Diarrheal Diseases: A Review on Gastroenteritis Bacteria Global Burden and Alternative Control of Multidrug-Resistant Strains

Diarrheal diseases represent a significant and pervasive health challenge for humanity. The aetiology of diarrheal diseases is typically associated with the presence of enteropathogens, including viruses, bacteria and parasites. The implementation of preventive measures, including the maintenance of good food hygiene, effective water sanitation, and the development of rotavirus vaccines, has resulted in a notable reduction in the prevalence of the disease. However, the emergence of bacterial multidrug resistance due to the past or present inappropriate use of antibiotics has rendered bacterial infections a significant challenge. The objective of this review is threefold: firstly, to provide an overview of diarrheal diseases associated with bacteria;secondly, to offer a concise analysis of bacterial multidrug resistance on a global scale;and thirdly, to present the potential of filamentous fungi as an alternative solution to the challenge posed by multidrug-resistant strains. Campylobacter spp. is the most dangerous bacteria, followed by Shigella spp. and Vibrio cholerae in all age groups combined. However, Shigella spp. was the deadliest in children under five years of age and, together with E. coli, are the most antibiotic-resistant bacteria. With their highly developed secondary metabolism, fungi are a reservoir of natural bioactive compounds.

Accessibility to Safe Drinking Water and Diarrheal Diseases: A Quasi-Experiment on a Case of Water Well Drilling in the Village of Kassouala, Municipality of Tchaourou, Benin, January 2018-July 2019

Background: In 2017, 900 million people in the world did not have sustainable access to safe drinking water (SDW). In addition, between 2016 and 2020, the global population with safely managed drinking water at home increased from 70 percent to 74 percent. Drinking water insecurity is the daily situation of people in developing countries. The lack of SDW supply is at the root of many diseases, including diarrheal diseases. Kassouala is a village in the municipality of Tchaourou without access to SDW, but having benefited from the drilling of a well in September 2018. The objective of this study was to study the effect of access to safe drinking water on the frequency of diarrheal diseases in Kassouala between January 2018 and July 2019. Methods: We conducted a quasi-experimental study in Kassouala using the natural experiments of the village of Bérétou as a control group for estimating the effect of a causal nature. There were double temporal (January 2018-July 2019) and geographical (Kassouala-Bérétou) comparisons based on data collected from health care registers. A population-based comparability survey of the two villages was conducted among 170 households in each village (experimental village, control village). A two-stage cluster sampling procedure was used to select the survey participants. Data were collected from heads of household by semi-structured questionnaire. We used Pearson or Mantel-Haenszel chi-square tests, as appropriate, and the “difference-in-difference” method to assess the effect. Results: In Kassouala, the proportion of households with access to safe drinking water had increased to 78.88%, whereas it was nil in 2018 before the well drilling, and the frequency of diarrheal diseases decreased significantly from January 2018 before drilling to July 2019 after drilling (57.11% to 44.64%;p Conclusion: Access to safe drinking water in Kassouala has a causal effect on the reduction of diarrheal diseases. However, for the supply of drinking water to be integrated into the community development plan of Tchaourou, it is necessary to support the scaling up of this intervention, which would be considered as a pilot, of a community participation program.

Water sanitation and hygiene in Sub-Saharan Africa:Coverage, risks of diarrheal diseases, and urbanization

Sub-Saharan Africa(SSA)has a rapidly growing urban population,with water,sanitation,and hygiene(WASH)services representing the central needs for this population.Incidentally,this region has the lowest global WASH coverage.Data from the‘WHO/UNICEF Joint Monitoring Programme for Water supply,Sanitation and Hygiene’and the‘Global Burden of Disease’study from the Institute for Health Metrics and Evaluation were used to assess WASH coverage and related health burden in SSA,its subregions,and rural and urban areas in SSA.WASH coverage in the SSA region appears to be low,but urban coverage is better than that in rural areas;however,there is unequal access to urban WASH and poor urban areas are underserved.In addition,7.75%(5.99–9.7%)of total deaths due to diarrheal diseases across SSA are attributed to unsafe WASH with a risk factor attribution(RFA)percentage of 95.93%(91.94–98.24%).Therefore,a correlation between WASH coverage and mortality due to diarrheal diseases could be established.There is a lack of data on WASH coverage in poor urban areas,although these areas have high incidence of WASH-related diseases including diarrhea.Disaggregated urban WASH data are needed to better understand the WASH service needs of poor urban areas,which would be helpful in ensuring a more inclusive implementation of WASH services.

