Etiology of Severely Dehydrating Diarrheal Illness in Infants and Young Children Residing in Low- and Middle-Income Countries

Anna Jones; Sharia M Ahmed; James A Platts-Mills; Karen L Kotloff; Adam C Levine; Eric J Nelson; Andrew T Pavia; Ashraful I Khan; Daniel T Leung

doi:10.1093/ofid/ofae619

Etiology of Severely Dehydrating Diarrheal Illness in Infants and Young Children Residing in Low- and Middle-Income Countries

Open Forum Infect Dis. 2024 Oct 11;11(11):ofae619. doi: 10.1093/ofid/ofae619. eCollection 2024 Nov.

Authors

Anna Jones¹, Sharia M Ahmed², James A Platts-Mills³, Karen L Kotloff⁴, Adam C Levine⁵, Eric J Nelson⁶, Andrew T Pavia⁷, Ashraful I Khan⁸, Daniel T Leung⁹

Affiliations

¹ Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah, USA.
² Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA.
³ Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, Virginia, USA.
⁴ Department of Pediatrics, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA.
⁵ Department of Emergency Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.
⁶ Department of Pediatrics and Environmental and Global Health, Emerging Pathogens Institute, University of Florida, Gainesville, Florida, USA.
⁷ Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah, USA.
⁸ Infectious Diseases Division, International Center for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.
⁹ Division of Infectious Diseases, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA.

Abstract

Background: Severe dehydration due to acute infectious diarrhea remains a leading cause of death among young children worldwide. Diarrhea with severe dehydration is a clinical syndrome with distinct management per the World Health Organization (WHO) Integrated Management of Childhood Illness (IMCI) and the WHO Global Task Force on Cholera Control (GTFCC) guidelines. We sought to characterize the pathogens causing severe dehydration using data from the Global Enteric Multicenter Study.

Methods: We used the IMCI and GTFCC guidelines to define severe dehydration and quantitative polymerase chain reaction-based attribution models to assign the etiology of diarrhea associated with severe dehydration.

Results: The IMCI or GTFCC guidelines classified 2284 of the 5304 (43%) cases with moderate-to-severe diarrhea as having severe dehydration. In one-third of the cases with severe dehydration, no pathogens were attributed. The top pathogens attributed to children with guidelines-classified severe dehydration varied by age and were similar among those requiring intravenous hydration and hospitalization. Rotavirus (30.9%), Cryptosporidium (12.0%), and heat-stable (ST) enterotoxigenic Escherichia coli (ETEC) (10.3%) were the most common pathogens for ages 0-11 months, while Shigella/enteroinvasive E coli (EIEC) (25.8%), rotavirus (19.3%), and ST-ETEC (10.9%) were the most common for ages 12-23 months. Shigella/EIEC (25.9%), Vibrio cholerae (10.4%), and rotavirus (9.2%) were the most common among ages 24-59 months.

Conclusions: The findings inform prioritization of pathogens, in addition to V cholerae, that cause severe dehydration for future preventive and treatment efforts. The schema for prioritization is driven primarily by age stratifications.

Keywords: dehydration; diarrhea; pediatric.