Multiple enteropathogens appeared to cause diarrhea in Bangladesh

Multiple enteropathogens work together, causing childhood diarrhea in Dhaka, Bangladesh, according to recent study findings published in the Journal of Infectious Diseases.

Researchers evaluated 420 episodes of diarrhea in children aged 0 to 1 year.

They found that by the first month of life, multiple enteropathogens were detected. Overall pathogen excess was associated with diarrhea (P<.05). Diarrhea was most frequently contributed by enteroaggregative Escherichia coli, Campylobacter, enteropathogenic E. coli, rotavirus and Entamoeba histolytica.

“The importance of this work is the demonstration that childhood diarrhea in this Bangladeshi setting appears to be polymicrobial and may be better conceptualized as a syndrome of enteropathogen excess than a single infection,” the researchers wrote. “Amidst the enteropathogen milieu of this region, where carriage of multiple enteropathogen targets was the norm, diarrhea reliably occurred when a quantitative threshold was exceeded.”

In an accompanying editorial, Edward T. Ryan, MD, of Massachusetts General Hospital, wrote that the results call for revision on how the enteropathogenic burden of infants in resource-limited areas of the world is conceptualized.

“Depressingly, it appears that is it ‘normal’ to be able to detect many pathogens in the intestines of infants in resource-limited areas, beginning with the first month of life, even in the absence of overt diarrhea,” Ryan wrote.

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Disclosure: The study was funded in part by the National Institute of Allergy and Infectious Diseases, NIH, and the Bill and Melinda Gates Foundation.