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Clinical, environmental, and behavioral characteristics associated with Cryptosporidium infection among children with moderate-to-severe diarrhea in rural western Kenya, 2008–2012: The Global Enteric Multicenter Study (GEMS)

BACKGROUND: Cryptosporidium is a leading cause of moderate-to-severe diarrhea (MSD) in young children in Africa. We examined factors associated with Cryptosporidium infection in MSD cases enrolled at the rural western Kenya Global Enteric Multicenter Study (GEMS) site from 2008-2012. METHODOLOGY/PRI...

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Autores principales: Delahoy, Miranda J., Omore, Richard, Ayers, Tracy L., Schilling, Katharine A., Blackstock, Anna J., Ochieng, J. Benjamin, Moke, Feny, Jaron, Peter, Awuor, Alex, Okonji, Caleb, Juma, Jane, Farag, Tamer H., Nasrin, Dilruba, Panchalingam, Sandra, Nataro, James P., Kotloff, Karen L., Levine, Myron M., Oundo, Joseph, Roellig, Dawn M., Xiao, Lihua, Parsons, Michele B., Laserson, Kayla, Mintz, Eric D., Breiman, Robert F., O'Reilly, Ciara E.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6057667/
https://www.ncbi.nlm.nih.gov/pubmed/30001340
http://dx.doi.org/10.1371/journal.pntd.0006640
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author Delahoy, Miranda J.
Omore, Richard
Ayers, Tracy L.
Schilling, Katharine A.
Blackstock, Anna J.
Ochieng, J. Benjamin
Moke, Feny
Jaron, Peter
Awuor, Alex
Okonji, Caleb
Juma, Jane
Farag, Tamer H.
Nasrin, Dilruba
Panchalingam, Sandra
Nataro, James P.
Kotloff, Karen L.
Levine, Myron M.
Oundo, Joseph
Roellig, Dawn M.
Xiao, Lihua
Parsons, Michele B.
Laserson, Kayla
Mintz, Eric D.
Breiman, Robert F.
O'Reilly, Ciara E.
author_facet Delahoy, Miranda J.
Omore, Richard
Ayers, Tracy L.
Schilling, Katharine A.
Blackstock, Anna J.
Ochieng, J. Benjamin
Moke, Feny
Jaron, Peter
Awuor, Alex
Okonji, Caleb
Juma, Jane
Farag, Tamer H.
Nasrin, Dilruba
Panchalingam, Sandra
Nataro, James P.
Kotloff, Karen L.
Levine, Myron M.
Oundo, Joseph
Roellig, Dawn M.
Xiao, Lihua
Parsons, Michele B.
Laserson, Kayla
Mintz, Eric D.
Breiman, Robert F.
O'Reilly, Ciara E.
author_sort Delahoy, Miranda J.
collection PubMed
description BACKGROUND: Cryptosporidium is a leading cause of moderate-to-severe diarrhea (MSD) in young children in Africa. We examined factors associated with Cryptosporidium infection in MSD cases enrolled at the rural western Kenya Global Enteric Multicenter Study (GEMS) site from 2008-2012. METHODOLOGY/PRINCIPAL FINDINGS: At health facility enrollment, stool samples were tested for enteric pathogens and data on clinical, environmental, and behavioral characteristics collected. Each child’s health status was recorded at 60-day follow-up. Data were analyzed using logistic regression. Of the 1,778 children with MSD enrolled as cases in the GEMS-Kenya case-control study, 11% had Cryptosporidium detected in stool by enzyme immunoassay; in a genotyped subset, 81% were C. hominis. Among MSD cases, being an infant, having mucus in stool, and having prolonged/persistent duration diarrhea were associated with being Cryptosporidium-positive. Both boiling drinking water and using rainwater as the main drinking water source were protective factors for being Cryptosporidium-positive. At follow-up, Cryptosporidium-positive cases had increased odds of being stunted (adjusted odds ratio [aOR] = 1.65, 95% CI: 1.06–2.57), underweight (aOR = 2.08, 95% CI: 1.34–3.22), or wasted (aOR = 2.04, 95% CI: 1.21–3.43), and had significantly larger negative changes in height- and weight-for-age z-scores from enrollment. CONCLUSIONS/SIGNIFICANCE: Cryptosporidium contributes significantly to diarrheal illness in young children in western Kenya. Advances in point of care detection, prevention/control approaches, effective water treatment technologies, and clinical management options for children with cryptosporidiosis are needed.
