https://www.clinicalmicrobiologyandinfection.com/article/S1198-743X(14)63352-8/pdf

Campylobacter, from obscurity to celebrity

Diarrhoeal illness is a leading cause of child mortality and morbidity worldwide. There are no precise or current estimates of the types and prevalence of pathogens associated with diarrheal illnesses in developed and developing settings. This systematic review assessed data from 60 studies published in the English language from five developing regions and developed countries worldwide to provide regional estimates of enteric pathogens affecting children. The random-effect method was used to establish the weighted average prevalence of pathogens in adults and children for each region. Significantly more pathogens were reported by studies from developing regions compared with Organisation for Economic Co-operation and Development countries (P<0.016). The identification rates of pathogens from community based and hospital based studies were similar (58.5% and 58.1% respectively, P<0.619). The overall detection of enteric pathogens in developing countries was higher in adults (74.8%; 95% CI 63.1-83.8%) compared with children (56.7%; 95% CI 53.0-60.4%) (P<0.001). Rotavirus was the most frequently detected pathogen in all regions with the highest rate, 24.8% (95% CI 18.0-33.1%), detected in the developed countries. This systematic review is the first to provide an estimate of the prevalence of enteric pathogens associated with diarrhoeal illnesses in adults and children in developed and developing settings. While pathogen detection rate is greater in developing regions the consistently high prevalence of rotavirus in both developed and developing settings underscores the urgent need for access to rotavirus vaccines. Increased travel between developing and developed countries increases disease risk, and hence developed countries have a vested interest in supporting vaccine accessibility in developing settings.

/pdf/prevalence-of-gastrointestinal-pathogens-in-developed-and-1vw0h2s50q.pdf

Prevalence of gastrointestinal pathogens in developed and developing countries: systematic review and meta-analysis

Diarrhea is a leading cause of illness and death, particularly in developing countries. Enteropathogenic Escherichia coli, enterotoxigenic E. coli (ETEC), enteroinvasive E. coli, enterohemorrhaghic E. coli (EHEC), enteroaggregative E. coli (EAEC) and diffusely adherent E. coli (DAEC) have been associated with diarrheal disease in different parts of Africa, particularly among young children, HIV-positive individuals, and visitors from abroad. Each of these E. coli pathotypes uses distinct mechanisms, which are only partially understood, to colonize infected hosts and produce diarrhea. All known diarrheagenic E. coli pathotypes have been reported from diverse locations within Africa but the true burden from these pathogens is unknown because very few studies seeking these organisms with discriminatory methodology have been performed. Recent reports implicate ETEC and EAEC in a considerable proportion of childhood and travellers' diarrheas and suggest that some sub-types of these categories may have greater epidemiological significance than others. The significant contribution of EHEC to bloody diarrhea and hemolytic uremic syndrome is underappreciated because diagnostic capacity for this pathotype is generally inferior to that for confounders such as Shigella and Entamoeba. Recent studies in Africa have revealed the worrisome emergence of antimicrobial resistance and high asymptomatic carriage rates for diarrheagenic E. coli but bacterial and host factors that predispose to disease, as well as non-human reservoirs, are largely unknown. Future diarrheal disease research needs to focus on broadening the repertoire of pathogens sought in epidemiological surveys to include multiple categories of diarrheagenic E. coli while building capacity to detect these pathogens in local reference laboratories.

https://jidc.org/index.php/journal/article/download/20061678/323

Diarrheagenic Escherichia coli in sub-Saharan Africa: status, uncertainties and necessities.

This study assesses the importance of enterotoxigenic Escherichia coli (ETEC) as a diarrhoeal agent in developing countries. Odds ratios were calculated for incurring ETEC-associated diarrhoea based on data reported between 1970 and 1999. Carriage of ETEC was associated with diarrhoea in children aged less than five years, except for hospitalized infants aged 0-11 month(s) and children aged 1-4 year(s) at outpatient clinics. Two hundred and eighty million episodes of diarrhoea due to ETEC were seen yearly among those aged less than five years, and close to 50 million children of this age group were asymptomatic carriers of ETEC. Every 7th diarrhoeal episode in children aged less than one year and close to 25% of diarrhoeal cases in children aged 1-4 year(s) were due to ETEC. A child born in a developing country is likely to experience 0.5 diarrhoeal episodes per year caused by ETEC until the age of five years, after which the yearly incidence drops to 0.1. To conclude, ETEC remains an important diarrhoeal pathogen among children in the developing world.

/pdf/prevalence-of-enterotoxigenic-escherichia-coli-associated-5ehru1zbvh.pdf

Prevalence of enterotoxigenic Escherichia coli-associated diarrhoea and carrier state in the developing world.

Epidemiology of diarrhoeal disease: implications for control by vaccines.

Enteropathogenic agents in children with diarrhoea in rural zaire

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Enteropathogenic agents in children with diarrhoea in rural zaire