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1.
Clin Infect Dis ; 2020 Oct 12.
Artigo em Inglês | MEDLINE | ID: mdl-33044509

RESUMO

BACKGROUND: Shigella is a leading cause of childhood diarrhea and target for vaccine development. Microbiologic and clinical case definitions are needed for pediatric field vaccine efficacy trials. METHODS: We compared characteristics of moderate to severe diarrhea (MSD) cases in the Global Enteric Multicenter Study (GEMS) between children with culture positive Shigella to those with culture-negative, qPCR-attributable Shigella (defined by an ipaH gene cycle threshold <27.9). Among Shigella MSD cases, we determined risk factors for death and derived a clinical severity score. RESULTS: Compared to culture-positive Shigella MSD cases (n=745), culture-negative/qPCR-attributable Shigella cases (n=852) were more likely to be under 12 months, stunted, have a longer duration of diarrhea, and less likely to have high stool frequency or a fever. There was no difference in dehydration, hospitalization, or severe classification from a modified Vesikari score. Twenty-two (1.8%) Shigella MSD cases died within the 14-days after presentation to health facilities, and 59.1% of these deaths were in culture-negative cases. Age < 12 months, diarrhea duration prior to presentation, vomiting, stunting, wasting, and hospitalization were associated with mortality. A model-derived score assigned points for dehydration, hospital admission, and longer diarrhea duration but was not significantly better at predicting 14-day mortality than a modified Vesikari score. CONCLUSIONS: A composite severity score consistent with severe disease or dysentery may be a pragmatic clinical endpoint for severe shigellosis in vaccine trials. Reliance on culture for microbiologic confirmation may miss a substantial number of Shigella cases but is currently required to measure serotype specific immunity.

2.
Artigo em Inglês | MEDLINE | ID: mdl-33124002

RESUMO

BACKGROUND: Although insufficient physical activity (PA), high sedentary behaviour (SB), and inadequate sleep are fairly common among children, little is known about these behaviours in immigrant children. This systematic review examined the prevalence of PA, SB, and sleep among immigrant children aged 5-17 years around the globe. METHODS: Four electronic databases were searched to retrieve the English language peer-reviewed original articles published between 2000 and 2019. Cross-sectional, cohort, or longitudinal studies that reported on the prevalence of PA, SB, or sleep-related outcomes among immigrant children were included. RESULTS: Of 2724 retrieved articles, 55 were selected for full-text screening and 12 met the eligibility criteria. Five studies were based on nationally representative samples. Over half (n = 7; 58%) of the studies assessed only PA, one reported only sleep, three reported both PA and SB, and one reported all three behaviours. Only one study used device-based measure. Assessment of PA and SB varied greatly across the studies with their differing definitions. The prevalence of doing PA ranged from 48 to 72%. Three studies reported an average sedentary time ranging from 1 to 3 h/day. One study reported that 10-13% of immigrant children in the USA had inadequate sleep. All of the studies reviewed were from Western countries with no study from non-Western countries. CONCLUSIONS: Future studies should include all three movement behaviours and use standard assessment tools and definitions. Future research should extend beyond Western countries to non-Western countries with immigrant children.

3.
Am J Trop Med Hyg ; 103(1): 520-527, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32431271

RESUMO

The microbial communities residing in the child gut are thought to play an important role in child growth, although the relationship is not well understood. We examined a cohort of young children from Mirzapur, Bangladesh, prospectively over 18 months. Four fecal markers of environmental enteropathy (EE) (high levels of alpha-1-antitrypsin, calprotectin, myeloperoxidase, and neopterin) were examined and anthropometric measures obtained from a cohort of 68 children. The 16S rRNA gene of bacterial DNA was sequenced from stool samples and used to estimate amplicon sequence variants (ASVs). We age-matched children with poor growth to children with normal growth within 1 month and compared the change in abundance and diversity of ASVs over time. Elevated EE markers and poor linear growth in children were associated with changes in microbial communities in the gut. There were increased amounts of Escherichia/Shigella and Proteobacteria and decreased amounts of Prevotella associated with poorly growing children consistent with the mounting evidence supporting the relationship between intestinal inflammation, child growth, and changes in gut microbiota composition. Future research is needed to investigate this association among young children in low- and middle-income countries.


Assuntos
Microbioma Gastrointestinal/genética , Transtornos do Crescimento/microbiologia , Enteropatias/metabolismo , Complexo Antígeno L1 Leucocitário/metabolismo , Neopterina/metabolismo , Peroxidase/metabolismo , alfa 1-Antitripsina/metabolismo , Bangladesh/epidemiologia , Biomarcadores , Estudos de Casos e Controles , Pré-Escolar , Escherichia , Fezes/química , Feminino , Transtornos do Crescimento/epidemiologia , Transtornos do Crescimento/metabolismo , Humanos , Lactente , Inflamação , Enteropatias/epidemiologia , Masculino , Prevotella , Proteobactérias , RNA Ribossômico 16S/genética , Estudos Retrospectivos , Shigella
4.
Trop Med Int Health ; 25(8): 1032-1042, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32428974

