Persistent diarrhea: a persistent infection with enteropathogens or a gut commensal dysbiosis?

Summary In children from developing countries 5–10% of acute diarrhea (AD) episodes develop into persistent diarrhea (PD) defined by > 14 days of diarrhea duration. PD represents a major health burden leading to growth faltering. It is also associated with half of all diarrhea mortality. A ration...

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Bibliographic Details
Published in:Environmental microbiology 2017-10, Vol.19 (10), p.3789-3801
Main Authors: Sarker, Shafiqul A., Ahmed, Tahmeed, Brüssow, Harald
Format: Article
Language:English
Subjects:
Anti-Bacterial Agents - adverse effects
Anti-Bacterial Agents - therapeutic use
Antibiotics
Asia
Child
Children
Developing countries
Diarrhea
Diarrhea - drug therapy
Diarrhea - microbiology
Diarrhea - pathology
Duration
Dysbacteriosis
Dysbiosis - microbiology
E coli
Empirical analysis
Enteropathogenic Escherichia coli - pathogenicity
Epidemiology
Escherichia coli Infections - drug therapy
Escherichia coli Infections - microbiology
Gastrointestinal Microbiome - drug effects
Humans
Identification
Intestinal flora
Intestinal microflora
Lactose
LDCs
Pathogenesis
Persistent infection
Polysaccharides
Surveys
Symbiosis
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Summary:Summary In children from developing countries 5–10% of acute diarrhea (AD) episodes develop into persistent diarrhea (PD) defined by > 14 days of diarrhea duration. PD represents a major health burden leading to growth faltering. It is also associated with half of all diarrhea mortality. A rational intervention is thus crucial, but depends on an understanding of the pathogenesis of PD, which is still lacking. Many surveys were conducted in Latin America and in South Asia; they differ, however, with respect to enteropathogens associated with PD. Enteroaggregative strains of Escherichia coli (EAEC) were identified by several studies, but they may reflect selection by the frequent antibiotic use during the preceding AD episode. Epidemiologists have in fact identified antibiotic misuse as a major risk factor for PD. Together with the effectiveness of empirical treatment based on nutritional interventions with lactose‐reduced and lactose‐free diets and particularly complex plant polysaccharides from green banana, one might suspect a role of commensal gut microbiota dysbiosis instead of a persistent infection with enteropathogens in many PD cases. An analysis of the commensal gut microbiota development in persistent diarrhea during nutritional interventions is likely to increase our understanding of PD pathogenesis.
ISSN:1462-2912
1462-2920
DOI:10.1111/1462-2920.13873