Nutrition and Clinical Services Division, International Center for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh.
Emerging Infections and Parasitology Laboratory, International Center for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh.
Am J Trop Med Hyg. 2022 Jan 31;106(3):915-922. doi: 10.4269/ajtmh.21-0780.
Despite reports of enterotoxigenic Bacteroides fragilis (ETBF) isolation from asymptomatic children, no reports exist regarding the possible association of ETBF with long-term complications such as development of environmental enteric dysfunction (EED) and subsequent linear growth faltering in childhood. We aimed to establish a potential association between the burden of asymptomatic ETBF infection and EED and linear growth at 24 months of age using the data collected from 1,715 children enrolled in the multi-country birth cohort study, known as the Etiology, Risk Factors, and Interactions of Enteric Infections and Malnutrition and the Consequences for Child Health study. Using Poisson regression models, we evaluated the site-specific incidence rate and, subsequently, identified the risk factors and assessed the association between the burden of ETBF infection and EED score and linear growth at 24 months of age. The overall incidence rate of ETBF infections per 100 child-months across all study sites was 10.6%, with the highest and lowest incidence of ETBF infections being reported in Tanzania (19.6%) and Peru (3.6%), respectively. Female gender, longer duration of breastfeeding, and improved water access, sanitation, and hygiene practices, such as improved drinking water source, improved sanitation, and improved floor material in households, along with enhanced maternal education and less crowding in the households were found to be protective against incidences of ETBF infection. The burden of ETBF infections was found to have significant associations with EED and linear growth faltering at 24 months of age across all the study sites. Our findings warrant regular clinical monitoring to reduce the burden of ETBF infections and diminish the burden of enteropathy and linear growth faltering in childhood.
尽管有报道称无症状儿童中分离出了产肠毒素脆弱拟杆菌（ETBF），但尚无关于 ETBF 可能与长期并发症相关的报道，例如环境肠道功能障碍（EED）的发展和随后的儿童期线性生长迟缓。我们旨在使用从多国家出生队列研究中收集的数据，即肠道感染和营养不良的病因、危险因素和相互作用及其对儿童健康的后果研究，来确定无症状 ETBF 感染负担与 EED 和 24 月龄线性生长之间的潜在关联。我们使用泊松回归模型评估了特定部位的发病率，随后确定了危险因素，并评估了 ETBF 感染负担与 EED 评分和 24 月龄线性生长之间的关联。所有研究地点的 ETBF 感染每 100 名儿童月的总发病率为 10.6%，坦桑尼亚（19.6%）和秘鲁（3.6%）的 ETBF 感染发病率最高和最低。女性性别、母乳喂养时间较长、改善水的获取、卫生和个人卫生习惯，例如改善饮用水源、改善卫生和改善家庭地板材料，以及提高母亲教育水平和减少家庭拥挤程度，都被发现可以预防 ETBF 感染的发生。在所有研究地点，ETBF 感染负担与 EED 和 24 月龄线性生长迟缓均有显著关联。我们的研究结果需要定期进行临床监测，以降低 ETBF 感染的负担，并减少儿童期肠病和线性生长迟缓的负担。