RESUMO

OBJECTIVE: To determine the pathogen-specific risk of seizure in under-five children hospitalised with moderate-to-severe diarrhoea (MSD) in rural settings. METHOD: This was a prospective case-control study with follow-up, conducted in a sentinel facility of Global Enteric Multicenter Study in Mirzapur, a rural community of Bangladesh between 2007 and 2010. Children aged 0-59 months who presented with MSD and seizure constituted the cases whereas those who did not have seizure comprised the controls. MSD was defined if the episodes were associated with dehydration or dysentery or required hospitalisation with diarrhoea or dysentery. All enrolled children were followed up at home within 50-90 days of enrolment. A total of 64 cases and 128 randomly selected controls formed the analysable dataset. RESULTS: The result of logistic regression analysis after adjusting for potential confounders revealed that shigellosis (Shigella species, OR = 5.34, 95% CI = 2.37-12.04) particularly S. flexneri (OR = 3.34, 95% CI = 1.48-7.57), S. flexneri 6 (OR = 23.24, 95% CI = 2.79-193.85), S. sonnei (OR = 6.90, 95% CI = 2.34-19.85); norovirus (OR = 6.77, 95% CI = 1.69-27.11), fever (OR = 16.75, 95% CI = 1.81-154.70) and loss of consciousness (OR = 35.25, 95% CI = 1.71-726.20) were the independent risk factors for seizure in MSD children. At enrolment, cases had lower WHZ (P = 0.006) compared to their peers, follow-up anthropometrics showed significant improvement in WHZ (P < 0.001) and WAZ (P < 0.05), whereas deterioration in HAZ (P < 0.001) in both cases and controls. CONCLUSION: Childhood MSD episodes particularly due to Shigella and norovirus are often associated with seizure. Prompt identification and appropriate management of children with shigellosis may reduce occurrence and adverse consequences of seizure linked with MSD.


Assuntos
Diarreia/epidemiologia , Diarreia/microbiologia , Disenteria Bacilar/epidemiologia , Disenteria Bacilar/microbiologia , Convulsões/epidemiologia , Convulsões/microbiologia , Bangladesh/epidemiologia , Estudos de Casos e Controles , Pré-Escolar , Comorbidade , Feminino , Seguimentos , Humanos , Lactente , Recém-Nascido , Masculino , Estudos Prospectivos , Medição de Risco , Fatores de Risco , População Rural/estatística & dados numéricos , Índice de Gravidade de Doença , Shigella
5.
Lancet Glob Health ; 8(2): e204-e214, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31864916

RESUMO

BACKGROUND: The Global Enteric Multicenter Study (GEMS) was a 3-year case-control study that measured the burden, aetiology, and consequences of moderate-to-severe diarrhoea (MSD) in children aged 0-59 months. GEMS-1A, a 12-month follow-on study, comprised two parallel case-control studies, one assessing MSD and the other less-severe diarrhoea (LSD). In this report, we analyse the risk of death with each diarrhoea type and the specific pathogens associated with fatal outcomes. METHODS: GEMS was a prospective, age-stratified, matched case-control study done at seven sites in Africa and Asia. Children aged 0-59 months with MSD seeking care at sentinel health centres were recruited along with one to three randomly selected matched community control children without diarrhoea. In the 12-month GEMS-1A follow-on study, children with LSD and matched controls, in addition to children with MSD and matched controls, were recruited at six of the seven sites; only cases of MSD and controls were enrolled at the seventh site. We compared risk of death during the period between enrolment and one follow-up household visit done about 60 days later (range 50-90 days) in children with MSD and LSD and in their respective controls. Approximately 50 pathogens were detected using, as appropriate, classic bacteriology, immunoassays, gel-based PCR and reverse transcriptase PCR, and quantitative real-time PCR (qPCR). Specimens from a subset of GEMS cases and controls were also tested by a TaqMan Array Card that compartmentalised probe-based qPCR for 32 enteropathogens. FINDINGS: 223 (2·0%) of 11 108 children with MSD and 43 (0·3%) of 16 369 matched controls died between study enrolment and the follow-up visit at about 60 days (hazard ratio [HR] 8·16, 95% CI 5·69-11·68, p<0·0001). 12 (0·4%) of 2962 children with LSD and seven (0·2%) of 4074 matched controls died during the follow-up period (HR 2·78, 95% CI 0·95-8·11, p=0·061). Risk of death was lower in children with dysenteric MSD than in children with non-dysenteric MSD (HR 0·20, 95% CI 0·05-0·87, p=0·032), and lower in children with LSD than in those with non-dysenteric MSD (HR 0·29, 0·14-0·59, p=0·0006). In children younger than 24 months with MSD, infection with typical enteropathogenic Escherichia coli, enterotoxigenic E coli encoding heat-stable toxin, enteroaggregative E coli, Shigella spp (non-dysentery cases), Aeromonas spp, Cryptosporidium spp, and Entamoeba histolytica increased risk of death. Of 61 deaths in children aged 12-59 months with non-dysenteric MSD, 31 occurred among 942 children qPCR-positive for Shigella spp and 30 deaths occurred in 1384 qPCR-negative children (HR 2·2, 95% CI 1·2-3·9, p=0·0090), showing that Shigella was strongly associated with increased risk of death. INTERPRETATION: Risk of death is increased following MSD and, to a lesser extent, LSD. Considering there are approximately three times more cases of LSD than MSD in the population, more deaths are expected among children with LSD than in those with MSD. Because the major attributable LSD-associated and MSD-associated pathogens are the same, implementing vaccines and rapid diagnosis and treatment interventions against these major pathogens are rational investments. FUNDING: Bill & Melinda Gates Foundation.


