Persistent diarrhea signals a critical period of increased diarrhea burdens and nutritional shortfalls: A prospective cohort study among children in northeastern Brazil

被引:162
作者
Lima, AAM
Moore, SR
Barboza, MS
Soares, AM
Schleupner, MA
Newman, RD
Sears, CL
Nataro, JP
Fedorko, DP
Wuhib, T
Schorling, JB
Guerrant, RL
机构
[1] Univ Fed Ceara, Hosp Walter Condidio, Dept Physiol & Pharmacol, Fac Med,Clin Res Unit, BR-60436160 Fortaleza, Ceara, Brazil
[2] Univ Virginia, Sch Med, Dept Med, Div Geograph & Int Med, Charlottesville, VA 22908 USA
[3] Univ Washington, Sch Med, Dept Pediat, Div Gen Pediat, Seattle, WA 98195 USA
[4] Hlth Alliance Int, Seattle, WA USA
[5] Johns Hopkins Univ, Sch Med, Div Infect Dis & Gastroenterol, Dept Med, Baltimore, MD 21205 USA
[6] Univ Maryland, Ctr Vaccine Dev, Baltimore, MD 21201 USA
[7] NIH, Dept Clin Pathol, Microbiol Serv, Bethesda, MD 20892 USA
[8] Ctr Dis Control & Prevent, Div HIV AIDS, Atlanta, GA USA
关键词
D O I
10.1086/315423
中图分类号
R392 [医学免疫学]; Q939.91 [免疫学];
学科分类号
100102 ;
摘要
Persistent diarrhea (PD; duration greater than or equal to 14 days) is a growing part of the global burden of diarrheal diseases. A 45-month prospective cohort study (with illness, nutritional, and microbiologic surveillance) was conducted in a shantytown in northeastern Brazil, to elucidate the epidemiology, nutritional impact, and causes of PD in early childhood (0-3 years of age). A nested case-control design was used to examine children's diarrhea burden and nutritional status before and after a first PD illness. PD illnesses accounted for 8% of episodes and 34% of days of diarrhea, First PD illnesses were preceded by a doubling of acute diarrhea burdens, were followed by further 2.6-3.5-fold increased diarrhea burdens for 18 months, and were associated with acute weight shortfalls. Exclusively breast-fed children had 8-fold lower diarrhea rates than did weaned children. PD-associated etiologic agents included Cryptosporidium, Giardia, enteric adenoviruses, and enterotoxigenic Escherichia coli, PD signals growth shortfalls and increased diarrhea burdens; children with PD merit extended support, and the illness warrants further study to elucidate its prevention, treatment, and impact.
引用
收藏
页码:1643 / 1651
页数:9
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