Abstract

Enteric dysfunction and enteropathogens among hospitalized south Asian and sub-Saharan African children

Shahid, Asmsb Denno, D. M. Kariuki, K. Rwigi, D. Gazi, A. Shahrin, L. Gumbi, W. Njunge, J. M. Chisti, M. J. Ahmed, T. Houpt, E. R. Liu, J. Taniuchi, M. Singa, B. O. Bandsma, R. H. J. Voskuijl, W. Saleem, A. F. Lancioni, C. L. Mupere, E. Diallo, A. H. Walson, J. L. Berkley, J. A. Tickell, K. D.
PLOS Glob Public Health. 2026; 6e0006873

Permanent descriptor

https://doi.org/10.1371/journal.pgph.0006873

Enteropathogens and enteric dysfunction (ED) among acutely ill children in low-and-middle income countries (LMICs) may contribute to poor post-discharge outcomes. Enteropathogen prevalence and fecal ED biomarkers (myeloperoxidase, calprotectin, alpha-1-antitrypsin) from children aged 2-23 months hospitalized at nine LMIC facilities (n = 811) were compared to community children (n = 248). Host and pathogen correlates of ED biomarkers were identified through crude and adjusted linear mixed effect models, and Cox-proportional hazard models assessed ED biomarker associations with mortality in the 30-days following admission and 180-days following discharge. Invasive enteropathogens were more prevalent at admission (69%) than discharge (60%, p < 0.001) or among community children (61%, p = 0.004). Among the biomarkers, myeloperoxidase was higher at admission (2290 ng/ml, interquartile range [IQR]: 868, 6052, p = 0.014), and lower at discharge (1380 ng/ml, IQR: 611, 3193, p < 0.001) compared to community children (2268 ng/ml, IQR: 1051, 5421), while calprotectin was similar at admission (215 ug/ml, IQR: 77, 746, p = 0.351), but lower at discharge (170 ug/ml, IQR: 68, 369, p = 0.007) when compared the community children (252 ug/ml, IQR: 124, 691). alpha-1-antitrypsin concentrations were lower at admission (121 mg/l, IQR: 49, 303, p = 0.049) compared to the community (201 mg/ml, IQR: 100, 412), but more comparable at discharge (144 mg/ml, IQR: 69, 275, p = 0.380). Admission myeloperoxidase and calprotectin concentrations were associated with invasive enteropathogens detection (respectively, p = 0.003 and p = 0.002) and lower MUAC (respectively, p = 0.002 and p = 0.012), while admission alpha-1-antitrypsin was associated with breastfeeding, diarrhea, malaria and pneumonia (all p < 0.05). The only ED biomarker associated with mortality after confounder adjustment was fecal calprotectin (hazard ratio: 1.36, 95% CI:1.07,1.72, p = 0.011) at discharge. Enteric inflammation biomarker concentrations and enteropathogen prevalence were high at hospital admission, but by discharge were lower than among community peers. Interventions to prevent re-colonization with enteropathogens and increased enteric inflammation may improve child health in the post discharge period.