Fecal biomarkers to characterize intestinal inflammation among children with medically attended diarrhea across six low-resource settings: Findings from the Enterics for Global Health (EFGH) Shigella surveillance study

Authors

• BriAnna Horne, University of Maryland,USA
• Brian Otieno Onyando, Center for Global Health Research, Kenya
• Henry Badji, London School of Hygiene & Tropical Medicine,UK
• Wardah Mujahid, Aga Khan UniversityFollow
• Junaid Iqbal, Aga Khan UniversityFollow
• Naveed Ahmed, Aga Khan UniversityFollow
• Zarfishan Hussain, Aga Khan UniversityFollow
• Mohammad Tahir Yousafzai, Aga Khan UniversityFollow
• Taufiqur Rahman Bhuiyan, International Centre for Diarrhoeal Disease Research, Bangladesh
• Mutsai Bakali, Research institute Malawi

Document Type

Article

Department

Paediatrics and Child Health

Abstract

Background: Frequent enteric infections can damage the small intestine causing inflammation and malabsorption, leading to environmental enteric dysfunction. We aimed to characterize the association between intestinal inflammation and enteric pathogens among children in low- and middle-income countries (LMICs) who presented to care with diarrhea.
Methodology/principle findings: We conducted a cross-sectional analysis within the Enterics for Global Health - Shigella surveillance study at six LMIC sites: Bangladesh, Kenya, Malawi, Pakistan, Peru, and The Gambia. From August 2022 to July 2024, rectal swabs and whole stool samples were collected from 4,903 children with medically attended diarrhea aged 6-35 months (44.4% females, n = 2178/4903; mean age: 15.4 months ± 7.4 months) and were analyzed for Shigella and four fecal inflammatory biomarkers: hemoglobin, lipocalin-2, myeloperoxidase, and calprotectin via Enzyme Linked Immunosorbent Assays. Caregivers and clinicians demonstrated moderate accuracy in identifying blood in stool compared to fecal hemoglobin (area under the curve (AUC)=0.70). Among 10 pathogens evaluated, Shigella-attributable diarrhea had the highest concentrations of calprotectin, hemoglobin, and myeloperoxidase. Shigella culture-/PCR+ episodes had intermediate levels of inflammation between culture-/PCR- and culture+ episodes. In multivariable models restricted to Shigella episodes, dysentery was positively associated and vomiting was negatively associated with biomarker concentrations, with the strongest associations observed for hemoglobin (dysentery geometric mean ratio: 12.82 (95% CI: 7.21, 22.77) and vomiting geometric mean ratio: 0.45 (95% CI: 0.23, 0.86)). Age, sex, and both acute and chronic malnutrition were not associated with inflammatory biomarker concentrations.

Comments

Pagination is not provided by author/publisher.

Publication (Name of Journal)

PLOS Neglected Tropical Diseases

DOI

10.1371/journal.pntd.0014320

Recommended Citation

Horne, B., Onyando, B. O., Badji, H., Mujahid, W., Iqbal, J., Ahmed, N., Hussain, Z., Yousafzai, M. T., Bhuiyan, T. R., Bakali, M. (2026). Fecal biomarkers to characterize intestinal inflammation among children with medically attended diarrhea across six low-resource settings: Findings from the Enterics for Global Health (EFGH) Shigella surveillance study. PLOS Neglected Tropical Diseases, 20(9).
Available at: https://ecommons.aku.edu/pakistan_fhs_mc_women_childhealth_paediatr/1775