title: Etiology of diarrhea in Bangladeshi infants in the first year of life analyzed using molecular methods.
abstract: BACKGROUND
  Diarrhea causes enormous morbidity and mortality in developing countries, yet the relative importance of multiple potential enteropathogens has been difficult to ascertain.
  
  
  METHODS
  We performed a longitudinal cohort study from birth to 1 year of age in 147 infants in Dhaka, Bangladesh. Using multiplex polymerase chain reaction, we analyzed 420 episodes of diarrhea and 1385 monthly surveillance stool specimens for 32 enteropathogen gene targets. For each infant we examined enteropathogen quantities over time to ascribe each positive target as a probable or less-likely contributor to diarrhea.
  
  
  RESULTS
  Multiple enteropathogens were detected by the first month of life. Diarrhea was associated with a state of overall pathogen excess (mean number of enteropathogen gene targets (± SE), 5.6 ± 0.1 vs 4.3 ± 0.1 in surveillance stool specimens; P < .05). After a longitudinal, quantitative approach was applied to filter out less-likely contributors, each diarrheal episode still had an average of 3.3 probable or dominant targets. Enteroaggregative Escherichia coli, Campylobacter, enteropathogenic E. coli, rotavirus, and Entamoeba histolytica were the most frequent probable contributors to diarrhea. Rotavirus was enriched in moderate to severe diarrheal episodes.
  
  
  CONCLUSIONS
  In this community-based study diarrhea seemed to be a multipathogen event and a state of enteropathogen excess above a high carriage baseline.
authors.affiliation: Division of Infectious Diseases and International Health, Department of Medicine.
authors.forename: Mami
authors.initials: M
authors.lastname: Taniuchi
authors.forename: Shihab U
authors.initials: SU
authors.lastname: Sobuz
authors.forename: Sharmin
authors.initials: S
authors.lastname: Begum
authors.forename: James A
authors.initials: JA
authors.lastname: Platts-Mills
authors.forename: Jie
authors.initials: J
authors.lastname: Liu
authors.forename: Zhengyu
authors.initials: Z
authors.lastname: Yang
authors.forename: Xin-Qun
authors.initials: XQ
authors.lastname: Wang
authors.forename: William A
authors.initials: WA
authors.lastname: Petri
authors.forename: Rashidul
authors.initials: R
authors.lastname: Haque
authors.forename: Eric R
authors.initials: ER
authors.lastname: Houpt
mesh_terms: D001459:Bangladesh / Q000453:epidemiology; D002167:Campylobacter / Q000235:genetics / Q000302:isolation & purification; D002169:Campylobacter Infections / Q000150:complications* / Q000382:microbiology; D015331:Cohort Studies; D003906:Developing Countries; D003968:Diarrhea, Infantile / Q000453:epidemiology / Q000209:etiology* / Q000382:microbiology / Q000469:parasitology; D004748:Entamoeba histolytica / Q000235:genetics / Q000302:isolation & purification; D004749:Entamoebiasis / Q000150:complications* / Q000382:microbiology; D054308:Enteropathogenic Escherichia coli / Q000235:genetics / Q000302:isolation & purification; D004926:Escherichia coli / Q000235:genetics / Q000302:isolation & purification; D004927:Escherichia coli Infections / Q000150:complications* / Q000382:microbiology; D005243:Feces / Q000382:microbiology / Q000469:parasitology; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008137:Longitudinal Studies; D008297:Male; D060885:Multiplex Polymerase Chain Reaction; D012401:Rotavirus / Q000235:genetics / Q000302:isolation & purification; D012400:Rotavirus Infections / Q000150:complications* / Q000821:virology
keywords: Campylobacter; Diarrhea; PCR; enteroaggregative e.coli; rotavirus
references.citation: Lancet. 2010 Aug 21;376(9741):615-23
references.pmid: 20692031
references.citation: Lancet. 2005 Mar 26-Apr 1;365(9465):1147-52
references.pmid: 15794969
references.citation: PLoS Med. 2009 Mar 10;6(3):e41
references.pmid: 19278292
references.citation: J Clin Microbiol. 2006 Nov;44(11):3872-7
references.pmid: 16943355
references.citation: Lancet. 2008 Jan 19;371(9608):243-60
references.pmid: 18207566
references.citation: Am J Trop Med Hyg. 2011 Feb;84(2):332-7
references.pmid: 21292910
references.citation: BMC Med Res Methodol. 2009 Jan 23;9:7
references.pmid: 19166593
references.citation: Int J Epidemiol. 2010 Aug;39(4):1103-14
references.pmid: 20519334
references.citation: PLoS One. 2012;7(1):e29151
references.pmid: 22235266
references.citation: Lancet. 2010 Aug 21;376(9741):606-14
references.pmid: 20692030
references.citation: J Clin Virol. 2011 Apr;50(4):308-13
references.pmid: 21256076
references.citation: Clin Infect Dis. 2012 Jan 15;54(2):185-92
references.pmid: 22109945
references.citation: PLoS Med. 2011 Mar;8(3):e1000428
references.pmid: 21445330
references.citation: Lancet. 2008 Jun 14;371(9629):2019-25
references.pmid: 18554712
references.citation: Curr Infect Dis Rep. 2012 Feb;14(1):41-6
references.pmid: 22116640
references.citation: Diagn Microbiol Infect Dis. 2012 Jun;73(2):121-8
references.pmid: 22541788
references.citation: Diagn Microbiol Infect Dis. 2011 Dec;71(4):386-90
references.pmid: 21982218
references.citation: Clin Infect Dis. 2011 Dec;53(12):1223-9
references.pmid: 22028433
references.citation: N Engl J Med. 2010 Jan 28;362(4):289-98
references.pmid: 20107214
references.citation: Eur J Clin Microbiol Infect Dis. 2007 May;26(5):311-23
references.pmid: 17447091
references.citation: Scand J Infect Dis. 1990;22(3):259-67
references.pmid: 2371542
references.citation: Clin Microbiol Rev. 1996 Jan;9(1):18-33
references.pmid: 8665474
references.citation: J Clin Microbiol. 2012 Jan;50(1):98-103
references.pmid: 22075596
references.citation: Bull World Health Organ. 1992;70(6):705-14
references.pmid: 1486666
references.citation: Am J Trop Med Hyg. 2007 Apr;76(4):713-7
references.pmid: 17426176
references.citation: Clin Infect Dis. 2012 Dec;55 Suppl 4:S294-302
references.pmid: 23169941
references.citation: Int J Med Microbiol. 2006 Oct;296(6):397-403
references.pmid: 16753339
references.citation: Environ Health Perspect. 2002 Nov;110(11):1057-68
references.pmid: 12417475
references.citation: J Clin Microbiol. 1999 Nov;37(11):3458-64
references.pmid: 10523534
references.citation: J Clin Microbiol. 2013 Feb;51(2):472-80
references.pmid: 23175269