title: Aeromonas-Associated Diarrhea in Children Under 5 Years: The GEMS Experience.
abstract: We report the clinical findings, epidemiology, and risk factors for moderate-to-severe diarrhea (MSD) associated with Aeromonas species in children 0-59 months of age, from the Global Enteric Multicenter Study, conducted at three sites in south Asia and four sites in sub-Saharan Africa. Children with MSD were enrolled along with controls matched for age, gender, and neighborhood. Pooled, age-stratified conditional logistic regression models were applied to evaluate the association of Aeromonas infection controlling for coinfecting pathogens and sociodemographic variables. A pooled, age-stratified, multivariate logistic regression analysis was done to identify risk factors associated with Aeromonas positivity in MSD cases. A total of 12,110 cases and 17,291 matched controls were enrolled over a period of 48 months. Aeromonas was identified as a significant pathogen in 736 cases of MSD in Pakistan and Bangladesh (22.2%). Aeromonas remained a significant pathogen even after adjustment for the presence of other pathogens and sociodemographic factors. Odds ratio (OR) for Aeromonas were higher in the presence of Shigella (matched OR: 6.2, 95% confidence interval [CI]: 1.9-20.2). Cases of Aeromonas were likely to present with dysentery, particularly in the 0-11 months (OR: 1.4, 95% CI 1.0-2.0) and 12-23 months (OR: 1.8, 95% CI: 1.3-2.5) age group. The odds of Aeromonas increased with increasing degree of stunting, being highest for severe stunting (OR: 10.1, 95% CI: 3.6-28.9). Aeromonas is a significant pathogen for MSD in Pakistan and Bangladesh. Presence of dysentery and co-occurrence with other pathogens, notably Shigella spp. are significant features of Aeromonas-associated diarrhea.
authors.affiliation: Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan. farah.qamar@aku.edu.
authors.forename: Farah Naz
authors.initials: FN
authors.lastname: Qamar
authors.affiliation: Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan.
authors.forename: Muhammad Imran
authors.initials: MI
authors.lastname: Nisar
authors.affiliation: Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan.
authors.forename: Farheen
authors.initials: F
authors.lastname: Quadri
authors.affiliation: Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan.
authors.forename: Sadia
authors.initials: S
authors.lastname: Shakoor
authors.affiliation: Center for Vaccine Development, Ministry of Health, Bamako, Mali.
authors.forename: Samba O
authors.initials: SO
authors.lastname: Sow
authors.affiliation: Department of Medicine, University of Maryland, Baltimore School of Medicine, Maryland. Center for Vaccine Development, University of Maryland School of Medicine, Baltimore, Maryland.
authors.forename: Dilruba
authors.initials: D
authors.lastname: Nasrin
authors.affiliation: Department of Medicine, University of Maryland, Baltimore School of Medicine, Maryland. Center for Vaccine Development, University of Maryland School of Medicine, Baltimore, Maryland.
authors.forename: William C
authors.initials: WC
authors.lastname: Blackwelder
authors.affiliation: Department of Medicine, University of Maryland, Baltimore School of Medicine, Maryland. Center for Vaccine Development, University of Maryland School of Medicine, Baltimore, Maryland.
authors.forename: Yukun
authors.initials: Y
authors.lastname: Wu
authors.affiliation: Department of Medicine, University of Maryland, Baltimore School of Medicine, Maryland. Center for Vaccine Development, University of Maryland School of Medicine, Baltimore, Maryland. Vaccine Development and Surveillance, Bill & Melinda Gates Foundation, Seattle, Washington.
authors.forename: Tamer
authors.initials: T
authors.lastname: Farag
authors.affiliation: Department of Medicine, University of Maryland, Baltimore School of Medicine, Maryland.
authors.forename: Sandra
authors.initials: S
authors.lastname: Panchalingham
authors.affiliation: Division of Epidemiology, National Institute of Cholera and Enteric Diseases, Kolkata, India.
authors.forename: Dipika
authors.initials: D
authors.lastname: Sur
authors.affiliation: Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan.
authors.forename: Shahida
authors.initials: S
authors.lastname: Qureshi
authors.affiliation: Clinical Sciences Division, International Centre for Diarrheal Disease Research (icddr,b), Dhaka, Bangladesh.
authors.forename: Abu S G
authors.initials: AS
authors.lastname: Faruque
authors.affiliation: Centre for Nutrition and Food Security (CNFS), International Centre for Diarrheal Disease Research (icddr,b), Dhaka, Bangladesh.
authors.forename: Debasish
authors.initials: D
authors.lastname: Saha
authors.affiliation: International Health Research, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain. Microbiology, Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique.