Assuntos
Países em Desenvolvimento/estatística & dados numéricos , Diarreia/epidemiologia , Diarreia/mortalidade , Carga Global da Doença/estatística & dados numéricos , Pobreza/estatística & dados numéricos , Estudos de Casos e Controles , Pré-Escolar , Feminino , Seguimentos , Humanos , Lactente , Recém-Nascido , Masculino , Mortalidade , Estudos Prospectivos
6.
Nat Commun ; 10(1): 3721, 2019 Aug 19.
Artigo em Inglês | MEDLINE | ID: mdl-31427583

RESUMO

A quantum system weakly coupled to a zero-temperature environment will relax, via spontaneous emission, to its ground-state. However, when the coupling to the environment is ultra-strong the ground-state is expected to become dressed with virtual excitations. This regime is difficult to capture with some traditional methods because of the explosion in the number of Matsubara frequencies, i.e., exponential terms in the free-bath correlation function. To access this regime we generalize both the hierarchical equations of motion and pseudomode methods, taking into account this explosion using only a biexponential fitting function. We compare these methods to the reaction coordinate mapping, which helps show how these sometimes neglected Matsubara terms are important to regulate detailed balance and prevent the unphysical emission of virtual excitations. For the pseudomode method, we present a general proof of validity for the use of superficially unphysical Matsubara-modes, which mirror the mathematical essence of the Matsubara frequencies.

7.
Am J Trop Med Hyg ; 101(2): 304-309, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31264563

RESUMO

Diarrheal disease is a leading cause of childhood morbidity and mortality worldwide, but particularly in low-income countries in sub-Saharan Africa and South Asia. The Global Enteric Multicenter Study (GEMS) examined the infectious etiologies as well as associated demographics, socioeconomic markers, health-care-seeking behaviors, and handwashing practices of the households of children with diarrhea and their age- and gender-matched controls in seven countries over a 3-year period (December 2007-December 2010). Stool studies to determine diarrheal etiologies and anthropometry were performed at baseline and at 60-day follow-up visits, along with surveys to record demographics and living conditions of the children. We performed secondary analyses of the GEMS data derived from the Bangladesh portion of the study in children with diarrhea associated with viral enteropathogens and explored pathogen-specific features of disease burden. Rotavirus and norovirus were the most prevalent pathogens (39.3% and 35%, respectively). Disease due to rotavirus and adenovirus was more common in infants than in older children (P < 0.001 and P = 0.001, respectively). Height for age decreased from baseline to follow-up in children with diarrhea associated with rotavirus, norovirus, and adenovirus (P < 0.001). Based on these analyses, preventive measures targeted at rotavirus, norovirus, and adenovirus will be expected to have meaningful clinical impact. Cost of treatment was highest for rotavirus as well, making it an obvious target for intervention. Association of specific viruses with stunting is particularly notable, as stunting is an attributable risk factor for poor cognitive development and future productivity and economic potential.


Assuntos
Efeitos Psicossociais da Doença , Diarreia/virologia , População Rural , Vírus/patogenicidade , Adenoviridae/patogenicidade , Bangladesh , Estudos de Casos e Controles , Pré-Escolar , Diarreia/economia , Características da Família , Fezes/virologia , Feminino , Transtornos do Crescimento/virologia , Humanos , Lactente , Recém-Nascido , Masculino , Norovirus/patogenicidade , Fatores de Risco , Rotavirus/patogenicidade
8.
Trop Med Health ; 47: 29, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31073272

RESUMO

Background: Diarrheal disease still remains a major public health threat and is often associated with fatal outcome especially in children with shigellosis mostly in developing countries. This study aimed to determine the presence of any associations between drinking shallow tube well (STW) water and childhood shigellosis. A total of 1394 children aged 0-59 months who presented with moderate-to-severe diarrhea (MSD) in Kumudini Women's Medical College and Hospital, Bangladesh, from December 2007 to March 2011 were enrolled into the study. Results: Among the study children, STW users often represented poor families (44% vs. 37%, p = 0.010); less often had household electricity (60% vs. 68%, p = 0.001) and cemented floor material (12% vs. 21%, p < 0.001); washed hand before eating (79% vs. 84%, p = 0.020); and had Shigella sonnei infections (7.8% vs. 13.1, p = 0.002) compared to deep tube well (DTW) water families (in bivariate analysis). After adjusting for covariates, a significant negative association was observed between childhood MSD episodes due to Shigella sonnei infections and the use of STW water (aOR 0.53, 95% CI 0.36, 0.79). Conclusions: An emergence of less severe Shigella sonnei has replaced relatively more severe Shigella flexneri among the MSD children from DTW-user families. However, more monitoring in terms of disease surveillance for changes in the distribution of Shigella serogroups and serotypes and its upsurges and antimicrobial susceptibility is essential.