Epidemiological Surveillance: Genetic Diversity of Rotavirus Group A in the Pearl River Delta, Guangdong, China in 2019

Objective This study aimed to understand the epidemic status and phylogenetic relationships of rotavirus group A(RVA)in the Pearl River Delta region of Guangdong Province,China.Methods This study included individuals aged 28 days–85 years.A total of 706 stool samples from patients with acute gastroenteritis collected between January 2019 and January 2020 were analyzed for 17 causative pathogens,including RVA,using a Gastrointestinal Pathogen Panel,followed by genotyping,virus isolation,and complete sequencing to assess the genetic diversity of RVA.Results The overall RVA infection rate was 14.59%(103/706),with an irregular epidemiological pattern.The proportion of co-infection with RVA and other pathogens was 39.81%(41/103).Acute gastroenteritis is highly prevalent in young children aged 0–1 year,and RVA is the key pathogen circulating in patients 6–10 months of age with diarrhea.G9P[8](58.25%,60/103)was found to be the predominant genotype in the RVA strains,and the 41 RVA-positive strains that were successfully sequenced belonged to three different RVA genotypes in the phylogenetic analysis.Recombination analysis showed that gene reassortment events,selection pressure,codon usage bias,gene polymorphism,and post-translational modifications(PTMs)occurred in the G9P[8]and G3P[8]strains.Conclusion This study provides molecular evidence of RVA prevalence in the Pearl River Delta region of China,further enriching the existing information on its genetics and evolutionary characteristics and suggesting the emergence of genetic diversity.Strengthening the surveillance of genotypic changes and gene reassortment in RVA strains is essential for further research and a better understanding of strain variations for further vaccine development.

Postnatal Total Serum Protein Concentration Influences the Health and Growth Parameters of Preweaned Female Holstein Friesian Calves

