Polymicrobial enteric infections in African infants with diarrhoeadresults from a longitudinal prospective caseecontrol study
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2021
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Abstract
Objectives: This longitudinal caseecontrol study aimed to determine the frequency of polymicrobial
enteric detections in Ghanaian infants with and without diarrhoea.
Methods: Infants aged 1e12 months with and without diarrhoea attending the outpatient department of
a peri-urban Ghanaian hospital were prospectively assessed and stool samples were collected on days 0,
6 and 28 and analysed for 18 enteric pathogens with PCR.
Results: At least one enteric pathogen was detected in 100 of 107 cases with diarrhoea (93%) and in 82 of
97 controls (85%). The number of pathogens was higher in cases than in controls (median three versus
two pathogens, p 0.001). The adjusted attributable fraction (AF) for diarrhoea was highest for entero toxigenic
Escherichia coli (7.2%, 95% CI e2.0% to 16.3%), rotavirus (4.1%, 95% CI 0.6%e7.5%), Giardia lamblia
(2.3%, 95% CI e0.7 to 5.3%) and astrovirus (2.3%, 95% CI e2.9 to 7.5%). In cases, a higher pathogen number
was significantly associated with watery stool consistency (median 3, interquartile range (IQR) 2e5
versus median 2.5, IQR 1e4, p 0.014), stool frequency five or more per day (median 4, IQR 3e5 versus
median 3, IQR 2e4, p 0.048) and vomiting (median 4, IQR 3e5 versus median 3, IQR 2e4, p 0.025).
During follow-up, 94% (78/83) of cases and 85% (67/79) of controls had acquired at least one new
pathogen without developing a new episode of diarrhoea.
Conclusion: Enteric pathogens could be identified in the stool of the vast majority of Ghanaian infants,
whereby pathogens were very frequently acquired without resulting in new episodes of diarrhoea during
follow-up. A higher number of co-occurring pathogens may increase the risk of diarrhoea and disease
severity. Melina Heinemann, Clin Microbiol Infect 2021;27:1792
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This article is published by Elsevier and is also available at www.clinicalmicrobiologyandinfection.com
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Clinical Microbiology and Infection 27 (2021) 1792e1798