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Etiology and severity of diarrheal diseases in infants at the semiarid region of Brazil: A case-control study

2019; Public Library of Science; Volume: 13; Issue: 2 Linguagem: Inglês

10.1371/journal.pntd.0007154

1935-2735

Aldo Â. M. Lima, Domingos B. Oliveira, Josiane da Silva Quetz, Alexandre Havt, Mara de Moura Gondim Prata, Ila F.N. Lima, Alberto M. Soares, José Q. Filho, Noélia L. Lima, Pedro Henrique Quintela Soares de Medeiros, Ana Karolina Silva dos Santos, Herlice N. Veras, Rafhaella N. D. G. Gondim, Rafaela C. Pankov, Mariana Duarte Bona, F.A.P. Rodrigues, Renato de Azevedo Moreira, Ana C. O. M. Moreira, M. Bertolini, Luciana Relly Bertolini, Vicente José de Figueirêdo Freitas, Eric R. Houpt, Richard L. Guerrant,

Congenital Anomalies and Fetal Surgery

Background Diarrheal diseases are an important cause of morbidity and mortality among children in developing countries. We aimed to study the etiology and severity of diarrhea in children living in the low-income semiarid region of Brazil. Methodology This is a cross-sectional, age-matched case-control study of diarrhea in children aged 2–36 months from six cities in Brazil's semiarid region. Clinical, epidemiological, and anthropometric data were matched with fecal samples collected for the identification of enteropathogens. Results We enrolled 1,200 children, 596 cases and 604 controls. By univariate analysis, eight enteropathogens were associated with diarrhea: Norovirus GII (OR 5.08, 95% CI 2.10, 12.30), Adenovirus (OR 3.79, 95% CI 1.41, 10.23), typical enteropathogenic Escherichia coli (tEPEC), (OR 3.28, 95% CI 1.39, 7.73), enterotoxigenic E. coli (ETEC LT and ST producing toxins), (OR 2.58, 95% CI 0.99, 6.69), rotavirus (OR 1.91, 95% CI 1.20, 3.02), shiga toxin-producing E. coli (STEC; OR 1.77, 95% CI 1.16, 2.69), enteroaggregative E. coli (EAEC), (OR 1.45, 95% CI 1.16, 1.83) and Giardia spp. (OR 1.39, 95% CI 1.05, 1.84). By logistic regression of all enteropathogens, the best predictors of diarrhea were norovirus, adenovirus, rotavirus, STEC, Giardia spp. and EAEC. A high diarrhea severity score was associated with EAEC. Conclusions Six enteropathogens: Norovirus, Adenovirus, Rotavirus, STEC, Giardia spp., and EAEC were associated with diarrhea in children from Brazil's semiarid region. EAEC was associated with increased diarrhea severity.