Unité de Bactériologie Expérimentale, Institut Pasteur de Madagascar, Antananarivo, Madagascar.
Unité d'Epidémiologie et de Recherche Clinique, Institut Pasteur de Madagascar, Antananarivo, Madagascar.
PLoS Negl Trop Dis. 2022 May 9;16(5):e0009849. doi: 10.1371/journal.pntd.0009849. eCollection 2022 May.
Environmental Enteric Dysfunction (EED) refers to an incompletely defined syndrome of inflammation, reduced absorptive capacity, and reduced barrier function in the small intestine. It is widespread among children and adults in low- and middle-income countries and is also associated with poor sanitation and certain gut infections possibly resulting in an abnormal gut microbiota, small intestinal bacterial overgrowth (SIBO) and stunting. We investigated bacterial pathogen exposure in stunted and non-stunted children in Antananarivo, Madagascar by collecting fecal samples from 464 children (96 severely stunted, 104 moderately stunted and 264 non-stunted) and the prevalence of SIBO in 109 duodenal aspirates from stunted children (61 from severely stunted and 48 from moderately stunted children). SIBO assessed by both aerobic and anaerobic plating techniques was very high: 85.3% when selecting a threshold of ≥105 CFU/ml of bacteria in the upper intestinal aspirates. Moreover, 58.7% of the children showed more than 106 bacteria/ml in these aspirates. The most prevalent cultivated genera recovered were Streptococcus, Neisseria, Staphylococcus, Rothia, Haemophilus, Pantoea and Branhamella. Feces screening by qPCR showed a high prevalence of bacterial enteropathogens, especially those categorized as being enteroinvasive or causing mucosal disruption, such as Shigella spp., enterotoxigenic Escherichia coli, enteropathogenic E. coli and enteroaggregative E. coli. These pathogens were detected at a similar rate in stunted children and controls, all showing no sign of severe diarrhea the day of inclusion but both living in a highly contaminated environment (slum-dwelling). Interestingly Shigella spp. was the most prevalent enteropathogen found in this study (83.3%) without overrepresentation in stunted children.
肠病相关的环境因素(EED)是一种不完全定义的综合征,表现为小肠炎症、吸收能力降低和屏障功能降低。它在中低收入国家的儿童和成人中广泛存在,也与卫生条件差和某些肠道感染有关,可能导致肠道微生物群异常、小肠细菌过度生长(SIBO)和发育迟缓。我们通过收集来自 464 名儿童(96 名严重发育迟缓、104 名中度发育迟缓、264 名非发育迟缓)的粪便样本,并对 109 名发育迟缓儿童的十二指肠抽吸物中 SIBO 的患病率进行了调查,来研究马达加斯加塔那那利佛发育迟缓儿童和非发育迟缓儿童的细菌病原体暴露情况(61 名来自严重发育迟缓儿童,48 名来自中度发育迟缓儿童)。通过需氧和厌氧平板技术评估的 SIBO 非常高:当选择上消化道抽吸物中细菌≥105 CFU/ml 的阈值时,为 85.3%。此外,58.7%的儿童在这些抽吸物中显示出超过 106 个细菌/ml。培养出的最常见的属是链球菌、奈瑟菌、葡萄球菌、罗特氏菌、嗜血杆菌、泛菌属和布兰汉氏菌。qPCR 粪便筛查显示出高比例的细菌肠道病原体,特别是那些被归类为侵袭性或导致黏膜破坏的病原体,如志贺氏菌属、肠毒性大肠杆菌、肠致病性大肠杆菌和肠聚集性大肠杆菌。在发育迟缓儿童和对照组中,这些病原体的检出率相似,所有儿童在纳入当天均无严重腹泻迹象,但均生活在高度污染的环境(贫民窟)中。有趣的是,在本研究中,志贺氏菌属是最常见的肠道病原体(83.3%),在发育迟缓儿童中没有过度表达。