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spelling pubmed-60576672018-08-06 Clinical, environmental, and behavioral characteristics associated with Cryptosporidium infection among children with moderate-to-severe diarrhea in rural western Kenya, 2008–2012: The Global Enteric Multicenter Study (GEMS) Delahoy, Miranda J. Omore, Richard Ayers, Tracy L. Schilling, Katharine A. Blackstock, Anna J. Ochieng, J. Benjamin Moke, Feny Jaron, Peter Awuor, Alex Okonji, Caleb Juma, Jane Farag, Tamer H. Nasrin, Dilruba Panchalingam, Sandra Nataro, James P. Kotloff, Karen L. Levine, Myron M. Oundo, Joseph Roellig, Dawn M. Xiao, Lihua Parsons, Michele B. Laserson, Kayla Mintz, Eric D. Breiman, Robert F. O'Reilly, Ciara E. PLoS Negl Trop Dis Research Article BACKGROUND: Cryptosporidium is a leading cause of moderate-to-severe diarrhea (MSD) in young children in Africa. We examined factors associated with Cryptosporidium infection in MSD cases enrolled at the rural western Kenya Global Enteric Multicenter Study (GEMS) site from 2008-2012. METHODOLOGY/PRINCIPAL FINDINGS: At health facility enrollment, stool samples were tested for enteric pathogens and data on clinical, environmental, and behavioral characteristics collected. Each child’s health status was recorded at 60-day follow-up. Data were analyzed using logistic regression. Of the 1,778 children with MSD enrolled as cases in the GEMS-Kenya case-control study, 11% had Cryptosporidium detected in stool by enzyme immunoassay; in a genotyped subset, 81% were C. hominis. Among MSD cases, being an infant, having mucus in stool, and having prolonged/persistent duration diarrhea were associated with being Cryptosporidium-positive. Both boiling drinking water and using rainwater as the main drinking water source were protective factors for being Cryptosporidium-positive. At follow-up, Cryptosporidium-positive cases had increased odds of being stunted (adjusted odds ratio [aOR] = 1.65, 95% CI: 1.06–2.57), underweight (aOR = 2.08, 95% CI: 1.34–3.22), or wasted (aOR = 2.04, 95% CI: 1.21–3.43), and had significantly larger negative changes in height- and weight-for-age z-scores from enrollment. CONCLUSIONS/SIGNIFICANCE: Cryptosporidium contributes significantly to diarrheal illness in young children in western Kenya. Advances in point of care detection, prevention/control approaches, effective water treatment technologies, and clinical management options for children with cryptosporidiosis are needed. Public Library of Science 2018-07-12 /pmc/articles/PMC6057667/ /pubmed/30001340 http://dx.doi.org/10.1371/journal.pntd.0006640 Text en https://creativecommons.org/publicdomain/zero/1.0/ This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 (https://creativecommons.org/publicdomain/zero/1.0/) public domain dedication.
spellingShingle Research Article
Delahoy, Miranda J.
Omore, Richard
Ayers, Tracy L.
Schilling, Katharine A.
Blackstock, Anna J.
Ochieng, J. Benjamin
Moke, Feny
Jaron, Peter
Awuor, Alex
Okonji, Caleb
Juma, Jane
Farag, Tamer H.
Nasrin, Dilruba
Panchalingam, Sandra
Nataro, James P.
Kotloff, Karen L.
Levine, Myron M.
Oundo, Joseph
Roellig, Dawn M.
Xiao, Lihua
Parsons, Michele B.
Laserson, Kayla
Mintz, Eric D.
Breiman, Robert F.
O'Reilly, Ciara E.
Clinical, environmental, and behavioral characteristics associated with Cryptosporidium infection among children with moderate-to-severe diarrhea in rural western Kenya, 2008–2012: The Global Enteric Multicenter Study (GEMS)
title Clinical, environmental, and behavioral characteristics associated with Cryptosporidium infection among children with moderate-to-severe diarrhea in rural western Kenya, 2008–2012: The Global Enteric Multicenter Study (GEMS)
title_full Clinical, environmental, and behavioral characteristics associated with Cryptosporidium infection among children with moderate-to-severe diarrhea in rural western Kenya, 2008–2012: The Global Enteric Multicenter Study (GEMS)
title_fullStr Clinical, environmental, and behavioral characteristics associated with Cryptosporidium infection among children with moderate-to-severe diarrhea in rural western Kenya, 2008–2012: The Global Enteric Multicenter Study (GEMS)
title_full_unstemmed Clinical, environmental, and behavioral characteristics associated with Cryptosporidium infection among children with moderate-to-severe diarrhea in rural western Kenya, 2008–2012: The Global Enteric Multicenter Study (GEMS)
title_short Clinical, environmental, and behavioral characteristics associated with Cryptosporidium infection among children with moderate-to-severe diarrhea in rural western Kenya, 2008–2012: The Global Enteric Multicenter Study (GEMS)
title_sort clinical, environmental, and behavioral characteristics associated with cryptosporidium infection among children with moderate-to-severe diarrhea in rural western kenya, 2008–2012: the global enteric multicenter study (gems)
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6057667/
https://www.ncbi.nlm.nih.gov/pubmed/30001340
http://dx.doi.org/10.1371/journal.pntd.0006640
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