Kinetics of enteric pathogen quantity during acute diarrhea in children in resource-limited settings

Authors

• William J. Lain, University of Virginia School of Medicine
• Sarah E. Elwood, University of Virginia School of Medicine
• Jie Liu, Qingdao University
• Elizabeth T Rogawski McQuade, University of Virginia School of Medicine
• Gagandeep Kang, Christian Medical College
• Margaret N. Kosek, University of Virginia School of Medicine
• Aldo A M Lima, Federal University of Ceara
• Pascal O. Bessong, University of Venda
• Amidou Samie, University of Venda
• Rashidul Haque, nternational Centre for Diarrhoeal Disease Research
• Estomih R. Mduma, Haydom Global Health Research Centre
• Jose Paulo Leite, Fundação Oswaldo Cruz
• Ladaporn Bodhidatta, Armed Forces Research Institute of Medical Sciences
• Najeeha Talat Iqbal, Aga Khan UniversityFollow
• Nicola Page, National Institute for Communicable Diseases
• Ireen Kiwelu, Kilimanjaro Clinical Research Institute
• Zulfiqar Ahmed Bhutta, Aga Khan UniversityFollow
• Tahmeed Ahmed, International Centre for Diarrhoeal Disease Research
• Eric R. Houpt, University of Virginia School of Medicine
• James A. Platts-Mills, University of Virginia School of Medicine

Document Type

Report

Department

Paediatrics and Child Health; Office of the Provost

Abstract

Pathogen quantity kinetics during childhood diarrhea have implications for etiology ascertainment. Using a multisite cohort, we modeled quantitative PCR quantity by symptom duration. Rotavirus had the largest log reduction in quantity by day 7 (-1.98; 95% confidence interval: -2.88, -1.08), followed by Shigella (-0.87; -1.46, -.28) and heat-stable toxin-producing Escherichia coli (-0.78; -1.57, .02). While peak quantity was robust to host factors, kinetics were not. For example, malnourished children had a minimal decline in Cryptosporidium quantity over the first 7 days of illness. Pathogen quantity, etiology attribution, and non-PCR test sensitivity all peaked early in illness. Diarrheal studies should collect samples early to reduce bias in etiology identification.

Publication (Name of Journal)

Open Forum Infectious Diseases

DOI

10.1093/ofid/ofag309

Recommended Citation

Lain, W. J., Elwood, S. E., Liu, J., McQuade, E. R., Kang, G., Kosek, M. N., Lima, A. A., Bessong, P. O., Samie, A., Haque, R., Mduma, E. R., Leite, J. P., Bodhidatta, L., Iqbal, N. T., Page, N., Kiwelu, I., Bhutta, Z. A., Ahmed, T., Houpt, E. R., Platts-Mills, J. A. (2026). Kinetics of enteric pathogen quantity during acute diarrhea in children in resource-limited settings. Open Forum Infectious Diseases, 13(5), 1-6.
Available at: https://ecommons.aku.edu/pakistan_fhs_mc_bbs/1119