This study focuses on the effect of the total serum protein(TSP)concentrations at 3 days after birth on the health and growth parameters of preweaned female Holstein Friesian calves.A total of 165 female calves were enrolled and evaluated for morbidity which included diarrhea(D),respiratory disease(Rd)and omphalitis(O).Also,calves with more than one disorder in the same time were recorded as multi-morbid.Body weight(BW)was determined at birth,30 and 60 days of age.Blood samples were taken at 3 days after birth and TSP was determined using a digital Brix refractometer.For statistical analysis all female calves based on TSP concentration were grouped into 3 categories:1-TSP≥6.2 g/dL,2-TSP 5.8-6.1 g/dL,and 3-TSP<5.8 g/dL.Overall,the average of TSP concentration was 6.38 g/dL.The prevalence of diarrhea,respiratory disease(Rd)and omphalitis(O)was 16.96%,7.88%and 4.85%respectively,in calves with one disorder and 6.06%in calves with D+Rd,3.64%in calves with Rd+O,3.03%in calves with O+D,and 3.64%in calves with D+Rd+O.As the TSP concentration in calves decreased from≥6.2 g/dL to<5.8 g/dL the calf hood disorders increased in female calves with one disorder and with more than one disorder.The female calves with fair to poor immunity(category 3-TSP<5.8 g/dL)were significantly more likely(OR 6.28,95%CI 2.91-13.5,p value<0.001)to be affected by diseases compared with female calves with excellent immunity(category 1-TSP≥6.2 g/dL).Also BW and average daily gain(ADG)at 30 and 62 days of life decreased as TSP concentrations decreased.The female calves with TSP≥6.2 g/dL at 3 days of life had the greatest BW at 30 and 62 days of age(51.8 kg and 77.1 kg respectively)compared with female calves with TSP<5.8 g/dL at 3 days of life(46.6 and 70.6 kg respectively).Moreover,starter feed intake during the first 30 days of life,31 to 62 days of life and 1 to 62 days of life was greater in female calves with excellent immunity(TSP≥6.2 g/dL)than female calves with good immunity(TSP 5.8-6.1 g/dL)or with fair to poor immunity(<5.8 g/dL TSP).Measuring the TSP at 3 days of calf’s This study focuses on the effect of the total serum protein(TSP)concentrations at 3 days after birth on the health and growth parameters of preweaned female Holstein Friesian calves.A total of 165 female calves were enrolled and evaluated for morbidity which included diarrhea(D),respiratory disease(Rd)and omphalitis(O).Also,calves with more than one disorder in the same time were recorded as multi-morbid.Body weight(BW)was determined at birth,30 and 60 days of age.Blood samples were taken at 3 days after birth and TSP was determined using a digital Brix refractometer.For statistical analysis all female calves based on TSP concentration were grouped into 3 categories:1-TSP≥6.2 g/dL,2-TSP 5.8-6.1 g/dL,and 3-TSP<5.8 g/dL.Overall,the average of TSP concentration was 6.38 g/dL.The prevalence of diarrhea,respiratory disease(Rd)and omphalitis(O)was 16.96%,7.88%and 4.85%respectively,in calves with one disorder and 6.06%in calves with D+Rd,3.64%in calves with Rd+O,3.03%in calves with O+D,and 3.64%in calves with D+Rd+O.As the TSP concentration in calves decreased from≥6.2 g/dL to<5.8 g/dL the calf hood disorders increased in female calves with one disorder and with more than one disorder.The female calves with fair to poor immunity(category 3-TSP<5.8 g/dL)were significantly more likely(OR 6.28,95%CI 2.91-13.5,p value<0.001)to be affected by diseases compared with female calves with excellent immunity(category 1-TSP≥6.2 g/dL).Also BW and average daily gain(ADG)at 30 and 62 days of life decreased as TSP concentrations decreased.The female calves with TSP≥6.2 g/dL at 3 days of life had the greatest BW at 30 and 62 days of age(51.8 kg and 77.1 kg respectively)compared with female calves with TSP<5.8 g/dL at 3 days of life(46.6 and 70.6 kg respectively).Moreover,starter feed intake during the first 30 days of life,31 to 62 days of life and 1 to 62 days of life was greater in female calves with excellent immunity(TSP≥6.2 g/dL)than female calves with good immunity(TSP 5.8-6.1 g/dL)or with fair to poor immunity(<5.8 g/dL TSP).Measuring the TSP at 3 days of calf’s life,offers information directly correlated to an individual calf’s immunity status,their likeliness of morbidity,mortality and body development and overall the effectiveness of the colostrum management program in the dairy farm.life,offers information directly correlated to an individual calf’s immunity status,their likeliness of morbidity,mortality and body development and overall the effectiveness of the colostrum management program in the dairy farm.

Global burden of enteric infections related foodborne diseases,1990-2021:findings from the Global Burden of Disease Study 2021

Background Understanding the global burden of enteric infections is crucial for prioritizing control strategies for foodborne and waterborne diseases.This study aimed to assess the global burden of enteric infections in 2021 and identify risk factors from One Health aspects.Methods Leveraging the Global Burden of Disease(GBD)2021 database,the incidence,disability-adjusted life years(DALYs),and deaths of enteric infections and the subtypes were estimated,including diarrheal diseases,typhoid and paratyphoid fever,invasive non-typhoidal Salmonella(iNTS)infections,and other intestinal infectious diseases.The estimates were quantified by absolute number,age-standardized incidence rate(ASIR),age-standardized mortality rate(ASMR)and age-standardized DALY rate with 95%uncertainty intervals(UIs).Thirteen pathogens and three risk factors associated with diarrheal diseases were analyzed.Results In 2021,the global age-standardized DALY rate of enteric infections was 1020.15 per 100,000 popultion(95%UI:822.70-1259.39 per 100,000 population)with an estimated annual percentage change(EAPC)of-4.11%(95%confidence interval:-4.31%to-3.90%)in 1990-2021.A larger burden was observed in regions with lower socio-demographic index(SDI)levels.Diarrheal disease was the most serious subtype with Western Sub-Saharan Africa exhibiting the highest age-standardized DALY rate(2769.81 per 100,000 population,95%UI:1976.80-3674.41 per 100,000 population).Children under 5 and adults over 65 years suffered more from diarrheal diseases with the former experiencing the highest global age-standardized DALY rate(9382.46 per 100,000 population,95%UI:6771.76-13,075.12 per 100,000 population).Rotavirus remained the leading cause of diarrheal diseases despite a cross-year decline in the observed age-standardized DALY rate.Unsafe water,sanitation,and handwashing contributed most to the disease burden.Conclusion The reduced burden of enteric infections suggested the effectiveness of previous control strategies;however,more efforts should be made in vulnerable regions and populations through a One Health approach.