9.
Lancet Glob Health ; 7(5): e568-e584, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-31000128

RESUMO

BACKGROUND: Diarrheal diseases remain a leading cause of illness and death among children younger than 5 years in low-income and middle-income countries. The Global Enteric Multicenter Study (GEMS) has described the incidence, aetiology, and sequelae of medically attended moderate-to-severe diarrhoea (MSD) among children aged 0-59 months residing in censused populations in sub-Saharan Africa and south Asia, where most child deaths occur. To further characterise this disease burden and guide interventions, we extended this study to include children with episodes of less-severe diarrhoea (LSD) seeking care at health centres serving six GEMS sites. METHODS: We report a 1-year, multisite, age-stratified, matched case-control study following on to the GEMS study. Six sites (Bamako, Mali; Manhiça, Mozambique; Basse, The Gambia; Mirzapur, Bangladesh; Kolkata, India; and Bin Qasim Town, Karachi, Pakistan) participated in this study. Children aged 0-59 months at each site who sought care at a sentinel hospital or health centre during a 12-month period were screened for diarrhoea. New (onset after ≥7 diarrhoea-free days) and acute (onset within the previous 7 days) episodes of diarrhoea in children who had sunken eyes, whose skin lost turgor, who received intravenous hydration, who had dysentery, or who were hospitalised were eligible for inclusion as MSD. The remaining new and acute diarrhoea episodes among children who sought care at the same health centres were considered LSD. We aimed to enrol the first eight or nine eligible children with MSD and LSD at each site during each fortnight in three age strata: infants (aged 0-11 months), toddlers (aged 12-23 months), and young children (aged 24-59 months). For each included case of MSD or LSD, we enrolled one to three community control children without diarrhoea during the previous 7 days. From patients and controls we collected clinical and epidemiological data, anthropometric measurements, and faecal samples to identify enteropathogens at enrolment, and we performed a follow-up home visit about 60 days later to ascertain vital status, clinical outcome, and interval growth. Primary outcomes were to characterise, for MSD and LSD, the pathogen-specific attributable risk and population-based incidence values, and to assess the frequency of adverse clinical consequences associated with these two diarrhoeal syndromes. FINDINGS: From Oct 31, 2011, to Nov 14, 2012, we recruited 2368 children with MSD, 3174 with LSD, and one to three randomly selected community control children without diarrhoea matched to cases with MSD (n=3597) or LSD (n=4236). Weighted adjusted population attributable fractions showed that most attributable cases of MSD and LSD were due to rotavirus, Cryptosporidium spp, enterotoxigenic Escherichia coli encoding heat-stable toxin (with or without genes encoding heat-labile enterotoxin), and Shigella spp. The attributable incidence per 100 child-years for LSD versus MSD, by age stratum, for rotavirus was 22·3 versus 5·5 (0-11 months), 9·8 versus 2·9 (12-23 months), and 0·5 versus 0·2 (24-59 months); for Cryptosporidium spp was 3·6 versus 2·3 (0-11 months), 4·3 versus 0·6 (12-23 months), and 0·3 versus 0·1 (24-59 months); for enterotoxigenic E coli encoding heat-stable toxin was 4·2 versus 0·1 (0-11 months), 5·2 versus 0·0 (12-23 months), and 1·1 versus 0·2 (24-59 months); and for Shigella spp was 1·0 versus 1·3 (0-11 months), 3·1 versus 2·4 (12-23 months), and 0·8 versus 0·7 (24-59 months). Participants with both MSD and LSD had significantly more linear growth faltering than controls at follow-up. INTERPRETATION: Inclusion of participants with LSD markedly expands the population of children who experience adverse clinical and nutritional outcomes from acute diarrhoeal diseases. Since MSD and LSD have similar aetiologies, interventions targeting rotavirus, Shigella spp, enterotoxigenic E coli producing heat-stable toxin, and Cryptosporidium spp might substantially reduce the diarrhoeal disease burden and its associated nutritional faltering. FUNDING: Bill & Melinda Gates Foundation.


Assuntos
Países em Desenvolvimento/estatística & dados numéricos , Diarreia Infantil/epidemiologia , Diarreia/epidemiologia , Fatores Etários , Estudos de Casos e Controles , Pré-Escolar , Diarreia/complicações , Diarreia/etiologia , Diarreia Infantil/complicações , Diarreia Infantil/etiologia , Feminino , Humanos , Incidência , Lactente , Recém-Nascido , Masculino
10.
PLoS Negl Trop Dis ; 13(1): e0007037, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30608930

RESUMO

BACKGROUND: Enterotoxigenic Escherichia coli (ETEC) encoding heat-stable enterotoxin (ST) alone or with heat-labile enterotoxin (LT) cause moderate-to-severe diarrhea (MSD) in developing country children. The Global Enteric Multicenter Study (GEMS) identified ETEC encoding ST among the top four enteropathogens. Since the GEMS objective was to provide evidence to guide development and implementation of enteric vaccines and other interventions to diminish diarrheal disease morbidity and mortality, we examined colonization factor (CF) prevalence among ETEC isolates from children age <5 years with MSD and from matched controls in four African and three Asian sites. We also assessed strength of association of specific CFs with MSD. METHODOLOGY/PRINCIPAL FINDINGS: MSD cases enrolled at healthcare facilities over three years and matched controls were tested in a standardized manner for many enteropathogens. To identify ETEC, three E. coli colonies per child were tested by polymerase chain reaction (PCR) to detect genes encoding LT, ST; confirmed ETEC were examined by PCR for major CFs (Colonization Factor Antigen I [CFA/I] or Coli Surface [CS] antigens CS1-CS6) and minor CFs (CS7, CS12, CS13, CS14, CS17, CS18, CS19, CS20, CS21, CS30). ETEC from 806 cases had a single toxin/CF profile in three tested strains per child. Major CFs, components of multiple ETEC vaccine candidates, were detected in 66.0% of LT/ST and ST-only cases and were associated with MSD versus matched controls by conditional logistic regression (p≤0.006); major CFs detected in only 25.0% of LT-only cases weren't associated with MSD. ETEC encoding exclusively CS14, identified among 19.9% of 291 ST-only and 1.5% of 259 LT/ST strains, were associated with MSD (p = 0.0011). No other minor CF exhibited prevalence ≥5% and significant association with MSD. CONCLUSIONS/SIGNIFICANCE: Major CF-based efficacious ETEC vaccines could potentially prevent up to 66% of pediatric MSD cases due to ST-encoding ETEC in developing countries; adding CS14 extends coverage to ~77%.


