# Clinico-Epidemiological Characteristics of Symptomatic and Asymptomatic Enterotoxigenic and Enteropathogenic Escherichia Coli Diarrhea and Impact on Child Growth

## TL;DR

This study examines how ETEC and EPEC infections affect children under 5, comparing symptoms, dehydration, and growth impacts.

## Contribution

The study identifies age-specific risks and growth impacts of ETEC and EPEC infections in children with and without symptoms.

## Key findings

- Children aged 12–23 months were more affected by ETEC-positive MSD than younger children.
- ETEC- and EPEC-positive MSD children showed more dehydration symptoms and required more intravenous rehydration.
- Significant growth faltering was observed in MSD children with ETEC or EPEC infections over 50–90 days.

## Abstract

Enterotoxigenic Escherichia (E.) coli (ETEC) and enteropathogenic E. coli (EPEC) are major bacterial causes of childhood diarrhea. We explored the clinico-epidemiological characteristics of children aged <5 years associated with moderate-to-severe diarrhea (MSD), asymptomatic ETEC or EPEC infections, and subsequent impact on growth reflected by z-score. Data from 9,439 MSD and 13,128 asymptomatic children were extracted from Global Enteric Multicenter Study, conducted between 2007 and 2011. Epidemiological risk factors and clinical characteristics of ETEC and EPEC infection were explored using multivariable logistic regression, and a paired t-test was used to investigate the impact of infection on nutritional status. Children aged 12–23 months were more affected by ETEC-positive MSD compared with 0–11 months, whereas children aged 0–11 months were more vulnerable to EPEC-positive MSD. ETEC- and EPEC-positive MSD children showed more characteristics of clinical dehydration like sunken eyes and loss of skin turgor preservation, and needed more intravenous rehydration than ETEC- and EPEC-negative MSD children. Among the other identified co-pathogen, presence of Campylobacter in the analyzed stool sample had higher likelihood to be associated with symptomatic MSD (adjusted odds ratio [aOR] 1.42, 95% CI 1.17–1.71) and asymptomatic children with ETEC infection (aOR 1.42, 95% CI 1.16–1.73) and asymptomatic EPEC infection (aOR 1.22, 95% CI 1.04–1.43). Significant growth faltering was noted in MSD children with ETEC (mean difference 0.22, 95% CI 0.10–0.34) and EPEC (mean difference 0.15, 95% CI 0.03–0.27) from baseline to ∼60 days (50–90 days). Our findings highlight the need to implement preventative strategies to reduce the risk of diarrheal illnesses.