{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,6]],"date-time":"2026-06-06T19:15:09Z","timestamp":1780773309784,"version":"3.54.1"},"reference-count":56,"publisher":"American Society of Tropical Medicine and Hygiene","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2010,10,5]]},"abstract":"<jats:p>Diarrhea is a major public health problem that affects the development of children. Anthropometric data were collected from 274 children with (<jats:italic>N<\/jats:italic> = 170) and without (<jats:italic>N<\/jats:italic> = 104) diarrhea. Stool specimens were analyzed by conventional culture, polymerase chain reaction for enteroaggregative <jats:italic>Escherichia coli<\/jats:italic> (EAEC), <jats:italic>Shigella<\/jats:italic>, <jats:italic>Cryptosporidium<\/jats:italic>, <jats:italic>Entamoeba<\/jats:italic>, and <jats:italic>Giardia<\/jats:italic> species, and by enzyme-linked immunosorbent assay for fecal lactoferrin levels. About 50% of the study population was mildly to severely malnourished. Fecal lactoferrin levels were higher in children with diarrhea (<jats:italic>P<\/jats:italic> = 0.019). Children who had EAEC infection, with or without diarrhea, had high mean lactoferrin levels regardless of nutritional status. The EAEC and <jats:italic>Cryptosporidium<\/jats:italic> were associated with diarrhea (<jats:italic>P<\/jats:italic> = 0.048 and 0.011, respectively), and malnourished children who had diarrhea were often co-infected with both <jats:italic>Cryptosporidium<\/jats:italic> and EAEC. In conclusion, the use of DNA-biomarkers revealed that EAEC and <jats:italic>Cryptosporidium<\/jats:italic> were common intestinal pathogens in Accra, and that elevated lactoferrin was associated with diarrhea in this group of children.<\/jats:p>","DOI":"10.4269\/ajtmh.2010.09-0792","type":"journal-article","created":{"date-parts":[[2010,10,1]],"date-time":"2010-10-01T17:15:08Z","timestamp":1285953308000},"page":"936-943","source":"Crossref","is-referenced-by-count":82,"title":["Pediatric Diarrhea in Southern Ghana: Etiology and Association with Intestinal Inflammation and Malnutrition"],"prefix":"10.4269","volume":"83","author":[{"given":"Japheth A.","family":"Opintan","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mercy J.","family":"Newman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick F.","family":"Ayeh-Kumi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raymond","family":"Affrim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rosina","family":"Gepi-Attee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jesus E. 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published between 1992 and 2000","volume":"81","author":"Kosek","year":"2003"},{"key":"R3","series-title":"Bull World Health Organ","first-page":"705","article-title":"The magnitude of the global problem of diarrhoeal disease: a ten-year update","volume":"70","author":"Bern","year":"1992"},{"key":"R4","series-title":"J Trop Pediatr","first-page":"271","article-title":"Impact of a standardized management protocol on mortality of children with diarrhoea: an update of risk factors for childhood death","volume":"50","author":"Durley","year":"2004"},{"key":"R5","series-title":"J Infect Dis","first-page":"1643","article-title":"Persistent diarrhea signals a critical period of increased diarrhea burdens and nutritional shortfalls: a prospective cohort study among children in northeastern Brazil","volume":"181","author":"Lima","year":"2000"},{"key":"R6","series-title":"Nutr Rev","first-page":"487","article-title":"Malnutrition as an enteric infectious disease with long-term effects on child development","volume":"66","author":"Guerrant","year":"2008"},{"key":"R7","series-title":"ChildInfo: Monitoring the Situation of Children and Women","author":"UNICEF, Ghana","year":"2009"},{"key":"R8","series-title":"Ghana Med