Assuntos
Escherichia coli Enterotoxigênica/genética , Escherichia coli Enterotoxigênica/isolamento & purificação , Infecções por Escherichia coli/epidemiologia , Infecções por Escherichia coli/microbiologia , Proteínas de Fímbrias/genética , Fatores de Virulência/genética , África/epidemiologia , Ásia/epidemiologia , Estudos de Casos e Controles , Pré-Escolar , Feminino , Genótipo , Humanos , Lactente , Recém-Nascido , Masculino , Reação em Cadeia da Polimerase , Prevalência
11.
Clin Infect Dis ; 68(7): 1073-1079, 2019 03 19.
Artigo em Inglês | MEDLINE | ID: mdl-30192924

RESUMO

BACKGROUND: Cryptosporidium is a leading contributor to diarrheal morbidity and mortality in under-5 children worldwide. As there is no vaccine and no effective drug therapy in young children for this infection, preventing infection is critical. We undertook a pilot case-control study to define the extent of person-to-person transmission of cryptosporidiosis within an urban and a rural community in Bangladesh. METHODS: We enrolled 48 case families with a Cryptosporidium-infected child aged 6-18 months. Controls were age- and sex-matched Cryptosporidium-negative children in 12 households. Children and household members were followed for 8 weeks with weekly illness survey and stool testing with quantitative polymerase chain reaction for Cryptosporidium. RESULTS: In the 24 urban case families, the secondary attack rate was 35.8% (19/53) vs 0% (0/11) in controls (P = .018, χ2 test). In contrast, in the 24 rural case families, the secondary attack rate was 7.8% (5/64) vs 0% (0/21) in controls (P = .19, χ2 test). Genotyping by gp60 demonstrated infection with the same subspecies in 5 families, and evidence of transmission in 2. Serologic response to Cryptosporidium infection was associated with younger age, longer duration of infection, and Cryptosporidium hominis gp60_IbA9G3R2 infection. CONCLUSIONS: In the urban site, the high rate of secondary infection and infection with the same subspecies within families suggests that person-to-person transmission is a major source of Cryptosporidium infection for young children living in this region. Molecular genotyping can be applied to determine transmission of Cryptosporidium in endemic regions. Further work is needed to understand the differences in parasite transmissibility and immunity to different genotypes.


Assuntos
Criptosporidiose/transmissão , Cryptosporidium/isolamento & purificação , Transmissão de Doença Infecciosa , Características da Família , Adulto , Bangladesh/epidemiologia , Estudos de Casos e Controles , Criança , Pré-Escolar , Criptosporidiose/epidemiologia , Cryptosporidium/classificação , Cryptosporidium/genética , Feminino , Genótipo , Técnicas de Genotipagem , Humanos , Lactente , Recém-Nascido , Masculino , População Rural , População Urbana , Adulto Jovem
12.
Clin Infect Dis ; 69(3): 505-513, 2019 07 18.
Artigo em Inglês | MEDLINE | ID: mdl-30351379

RESUMO

BACKGROUND: Noroviruses are the most common cause of epidemic and endemic acute gastroenteritis (AGE) worldwide. The burden of norovirus disease in low-income settings is poorly understood. METHODS: We tested stool samples from children less than 5 years of age with diarrhea who were admitted in a rural hospital in Bangladesh from 2010-2012 and from matched, healthy controls from the same catchment area. RESULTS: Norovirus was detected in 109 (18%) of 613 children with diarrhea and in 30 (15%) of 206 healthy controls. Most (n = 118; 85%) norovirus infections belonged to genogroup II (GII). Of these, GII.4 viruses were identified in 36 (33%) of the cases and in 6 (21%) of the controls. Other major genotypes included GII.3 (13%), GII.6 (11%), and GII.13 (11%) in the cases and GII.6 (17%) and GII.2 (14%) in the controls. The greatest risk of severe norovirus disease (Vesikari score ≥11) was associated with GII.4 infections. GII.4 viruses were the predominant genotype detected during the winter (55%) and rainy season (23%), while GII.3 (19%) and GII.13 (19%) viruses were the most prevalent genotypes during the summer. Vomiting was significantly associated with GII.4 infections, while longer durations of diarrhea were associated with GI.3 infections. CONCLUSIONS: Future studies are needed to understand the high rates of virus shedding in children without AGE symptoms.


