Aeromonas-Associated Diarrhea in Children Under 5 Years: The GEMS Experience.

Qamar, FN; Nisar, MI; Quadri, F; Shakoor, S; Sow, SO; Nasrin, D; Blackwelder, WC; Wu, Y; Farag, T; Panchalingham, S; +20 more...Sur, D; Qureshi, S; Faruque, AS; Saha, D; Alonso, PL; Breiman, RF; Bassat, Q; Tamboura, B; Ramamurthy, T; Kanungo, S; Ahmed, S; Hossain, A; Das, SK; Antonio, MORCID logo; Hossain, MJORCID logo; Mandomando, I; Tennant, SM; Kotloff, KL; Levine, MM; Zaidi, AK and (2016) Aeromonas-Associated Diarrhea in Children Under 5 Years: The GEMS Experience. AMERICAN JOURNAL OF TROPICAL MEDICINE AND HYGIENE, 95 (4). pp. 774-780. ISSN 0002-9637 DOI: 10.4269/ajtmh.16-0321
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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.


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