Enteric Infections in Young Children are Associated with Environmental Enteropathy and Impaired Growth

Objective To investigate the relationship between fecal contamination in child play spaces, enteric infections, environmental enteropathy (EE), and impaired growth among young children. Methods Prospective cohort study of 203 children 6-30 months of age in rural Bangladesh. Stool samples were analyzed by quantitative PCR for Shigella, Enterotoxigenic Escherichia coli (ETEC), Campylobacter jejuni, Giardia spp, and Cryptosporidium spp. Four fecal markers of intestinal inflammation were also measured: alpha-1-antitrypsin, myeloperoxidase, neopterin, and calprotectin. Child growth was measured at baseline and 9 months after enrollment. E. coli was measured in soil in the child's play spaces. Results 47% of study children had three or more enteric pathogens in their stool. 35% (71/203) of children had Shigella, 30%(61/203) had ETEC, 73% (148/203) had C. jejuni, 79% (160/203) had Giardia, and none had Cryptosporidium. Children with ETEC had significantly higher calprotectin concentrations (Coefficient: 1.35, 95% Confidence Interval [CI]: 1.005, 1.82). Children with Shigella had a significantly higher odds of being stunted at our 9-month follow-up (OR: 2.01 (95% CI: 1.02, 3.93). Children with Giardia in their stool played in spaces with significantly higher E.coli counts in the soil (OR: 1.23, 95% CI: 1.02, 1.48). Conclusion The presence of enteric pathogens in stool was significantly associated with EE and impaired growth in rural Bangladesh. These findings provide further evidence to support the hypothesis that contaminated soil in child play spaces can lead to enteric infections, many of which are likely subclinical, resulting in EE and impaired growth in young children. This article is protected by copyright. All rights reserved.