Assuntos
Infecções por Caliciviridae/epidemiologia , Diarreia/epidemiologia , Fezes/virologia , Norovirus/genética , Doença Aguda , Bangladesh/epidemiologia , Estudos de Casos e Controles , Pré-Escolar , Efeitos Psicossociais da Doença , Diarreia/virologia , Feminino , Gastroenterite/epidemiologia , Gastroenterite/virologia , Genótipo , Voluntários Saudáveis , Humanos , Lactente , Recém-Nascido , Masculino , Pobreza/estatística & dados numéricos , Prevalência , RNA Viral/genética , População Rural/estatística & dados numéricos , Estações do Ano , Eliminação de Partículas Virais
13.
Vaccine ; 36(43): 6393-6400, 2018 10 15.
Artigo em Inglês | MEDLINE | ID: mdl-30236635

RESUMO

Group A rotavirus causes a substantial proportion of diarrhoea related deaths worldwide among children under five years. We analyzed rotavirus prevalence and genotypes distribution among patients admitted with diarrhoea at icddr,b hospital in Dhaka during 2012-16. Stool specimens (n = 1110) were collected from diarrhoea patients and tested for RVA antigen using enzyme immunoassay. Rotavirus positive samples were G (VP7) and P (VP4) genotyped by RT-PCR and sanger sequencing. Data on clinical manifestations were collected from icddr,b hospital surveillance system. A total of 351 (32%) patients were positive for rotavirus antigen, about half of those were children under two years old. During the study period, G1P[8] (27%) was the most prevalent strain, followed by G12P[8] (15%) and G9[P4] (9%). Mixed G or P genotypes were identified in a substantial proportion (23%) with few strains of rare combinations such as G1P[4], G1P[6], G2P[6], G2P[8], G9P[6]. The genotypic fluctuation was noteworthy; G12P[8] was the major strain in 2012-14 but sharply decreased in 2015-16 when G1P[8] became the most common strain. G3P[8] re-emerged (17%) in 2016 after 11 years. Since the Government of Bangladesh has planned to include rotavirus vaccine in national immunization programme from 2018, our data will provide baseline information on rotavirus genotypes in the pre-vaccination era to observe the selection pressure on genotypes in the post vaccination epoch.


Assuntos
Genótipo , Infecções por Rotavirus/epidemiologia , Rotavirus/genética , Antígenos Virais/imunologia , Bangladesh/epidemiologia , Proteínas do Capsídeo/genética , Criança , Pré-Escolar , Diarreia/epidemiologia , Diarreia/virologia , Fezes/virologia , Feminino , Gastroenterite/epidemiologia , Gastroenterite/virologia , Humanos , Lactente , Filogenia , Prevalência , RNA Viral/genética , Infecções por Rotavirus/virologia , Vacinas contra Rotavirus/imunologia , Análise de Sequência de DNA
14.
Trop Med Health ; 46: 17, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29875615

RESUMO

Background: The present study aimed to examine the risk factors for death due to pneumonia in young children and healthcare behaviors of the guardians for children in rural Bangladesh. A prospective autopsy study was conducted among guardians of children aged 4 weeks to 59 months in Mirzapur, Bangladesh, from 2008 to 2012. Results: Pneumonia was the primary cause of death, accounting for 26.4% (n = 81) of all 307 deaths. Of the pneumonia deaths, 58% (n = 47) deaths occurred in younger infants (aged 4 weeks to < 6 months) and 24.7% (n = 20) in older infants (aged 6-11 months). The median duration of illness before pneumonia death was 8 days (interquartile range [IQR] 3-20 days). Prior to death, 91.4% (n = 74) children with pneumonia sought treatment, and of those who sought treatment, 52.7% (n = 39) sought treatment ≥ 2 days after the onset of disease. Younger infants of 4 weeks to < 6 months old were at 5.5-time (95% confidence interval [CI] 2.5, 12.0) and older infants aged 6-11 months were at 3-time (1.2, 7.5) greater risk of dying from pneumonia than older children aged 12-59 months. Children with a prolonged duration of illness (2-10 days) prior to death were at more risk for death by pneumonia than those who died from other causes (5.8 [2.1, 16.1]). Children who died from pneumonia sought treatment 3.4-time more than children who died from other causes. Delayed treatment seeking (≥ 2 days) behavior was 4.9-time more common in children who died from pneumonia than those who died from other causes. Children who died from pneumonia more often had access to care from multiple sources (5.7-time) than children who died from other causes. Conclusions: Delay in seeking appropriate care and access to multiple sources for treatment are the underlying risk factors for pneumonia death in young children in Bangladesh. These results indicate the perplexity in guardians' decisions to secure appropriate treatment for children with pneumonia. Therefore, it further underscores the importance of focusing on mass media coverage that can outline the benefits of seeking care early in the progression of pneumonia and the potential negative consequences of seeking care late.

