Nutrition & Clinical Services Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh.
Mater Medical Research Institute, South Brisbane, Australia.
Trop Med Int Health. 2020 Aug;25(8):1032-1042. doi: 10.1111/tmi.13445. Epub 2020 Jun 18.
To determine the pathogen-specific risk of seizure in under-five children hospitalised with moderate-to-severe diarrhoea (MSD) in rural settings.
This was a prospective case-control study with follow-up, conducted in a sentinel facility of Global Enteric Multicenter Study in Mirzapur, a rural community of Bangladesh between 2007 and 2010. Children aged 0-59 months who presented with MSD and seizure constituted the cases whereas those who did not have seizure comprised the controls. MSD was defined if the episodes were associated with dehydration or dysentery or required hospitalisation with diarrhoea or dysentery. All enrolled children were followed up at home within 50-90 days of enrolment. A total of 64 cases and 128 randomly selected controls formed the analysable dataset.
The result of logistic regression analysis after adjusting for potential confounders revealed that shigellosis (Shigella species, OR = 5.34, 95% CI = 2.37-12.04) particularly S. flexneri (OR = 3.34, 95% CI = 1.48-7.57), S. flexneri 6 (OR = 23.24, 95% CI = 2.79-193.85), S. sonnei (OR = 6.90, 95% CI = 2.34-19.85); norovirus (OR = 6.77, 95% CI = 1.69-27.11), fever (OR = 16.75, 95% CI = 1.81-154.70) and loss of consciousness (OR = 35.25, 95% CI = 1.71-726.20) were the independent risk factors for seizure in MSD children. At enrolment, cases had lower WHZ (P = 0.006) compared to their peers, follow-up anthropometrics showed significant improvement in WHZ (P < 0.001) and WAZ (P < 0.05), whereas deterioration in HAZ (P < 0.001) in both cases and controls.
Childhood MSD episodes particularly due to Shigella and norovirus are often associated with seizure. Prompt identification and appropriate management of children with shigellosis may reduce occurrence and adverse consequences of seizure linked with MSD.
确定在孟加拉国米尔扎普尔农村地区因中度至重度腹泻（MSD）住院的五岁以下儿童中，病原体特异性癫痫发作风险。
这是一项前瞻性病例对照研究，采用随访方式，于 2007 年至 2010 年在全球肠道多中心研究的哨点设施中进行。患有 MSD 和癫痫发作的 0-59 个月龄儿童为病例，而没有癫痫发作的儿童为对照组。如果腹泻或痢疾发作伴有脱水或痢疾，或需要因腹泻或痢疾住院，则定义为 MSD。所有入组的儿童在入组后 50-90 天内在家中接受随访。共有 64 例病例和 128 例随机选择的对照组成了可分析的数据集。
在调整潜在混杂因素后进行逻辑回归分析的结果表明，志贺菌病（志贺菌属，OR=5.34，95%CI=2.37-12.04），特别是福氏志贺菌（OR=3.34，95%CI=1.48-7.57），福氏志贺菌 6（OR=23.24，95%CI=2.79-193.85），宋内志贺菌（OR=6.90，95%CI=2.34-19.85）；诺如病毒（OR=6.77，95%CI=1.69-27.11），发热（OR=16.75，95%CI=1.81-154.70）和意识丧失（OR=35.25，95%CI=1.71-726.20）是 MSD 儿童癫痫发作的独立危险因素。在入组时，病例的 WHZ 较低（P=0.006），与同龄人相比，随访后的人体测量指标显示 WHZ（P<0.001）和 WAZ（P<0.05）显著改善，而病例和对照组的 HAZ 均恶化（P<0.001）。
儿童 MSD 发作，特别是由志贺菌和诺如病毒引起的发作，常与癫痫发作有关。及时识别和适当治疗志贺菌病患儿可能会减少与 MSD 相关的癫痫发作的发生和不良后果。
