Xian
collection PubMed
description BACKGROUND: Acute diarrhea is a global health problem, resulting in high morbidity and mortality in children. It has been suggested that enteric pathogen co-infections play an important role in gastroenteritis, but most research efforts have only focused on a small range of species belonging to a few pathogen groups. This study aimed to assess the impact of co-infections with a broad range of enteric pathogens on children aged below five years who suffer from acute diarrhea in southwest China. METHOD: A total of 1020 subjects (850 diarrhea cases and 170 healthy controls) were selected from four sentinel hospitals in Kunming, Yunnan province, southwest China, from June 2014 to July 2015. Stool specimens were collected to detect five virus (rotavirus group A, RVA; norovirus, NoV; Sapovirus, SaV; astrovirus, As; and adenovirus, Ad), seven bacterial (diarrheagenic Escherichia coli, DEC; non-typhoidal Salmonella, NTS; Shigella spp.; Vibrio cholera; Vibrio parahaemolyticus; Aeromonas spp.; and Plesiomonas spp.), and three protozoan (Cryptosporidium spp., Giardia lamblia, and Blastocystis hominis, B. hominis) species using standard microbiologic and molecular methods. Data were analyzed using the partial least square regression technique and chi-square test. RESULTS: At least one enteric pathogen was detected in 46.7 % (n = 397) of acute gastroenteritis cases and 13.5 % (n = 23) of healthy controls (χ(2) = 64.4, P < 0.05). Single infection with RVA was associated with acute diarrhea (26.5 % vs. 5.8 %, P < 0.05). The prevalence of a single infection with B. hominis in diarrhea cases was higher than in healthy controls (3.1 % vs. 0.5 %, OR = 4.7, 95 % CI: 1.01–112.0). Single infection with NoV GII was not associated with diarrhea (4.4 % vs. 3.5 %, OR = 1.2, 95 % CI: 0.5–3.3). Single infections with bacterial species were not observed. The prevalence of co-infections with two enteric pathogens in diarrhea cases was higher than in asymptomatic children (20.1 % vs. 5.3 %, P < 0.05). RVA-NoV GII was the most common co-infection in symptomatic children (4.4 %), with it aggravating the severity of diarrhea. CONCLUSIONS: Although it is clear that RVA has an overwhelming impact on diarrhea illnesses in children, co-infection with other enteric pathogens appears to also aggravate diarrhea severity. These findings should serve as evidence for public health services when planning and developing intervention programs. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s40249-016-0157-2) contains supplementary material, which is available to authorized users.
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spelling pubmed-49220622016-06-28 Impact of co-infections with enteric pathogens on children suffering from acute diarrhea in southwest China Zhang, Shun-Xian Zhou, Yong-Ming Xu, Wen Tian, Li-Guang Chen, Jia-Xu Chen, Shao-Hong Dang, Zhi-Sheng Gu, Wen-Peng Yin, Jian-Wen Serrano, Emmanuel Zhou, Xiao-Nong Infect Dis Poverty Research Article BACKGROUND: Acute diarrhea is a global health problem, resulting in high morbidity and mortality in children. It has been suggested that enteric pathogen co-infections play an important role in gastroenteritis, but most research efforts have only focused on a small range of species belonging to a few pathogen groups. This study aimed to assess the impact of co-infections with a broad range of enteric pathogens on children aged below five years who suffer from acute diarrhea in southwest China. METHOD: A total of 1020 subjects (850 diarrhea cases and 170 healthy controls) were selected from four sentinel hospitals in Kunming, Yunnan province, southwest China, from June 2014 to July 2015. Stool specimens were collected to detect five virus (rotavirus group A, RVA; norovirus, NoV; Sapovirus, SaV; astrovirus, As; and adenovirus, Ad), seven bacterial (diarrheagenic Escherichia coli, DEC; non-typhoidal Salmonella, NTS; Shigella spp.; Vibrio cholera; Vibrio parahaemolyticus; Aeromonas spp.; and Plesiomonas spp.), and three protozoan (Cryptosporidium spp., Giardia lamblia, and Blastocystis hominis, B. hominis) species using standard microbiologic and molecular methods. Data were analyzed using the partial least square regression technique and chi-square test. RESULTS: At least one enteric pathogen was detected in 46.7 % (n = 397) of acute gastroenteritis cases and 13.5 % (n = 23) of healthy controls (χ(2) = 64.4, P < 0.05). Single infection with RVA was associated with acute diarrhea (26.5 % vs. 5.8 %, P < 0.05). The prevalence of a single infection with B. hominis in diarrhea cases was higher than in healthy controls (3.1 % vs. 0.5 %, OR = 4.7, 95 % CI: 1.01–112.0). Single infection with NoV GII was not associated with diarrhea (4.4 % vs. 3.5 %, OR = 1.2, 95 % CI: 0.5–3.3). Single infections with bacterial species were not observed. The prevalence of co-infections with two enteric pathogens in diarrhea cases was higher than in asymptomatic children (20.1 % vs. 5.3 %, P < 0.05). RVA-NoV GII was the most common co-infection in symptomatic children (4.4 %), with it aggravating the severity of diarrhea. CONCLUSIONS: Although it is clear that RVA has an overwhelming impact on diarrhea illnesses in children, co-infection with other enteric pathogens appears to also aggravate diarrhea severity. These findings should serve as evidence for public health services when planning and developing intervention programs. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s40249-016-0157-2) contains supplementary material, which is available to authorized users. BioMed Central 2016-06-27 /pmc/articles/PMC4922062/ /pubmed/27349521 http://dx.doi.org/10.1186/s40249-016-0157-2 Text en © The Author(s). 2016 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Zhang, Shun-Xian
Zhou, Yong-Ming
Xu, Wen
Tian, Li-Guang
Chen, Jia-Xu
Chen, Shao-Hong
Dang, Zhi-Sheng
Gu, Wen-Peng
Yin, Jian-Wen
Serrano, Emmanuel
Zhou, Xiao-Nong
Impact of co-infections with enteric pathogens on children suffering from acute diarrhea in southwest China
title Impact of co-infections with enteric pathogens on children suffering from acute diarrhea in southwest China
title_full Impact of co-infections with enteric pathogens on children suffering from acute diarrhea in southwest China
title_fullStr Impact of co-infections with enteric pathogens on children suffering from acute diarrhea in southwest China
title_full_unstemmed Impact of co-infections with enteric pathogens on children suffering from acute diarrhea in southwest China
title_short Impact of co-infections with enteric pathogens on children suffering from acute diarrhea in southwest China
title_sort impact of co-infections with enteric pathogens on children suffering from acute diarrhea in southwest china
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4922062/
https://www.ncbi.nlm.nih.gov/pubmed/27349521
http://dx.doi.org/10.1186/s40249-016-0157-2
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