15.
Clin Infect Dis ; 67(9): 1347-1355, 2018 10 15.
Artigo em Inglês | MEDLINE | ID: mdl-29897482

RESUMO

Background: Cryptosporidiosis is a major cause of childhood diarrhea in low- and middle-income countries and has been linked to impairment of child growth. This study investigated the burden of cryptosporidiosis and its impact on child growth in both a rural and an urban site in Bangladesh. Methods: Pregnant women in the second trimester were identified at 2 sites in Bangladesh, 1 urban and 1 rural. Their offspring were enrolled at birth into the study (urban, n = 250; rural, n = 258). For 2 years, the children were actively monitored for diarrhea and anthropometric measurements were obtained every 3 months. Stool samples were collected monthly and during diarrheal episodes with Cryptosporidium infection and causative species determined by quantitative polymerase chain reaction assays. Results: Cryptosporidium infections were common at both sites and mostly subclinical. In the urban site, 161 (64%) children were infected and 65 (26%) had ≥2 infections. In the rural site, 114 (44%) were infected and 24 (9%) had multiple infections. Adjusted for potential confounders, cryptosporidiosis was associated with a significantly greater drop in the length-for-age z score (LAZ) at 24 months from LAZ at enrollment (Δ-LAZ), an effect greatest in the children with multiple episodes of cryptosporidiosis. The most common species in Mirpur was Cryptosporidium hominis, whereas Cryptosporidium meleagridis predominated in Mirzapur. Conclusions: Cryptosporidiosis is common in early childhood and associated with early growth faltering in Bangladeshi children. Predominant Cryptosporidium species differed between the 2 sites, suggesting different exposures or modes of transmission but similar consequences for child growth. Clinical Trials Registration: NCT02764918.


Assuntos
Infecções Assintomáticas/epidemiologia , Desenvolvimento Infantil , Criptosporidiose/complicações , Criptosporidiose/epidemiologia , Cryptosporidium/isolamento & purificação , Adulto , Bangladesh/epidemiologia , Pré-Escolar , Efeitos Psicossociais da Doença , Cryptosporidium/classificação , Diarreia/complicações , Diarreia/epidemiologia , Diarreia/parasitologia , Fezes/parasitologia , Feminino , Humanos , Lactente , Recém-Nascido , Estudos Longitudinais , Masculino , Parto , Gravidez , Estudos Prospectivos , População Rural , População Urbana , Adulto Jovem
16.
Clin Infect Dis ; 67(12): 1897-1903, 2018 11 28.
Artigo em Inglês | MEDLINE | ID: mdl-29718129

RESUMO

Background: Cryptosporidium is a major cause of childhood diarrhea. Current modes of cryptosporidiosis diagnosis involve procedures that are costly and require both a well-equipped laboratory and technical expertise. Therefore, a cost-effective, user-friendly, and rapid method for point-of-care detection of Cryptosporidium is desirable. Methods: A total of 832 diarrheal stool specimens collected from 200 children aged <2 years were tested by Giardia/Cryptosporidium QUIK CHEK, enzyme-linked immunosorbent assay (ELISA), and quantitative polymerase chain reaction (qPCR) to compare the performance of the individual techniques. We also tested for the presence of other diarrheal pathogens in qPCR-positive samples with a TaqMan Array Card (TAC) to assess whether Cryptosporidium was the sole causative agent for the diarrheal episodes. Results: Of 832 samples, 4.4% were found positive for Cryptosporidium by QUIK CHEK, 3.6% by ELISA, and 8.8% by qPCR. Using TAC-attributed Cryptosporidium diarrhea as the gold standard, the sensitivities of QUIK CHEK, ELISA, and qPCR were 92.3%, 71.8%, and 100%, respectively; the specificities were 97.1%, 94.3%, and 0%, respectively. Analysis of the qPCR-positive and QUIK CHEK-negative samples by TAC identified other enteropathogens as more likely than Cryptosporidium to be the causative agents of diarrhea. Conclusions: QUIK CHEK was more sensitive and specific than ELISA. While qPCR detected Cryptosporidium in more samples than QUIK CHEK, most of these were instances of qPCR detecting small quantities of Cryptosporidium DNA in a diarrheal episode caused by another enteropathogen. We concluded that QUIK CHEK was comparable in sensitivity and superior in specificity to qPCR for the diagnosis of Cryptosporidium diarrhea.


Assuntos
Criptosporidiose/diagnóstico , Giardíase/diagnóstico , Imunoensaio/métodos , Sistemas Automatizados de Assistência Junto ao Leito/normas , Antígenos de Protozoários/imunologia , Bangladesh , Cryptosporidium/isolamento & purificação , Diarreia/parasitologia , Ensaio de Imunoadsorção Enzimática , Giardia/isolamento & purificação , Humanos , Lactente , Reação em Cadeia da Polimerase , Sensibilidade e Especificidade
17.
Am J Trop Med Hyg ; 98(6): 1571-1576, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29714159

RESUMO

Antimicrobial overuse contributes to antimicrobial resistance. Empiric use of antimicrobials for diarrheal illness is warranted only in a minority of cases, because of its self-limiting nature and multifactorial etiology. This study aims to describe the factors contributing to antimicrobial overuse for diarrheal disease among children less than 5 years of age in rural Bangladesh. A total of 3,570 children less than 5 years of age presenting with diarrhea in a tertiary level hospital were enrolled in the study. The rate of antimicrobial use at home was 1,395 (39%), compared with 2,084 (89%) during a hospital visit. In a multivariate analysis, factors associated with antimicrobial use at home included residence located more than 5 miles from a hospital; use of zinc and oral rehydration salts at home; vomiting; greater than 10 stools per 24 hours; diarrheal duration greater than 3 days; and rotavirus diarrhea (P < 0.05 for all). Characteristics of children more likely to be given antimicrobials in a health-care setting included greater than 10 stools per 24 hours; duration of diarrhea greater than 3 days; use of antimicrobials before hospital presentation; fever (≥ 37.8°C); rectal straining; and Shigella infection (P < 0.05 for all). The most commonly used drugs in rotavirus diarrhea were azithromycin and erythromycin, both before hospital presentation and during hospital admission. Our study underscores the importance of diligent vigilance on the rationale use of antimicrobials both at home and in health-care facilities with a special concern for children less than 5 years of age living in rural Bangladesh.