Trends in epidemiological characteristics and etiologies of diarrheal disease in children under five:an ecological study based on Global Burden of Disease study 2021

Background Diarrhea remains a significant health threat to children under five years of age.The study aims to systematically elucidate the global burden of diarrhea in children,providing scientific insights for effective prevention and control strategies.Methods The data from the Global Burden of Disease(GBD)2021 study was analyzed to assess the trends in incidence,prevalence,mortality,and disability-adjusted life years(DALYs)of diarrhea in children under five years across the globe,21 geographical region,and 204 countries and territories,stratified by age group,sex,and socio-demographic index(SDI)levels.The trend of the disease burden for childhood diarrhea from 1990 to 2021 was described and estimated using the average annual percent change(AAPC),and a Bayesian age-period-cohort(BAPC)model was employed to predict the future burden of diarrhea in children.Results From 1990 to 2021,there was a significant decline in the global burden of diarrhea among children under five years of age.The AAPC for incidence(-4092.18,95%confidence interval[CI]:-4224.60 to-3959.76),prevalence(-70.98,95%CI:-72.67 to-69.28),mortality(-6.89,95%CI:-6.95 to-6.83),and DALYs rate(-621.79,95%CI:-627.20 to-616.38)of diarrhea in children all showed a marked downward trend.Diarrheal incidence(r=-0.782,P<0.001),prevalence(r=-0.777,P<0.001),mortality(r=-0.908,P<0.001),and DALYs rate(r=-0.904,P<0.001)were negatively correlated with the SDI.Between 2022 and 2035,the global incidence,prevalence,and mortality rates of diarrhea in children under five years are projected to continue declining.The leading causes of diarrheal mortality in children include wasting,underweight,and non-exclusive breastfeeding.Rotavirus remains the predominant pathogen associated with diarrhea-related mortality rate and DALY rate.Conclusion Although the global burden of diarrhea in children under five has steadily declined,it remains a significant health threat.Rotavirus is the leading pathogen,highlighting the importance of expanding rotavirus vaccination.Additionally,improving nutritional status,increasing exclusive breastfeeding rates,and enhancing access to sanitation and clean drinking water are crucial measures that,when widely implemented,can effectively reduce the health risks posed by diarrhea in children.

Brazilian Indigenous Children as Carriers of Diarrheagenic Escherichia coli Pathotypes

Introduction: Diarrheagenic Escherichia coli (DEC) is a relevant cause of diarrhea, particularly among infants and young children in developing countries. Methodology: We compared the frequency, antimicrobial resistance, adherence, enterovirulence and genetic diversity of DEC isolates from Guarani indigenous population under five living in distinct villages in Brazil. Results: Of the 314 E. coli isolates from 57 children, with and without diarrhea, 15% (48/314) were classified in DEC categories: aEPEC (56%, 27/48), EAEC (35%, 17/48) and ETEC (8%, 4/48). ETEC belonged to plylogroup A, EAEC to groups A, B1, B2 and D, and aEPEC to phylogroups A, B1, and B2. EAEC exhibited the aggregative adherence phenotype while ETEC and aEPEC the aggregative and undefined patterns. Multidrug-resistance was detected in aEPEC, ETEC and EAEC while extensive drug-resistance was found in EAEC and aEPEC. RAPD typing revealed a genetically diverse bacterial population. Conclusion: This is the first report regarding aspects of DEC in an indigenous Brazilian population, showing that Guarani children are DEC carriers and that antimicrobial resistance at high levels is widely disseminated among these enteropathogens.