title: Identifying etiological agents causing diarrhea in low income Ecuadorian communities.
abstract: Continued success in decreasing diarrheal disease burden requires targeted interventions. To develop such interventions, it is crucial to understand which pathogens cause diarrhea. Using a case-control design we tested stool samples, collected in both rural and urban Ecuador, for 15 pathogenic microorganisms. Pathogens were present in 51% of case and 27% of control samples from the urban community, and 62% of case and 18% of control samples collected from the rural community. Rotavirus and Shigellae were associated with diarrhea in the urban community; co-infections were more pathogenic than single infection; Campylobacter and Entamoeba histolytica were found in large numbers in cases and controls; and non-typhi Salmonella and enteropathogenic Escherichia coli were not found in any samples. Consistent with the Global Enteric Multicenter Study, focused in south Asia and sub-Saharan Africa, we found that in Ecuador a small group of pathogens accounted for a significant amount of the diarrheal disease burden.
authors.affiliation: Microbiology Institute, Universidad San Francisco de Quito, Quito, Ecuador; Centro de Biomedicina, Universidad Central del Ecuador, Quito, Ecuador; Department of Epidemiology, University of Michigan, Ann Arbor, Michigan; Centro de Salud de Guamaní, Ministerio de Salud Pública, Quito, Ecuador.
authors.forename: Gabriela
authors.initials: G
authors.lastname: Vasco
authors.affiliation: Microbiology Institute, Universidad San Francisco de Quito, Quito, Ecuador; Centro de Biomedicina, Universidad Central del Ecuador, Quito, Ecuador; Department of Epidemiology, University of Michigan, Ann Arbor, Michigan; Centro de Salud de Guamaní, Ministerio de Salud Pública, Quito, Ecuador.
authors.forename: Gabriel
authors.initials: G
authors.lastname: Trueba
authors.affiliation: Microbiology Institute, Universidad San Francisco de Quito, Quito, Ecuador; Centro de Biomedicina, Universidad Central del Ecuador, Quito, Ecuador; Department of Epidemiology, University of Michigan, Ann Arbor, Michigan; Centro de Salud de Guamaní, Ministerio de Salud Pública, Quito, Ecuador.
authors.forename: Richard
authors.initials: R
authors.lastname: Atherton
authors.affiliation: Microbiology Institute, Universidad San Francisco de Quito, Quito, Ecuador; Centro de Biomedicina, Universidad Central del Ecuador, Quito, Ecuador; Department of Epidemiology, University of Michigan, Ann Arbor, Michigan; Centro de Salud de Guamaní, Ministerio de Salud Pública, Quito, Ecuador.
authors.forename: Manuel
authors.initials: M
authors.lastname: Calvopiña
authors.affiliation: Microbiology Institute, Universidad San Francisco de Quito, Quito, Ecuador; Centro de Biomedicina, Universidad Central del Ecuador, Quito, Ecuador; Department of Epidemiology, University of Michigan, Ann Arbor, Michigan; Centro de Salud de Guamaní, Ministerio de Salud Pública, Quito, Ecuador.
authors.forename: William
authors.initials: W
authors.lastname: Cevallos
authors.affiliation: Microbiology Institute, Universidad San Francisco de Quito, Quito, Ecuador; Centro de Biomedicina, Universidad Central del Ecuador, Quito, Ecuador; Department of Epidemiology, University of Michigan, Ann Arbor, Michigan; Centro de Salud de Guamaní, Ministerio de Salud Pública, Quito, Ecuador.
authors.forename: Thamara
authors.initials: T
authors.lastname: Andrade
authors.affiliation: Microbiology Institute, Universidad San Francisco de Quito, Quito, Ecuador; Centro de Biomedicina, Universidad Central del Ecuador, Quito, Ecuador; Department of Epidemiology, University of Michigan, Ann Arbor, Michigan; Centro de Salud de Guamaní, Ministerio de Salud Pública, Quito, Ecuador.
authors.forename: Martha
authors.initials: M
authors.lastname: Eguiguren
authors.affiliation: Microbiology Institute, Universidad San Francisco de Quito, Quito, Ecuador; Centro de Biomedicina, Universidad Central del Ecuador, Quito, Ecuador; Department of Epidemiology, University of Michigan, Ann Arbor, Michigan; Centro de Salud de Guamaní, Ministerio de Salud Pública, Quito, Ecuador jnse@umich.com.
authors.forename: Joseph N S
authors.initials: JN
authors.lastname: Eisenberg
mesh_terms: D000293:Adolescent; D000328:Adult; D002167:Campylobacter / Q000302:isolation & purification*; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D060085:Coinfection; D003967:Diarrhea / Q000453:epidemiology* / Q000382:microbiology / Q000469:parasitology; D004484:Ecuador / Q000453:epidemiology; D004748:Entamoeba histolytica / Q000302:isolation & purification*; D005243:Feces / Q000382:microbiology / Q000469:parasitology; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D011203:Poverty; D012401:Rotavirus / Q000302:isolation & purification*; D012424:Rural Population; D012760:Shigella / Q000302:isolation & purification*; D014505:Urban Population; D055815:Young Adult