Assuntos
Anti-Infecciosos/uso terapêutico , Diarreia/tratamento farmacológico , Uso Excessivo de Medicamentos Prescritos/efeitos adversos , Anti-Infecciosos/efeitos adversos , Azitromicina/uso terapêutico , Bangladesh/epidemiologia , Pré-Escolar , Estudos Transversais , Diarreia/epidemiologia , Diarreia/microbiologia , Diarreia/virologia , Disenteria Bacilar/tratamento farmacológico , Disenteria Bacilar/epidemiologia , Eritromicina/uso terapêutico , Fezes/microbiologia , Feminino , Humanos , Lactente , Masculino , Análise Multivariada , Fatores de Risco , Infecções por Rotavirus/tratamento farmacológico , Infecções por Rotavirus/epidemiologia , População Rural , Sorotipagem , Shigella/classificação , Shigella/isolamento & purificação , Centros de Atenção Terciária , Fatores de Tempo
18.
IEEE Trans Image Process ; 27(8): 3870-3882, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29727272

RESUMO

Depth and surface normal estimation are crucial components in understanding 3D scene geometry from calibrated stereo images. In this paper, we propose visibility and disparity magnitude constraints for slanted patches in the scene. These constraints can be used to associate geometrically feasible planes with each point in the disparity space. The new constraints are validated in the PatchMatch Stereo framework. We use these new constraints not only for initialization, but also in the local plane refinement step of this iterative algorithm. The proposed constraints increase the probability of estimating correct plane parameters, and lead to an improved 3D reconstruction of the scene. Furthermore, the proposed constrained initialization reduces the number of iterations before convergence to the optimal plane parameters. In addition, as most stereo image pairs are not perfectly rectified, we modify the view propagation process by assigning the plane parameters to the neighbors of the candidate pixel. To update the plane parameters in the plane refinement step, we use a gradient free non-linear optimizer. The benefits of the new initialization, propagation, and refinement schemes are demonstrated.

19.
Indian J Public Health ; 62(1): 47-51, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29512565

RESUMO

Background: Mirpur treatment centre (MTC), Dhaka of the International Centre for Diarrhoeal Disease Research, Bangladesh, was established as a consequence of an outbreak of diarrheal disease during the summer month of April 2007 in Mirpur area. Objective: The present study aimed to evaluate the impact of this new facility on patient load, common etiology, and other characteristics of patient population who sought treatment at Dhaka Hospital. Methods: As part of the Diarrheal Disease Surveillance System (DDSS), 10% patients (every 10th) seeking care irrespective of age, sex, sociodemographic background, and severity of disease were enrolled at MTC as opposed to 2% (every 50th) at Dhaka Hospital following identical methodology from 2010 to 2013. Moreover, enrolled DDSS patients from 2005 to 2009 at Dhaka Hospital were also included in analysis to further examine the impact of MTC on Dhaka Hospital. Results: Patient load from Mirpur area attending the Dhaka Hospital reduced from 13% during epidemic in 2010 to 6% in 2013 (53% reduction), whereas attendance in MTC increased substantially by 33%. This changing trend was also observed among children <5 years old. A significant reduction of patients presenting with moderately severe disease from Mirpur area at Dhaka Hospital was observed (69% reduction); however, attendance at MTC increased by 26% during same period. Conclusion: The number of patients from Mirpur area in Dhaka Hospital reduced but increased at MTC explaining the need for establishment of a set up for early treatment and control of diarrheal disease when consistent increase in annual number of cases or at the time of upsurge of cases is observed.


Assuntos
Diarreia/epidemiologia , Diarreia/etiologia , Instalações de Saúde/estatística & dados numéricos , Adolescente , Adulto , Fatores Etários , Bangladesh/epidemiologia , Criança , Pré-Escolar , Diarreia/terapia , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Vigilância em Saúde Pública , Solução Salina/administração & dosagem , Índice de Gravidade de Doença , Fatores Sexuais , Fatores Socioeconômicos , Adulto Jovem
20.
J Infect Dis ; 218(2): 259-264, 2018 06 20.
Artigo em Inglês | MEDLINE | ID: mdl-29514308

RESUMO

We studied the genetic diversity of Cryptosporidium hominis infections in slum-dwelling infants from Dhaka over a 2-year period. Cryptosporidium hominis infections were common during the monsoon, and were genetically diverse as measured by gp60 genotyping and whole-genome resequencing. Recombination in the parasite was evidenced by the decay of linkage disequilibrium in the genome over <300 bp. Regions of the genome with high levels of polymorphism were also identified. Yet to be determined is if genomic diversity is responsible in part for the high rate of reinfection, seasonality, and varied clinical presentations of cryptosporidiosis in this population.


Assuntos
Criptosporidiose/microbiologia , Cryptosporidium/classificação , Cryptosporidium/genética , Variação Genética , Bangladesh/epidemiologia , Criptosporidiose/epidemiologia , Cryptosporidium/isolamento & purificação , Feminino , Proteínas Fúngicas/genética , Genótipo , Técnicas de Genotipagem , Humanos , Lactente , Recém-Nascido , Masculino , Áreas de Pobreza , Estudos Prospectivos , Sequenciamento Completo do Genoma
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