Etiology of Diarrhea, Nutritional Outcomes and Novel Intestinal Biomarkers in Tanzanian Infants: A Preliminary Study.

Objective: Diarrheal diseases are a leading cause of morbidity and mortality worldwide, but the etiology of diarrhea and its relationship to nutritional outcomes in resource-limited settings is poorly defined. We sought to determine the etiology of community-acquired diarrhea in Tanzanian infants, and to assess the association with anthropometrics and novel intestinal biomarkers. Methods: A convenience sample of infants in a trial of zinc and/or multivitamin supplementation in Tanzania was selected. Subjects were enrolled at age 6 weeks and followed for 18 months. Stool samples were obtained from children with acute diarrhea. A novel, PCR-based TaqMan array was used to screen stool for 15 enteropathogens. A subset of subjects had serum gastrointestinal biomarkers measured. Results: 123 subjects with diarrhea were enrolled. The mean +/- SD age at stool sample collection was 12.4 +/- 3.9 months. Thirty-five enteropathogens were identified in 34 (27.6%) subjects: 11 rotavirus, 9 Cryptosporidium spp, 7 Shigella spp, 3 Campylobacter jejuni / coli, 3 ST-enterotoxigenic E. coli and 2 enteropathogenic E. coli. Subjects with any identified enteropathogen had significantly lower weight-for-length z scores (-0.55 +/- 1.10 vs. 0.03 +/- 1.30, p = 0.03) at the final clinic visit, compared to those without an identified pathogen. Fifty of the 123 subjects (40.7%) had serum analyzed for antibodies to LPS and flagellin. Subjects with any identified enteropathogen had lower IgA antibodies to LPS (0.75 +/- 0.27 vs. 1.13 +/- 0.77, p = 0.01) and flagellin (0.52 +/- 0.16 vs. 0.73 +/- 0.47, p = 0.02), compared to those without an identified pathogen. Conclusion: This quantitative PCR method may allow identification of enteropathogens that place children at higher risk for suboptimal growth. IgA anti-LPS and flagellin antibodies hold promise as emerging intestinal biomarkers. (C) 2016 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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