authors.forename: Pedro L
authors.initials: PL
authors.lastname: Alonso
authors.affiliation: International Emerging Infections Program, Kenya Medical Research Institute/Centers for Disease Control and Prevention (KEMRI/CDC), Nairobi, Kenya.
authors.forename: Robert F
authors.initials: RF
authors.lastname: Breiman
authors.affiliation: International Health Research, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain. ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain.
authors.forename: Quique
authors.initials: Q
authors.lastname: Bassat
authors.affiliation: Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan. Centre National d'Appui à la lutte contre la Maladie/Centre pour le Développement des Vaccins (CNAM/CVD-Mali), Bamako, Mali.
authors.forename: Boubou
authors.initials: B
authors.lastname: Tamboura
authors.affiliation: Division of Epidemiology, National Institute of Cholera and Enteric Diseases, Kolkata, India.
authors.forename: Thandavarayan
authors.initials: T
authors.lastname: Ramamurthy
authors.affiliation: Division of Epidemiology, National Institute of Cholera and Enteric Diseases, Kolkata, India.
authors.forename: Suman
authors.initials: S
authors.lastname: Kanungo
authors.affiliation: Centre for Nutrition and Food Security (CNFS), International Centre for Diarrheal Disease Research (icddr,b), Dhaka, Bangladesh.
authors.forename: Shahnawaz
authors.initials: S
authors.lastname: Ahmed
authors.affiliation: Centre for Nutrition and Food Security (CNFS), International Centre for Diarrheal Disease Research (icddr,b), Dhaka, Bangladesh.
authors.forename: Anowar
authors.initials: A
authors.lastname: Hossain
authors.affiliation: Centre for Nutrition and Food Security (CNFS), International Centre for Diarrheal Disease Research (icddr,b), Dhaka, Bangladesh.
authors.forename: Sumon K
authors.initials: SK
authors.lastname: Das
authors.affiliation: Child Survival Theme, Molecular Diagnostics, Medical Research Council (MRC) Unit, Banjul, The Gambia.
authors.forename: Martin
authors.initials: M
authors.lastname: Antonio
authors.affiliation: Child Survival Theme, Molecular Diagnostics, Medical Research Council (MRC) Unit, Banjul, The Gambia.
authors.forename: M Jahangir
authors.initials: MJ
authors.lastname: Hossain
authors.affiliation: International Health Research, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain. Microbiology, Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique.
authors.forename: Inacio
authors.initials: I
authors.lastname: Mandomando
authors.affiliation: Department of Medicine, University of Maryland, Baltimore School of Medicine, Maryland. Center for Vaccine Development, University of Maryland School of Medicine, Baltimore, Maryland.
authors.forename: Sharon M
authors.initials: SM
authors.lastname: Tennant
authors.affiliation: Department of Medicine, University of Maryland, Baltimore School of Medicine, Maryland. Center for Vaccine Development, University of Maryland School of Medicine, Baltimore, Maryland.
authors.forename: Karen L
authors.initials: KL
authors.lastname: Kotloff
authors.affiliation: Department of Medicine, University of Maryland, Baltimore School of Medicine, Maryland. Center for Vaccine Development, University of Maryland School of Medicine, Baltimore, Maryland.
authors.forename: Myron M
authors.initials: MM
authors.lastname: Levine
authors.affiliation: Vaccine Development and Surveillance, Bill & Melinda Gates Foundation, Seattle, Washington.
authors.forename: Anita K M
authors.initials: AK
authors.lastname: Zaidi
mesh_terms: D000333:Aeromonas / Q000302:isolation & purification*; D017954:Africa South of the Sahara / Q000453:epidemiology; D001459:Bangladesh / Q000453:epidemiology; D016022:Case-Control Studies; D002675:Child, Preschool; D060085:Coinfection; D003967:Diarrhea / Q000453:epidemiology* / Q000209:etiology / Q000382:microbiology; D004403:Dysentery / Q000453:epidemiology / Q000209:etiology / Q000382:microbiology; D004405:Dysentery, Bacillary / Q000150:complications / Q000453:epidemiology* / Q000382:microbiology; D005260:Female; D016905:Gram-Negative Bacterial Infections / Q000150:complications / Q000453:epidemiology* / Q000382:microbiology; D006801:Humans; D007223:Infant; D016015:Logistic Models; D008297:Male; D010154:Pakistan / Q000453:epidemiology; D012307:Risk Factors; D012760:Shigella / Q000302:isolation & purification*; D012959:Socioeconomic Factors