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

Abstract 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.
PMID
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Authors

Mayor MeshTerms
Keywords
Journal Title plos neglected tropical diseases
Publication Year Start




PMID- 28742106
OWN - NLM
STAT- In-Process
DA  - 20170725
LR  - 20170803
IS  - 1935-2735 (Electronic)
IS  - 1935-2727 (Linking)
VI  - 11
IP  - 7
DP  - 2017 Jul
TI  - Epidemiology of enteroaggregative Escherichia coli infections and associated
      outcomes in the MAL-ED birth cohort.
PG  - e0005798
LID - 10.1371/journal.pntd.0005798 [doi]
AB  - BACKGROUND: 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. METHODS: 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. RESULTS: 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). 
      CONCLUSIONS: 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.
FAU - Rogawski, Elizabeth T
AU  - Rogawski ET
AUID- ORCID: http://orcid.org/0000-0002-4942-3747
AD  - Department of Public Health Sciences, University of Virginia, Charlottesville,
      Virginia, United States of America.
AD  - Division of Infectious Diseases and International Health, University of Virginia,
      Charlottesville, Virginia, United States of America.
FAU - Guerrant, Richard L
AU  - Guerrant RL
AD  - Division of Infectious Diseases and International Health, University of Virginia,
      Charlottesville, Virginia, United States of America.
FAU - Havt, Alexandre
AU  - Havt A
AD  - Clinical Research Unit and Institute of Biomedicine, Federal University of Ceara,
      Fortaleza, Brazil.
FAU - Lima, Ila F N
AU  - Lima IFN
AD  - Clinical Research Unit and Institute of Biomedicine, Federal University of Ceara,
      Fortaleza, Brazil.
FAU - Medeiros, Pedro H Q S
AU  - Medeiros PHQS
AD  - Clinical Research Unit and Institute of Biomedicine, Federal University of Ceara,
      Fortaleza, Brazil.
FAU - Seidman, Jessica C
AU  - Seidman JC
AD  - Fogarty International Center, National Institutes of Health, Bethesda, Maryland, 
      United States of America.
FAU - McCormick, Benjamin J J
AU  - McCormick BJJ
AD  - Fogarty International Center, National Institutes of Health, Bethesda, Maryland, 
      United States of America.
FAU - Babji, Sudhir
AU  - Babji S
AD  - Division of Gastrointestinal Sciences, Christian Medical College, Vellore, India.
FAU - Hariraju, Dinesh
AU  - Hariraju D
AD  - Division of Gastrointestinal Sciences, Christian Medical College, Vellore, India.
FAU - Bodhidatta, Ladaporn
AU  - Bodhidatta L
AD  - Department of Enteric Diseases, Armed Forces Research Institute of Medical
      Sciences, Bangkok, Thailand.
FAU - Shrestha, Jasmin
AU  - Shrestha J
AD  - Walter Reed-AFRIMS Research Unit, Nepal, Kathmandu, Nepal.
FAU - Anania, Japhat
AU  - Anania J
AD  - Haydom Global Health Research Center, Haydom Lutheran Hospital, Haydom, Tanzania.
FAU - Maro, Athanasia
AU  - Maro A
AD  - Haydom Global Health Research Center, Haydom Lutheran Hospital, Haydom, Tanzania.
FAU - Samie, Amidou
AU  - Samie A
AD  - Department of Microbiology, University of Venda, Thohoyandou, South Africa.
FAU - Yori, Pablo Penataro
AU  - Yori PP
AD  - Asociacion Benefica PRISMA, Iquitos, Peru.
FAU - Qureshi, Shahida
AU  - Qureshi S
AD  - Department of Paediatrics and Child Health, Aga Khan University, Karachi,
      Pakistan.
FAU - Mahfuz, Mustafa
AU  - Mahfuz M
AD  - Nutrition and Clinical Services Division, International Centre for Diarrhoeal
      Disease Research, Dhaka, Bangladesh.
FAU - Bessong, Pascal O
AU  - Bessong PO
AD  - Department of Microbiology, University of Venda, Thohoyandou, South Africa.
FAU - Kosek, Margaret N
AU  - Kosek MN
AD  - Asociacion Benefica PRISMA, Iquitos, Peru.
AD  - Department of International Health, Bloomberg School of Public Health, Johns
      Hopkins University, Baltimore, Maryland, United States of America.
FAU - Ahmed, Tahmeed
AU  - Ahmed T
AD  - Nutrition and Clinical Services Division, International Centre for Diarrhoeal
      Disease Research, Dhaka, Bangladesh.
FAU - Bhutta, Zulfiqar A
AU  - Bhutta ZA
AD  - Department of Paediatrics and Child Health, Aga Khan University, Karachi,
      Pakistan.
FAU - Lang, Dennis R
AU  - Lang DR
AD  - Foundation for the National Institutes of Health, Bethesda, Maryland, United
      States of America.
FAU - Gottlieb, Michael
AU  - Gottlieb M
AD  - Foundation for the National Institutes of Health, Bethesda, Maryland, United
      States of America.
FAU - Houpt, Eric R
AU  - Houpt ER
AD  - Division of Infectious Diseases and International Health, University of Virginia,
      Charlottesville, Virginia, United States of America.
FAU - Lima, Aldo A M
AU  - Lima AAM
AD  - Clinical Research Unit and Institute of Biomedicine, Federal University of Ceara,
      Fortaleza, Brazil.
CN  - MAL-ED Network Investigators
LA  - eng
PT  - Journal Article
DEP - 20170724
PL  - United States
TA  - PLoS Negl Trop Dis
JT  - PLoS neglected tropical diseases
JID - 101291488
EDAT- 2017/07/26 06:00
MHDA- 2017/07/26 06:00
CRDT- 2017/07/26 06:00
PHST- 2017/04/20 [received]
PHST- 2017/07/11 [accepted]
PHST- 2017/08/03 [revised]
AID - 10.1371/journal.pntd.0005798 [doi]
AID - PNTD-D-17-00609 [pii]
PST - epublish
SO  - PLoS Negl Trop Dis. 2017 Jul 24;11(7):e0005798. doi:
      10.1371/journal.pntd.0005798. eCollection 2017 Jul.