J","first-page":"101","article-title":"Malnutrition: missed opportunities for diagnosis","volume":"42","author":"Antwi","year":"2008"},{"key":"R9","series-title":"Curr Opin Pediatr","first-page":"590","article-title":"Prevalence of malnutrition in pediatric hospital patients","volume":"20","author":"Joosten","year":"2008"},{"key":"R10","series-title":"Diagn Microbiol Infect Dis","first-page":"1","article-title":"Detection of Escherichia coli, Salmonella spp., Shigella spp., Yersinia enterocolitica, Vibrio cholerae, and Campylobacter spp. enteropathogens by 3-reaction multiplex polymerase chain reaction","volume":"63","author":"Gomez-Duarte","year":"2009"},{"key":"R11","series-title":"Clin Infect Dis","first-page":"1706","article-title":"Enteroaggregative Escherichia coli as a major etiologic agent in traveler's diarrhea in 3 regions of the world","volume":"32","author":"Adachi","year":"2001"},{"key":"R12","series-title":"Curr Gastroenterol Rep","first-page":"473","article-title":"Travelers' diarrhea: an update on susceptibility, prevention, and treatment","volume":"10","author":"Cabada","year":"2008"},{"key":"R13","series-title":"FEMS Microbiol Lett","first-page":"319","article-title":"The significance of enteroaggregative Escherichia coli in the etiology of hospitalized diarrhoea in Calcutta, India and the demonstration of a new honey-combed pattern of aggregative adherence","volume":"117","author":"Paul","year":"1994"},{"key":"R14","series-title":"J Med Microbiol","first-page":"1141","article-title":"Enteroaggregative Escherichia coli associated with a foodborne outbreak of gastroenteritis","volume":"57","author":"Scavia","year":"2008"},{"key":"R15","series-title":"Am J Trop Med Hyg","first-page":"142","article-title":"Enteroaggregative Escherichia coli in Venda, South Africa: distribution of virulence-related genes by multiplex polymerase chain reaction in stool samples of human immunodeficiency virus (HIV)-positive and HIV-negative individuals and primary school children","volume":"77","author":"Samie","year":"2007"},{"key":"R16","series-title":"Pediatr Infect Dis J","first-page":"829","article-title":"Patterns of adherence of diarrheagenic Escherichia coli to HEp-2 cells","volume":"6","author":"Nataro","year":"1987"},{"key":"R17","series-title":"J Clin Microbiol","first-page":"4525","article-title":"Etiology of acute diarrhea in adults in southwestern Nigeria","volume":"41","author":"Okeke","year":"2003"},{"key":"R18","series-title":"N Engl J Med","first-page":"1565","article-title":"Amebiasis","volume":"348","author":"Haque","year":"2003"},{"key":"R19","series-title":"Lancet Infect Dis","first-page":"262","article-title":"Cryptosporidiosis: an update","volume":"1","author":"Kosek","year":"2001"},{"key":"R20","series-title":"Clin Infect Dis","first-page":"545","article-title":"Giardia: overview and update","volume":"25","author":"Ortega","year":"1997"},{"key":"R21","series-title":"J Clin Microbiol","first-page":"2138","article-title":"Multiplex PCR for detection of three plasmid-borne genes of enteroaggregative Escherichia coli strains","volume":"41","author":"Cerna","year":"2003"},{"key":"R22","series-title":"Infect Immun","first-page":"2692","article-title":"Phylogenetic analysis of enteroaggregative and diffusely adherent Escherichia coli","volume":"67","author":"Czeczulin","year":"1999"},{"key":"R23","series-title":"J Infect Dis","first-page":"458","article-title":"Detection of Shigellae and enteroinvasive Escherichia coli by amplification of the invasion plasmid antigen H DNA sequence in patients with dysentery","volume":"167","author":"Sethabutr","year":"1993"},{"key":"R24","series-title":"Cryptosporidium","year":"2009"},{"key":"R25","series-title":"Am J Trop Med Hyg","first-page":"713","article-title":"Multiplex real-time PCR assay for detection of Entamoeba histolytica, Giardia intestinalis, and Cryptosporidium spp","volume":"76","author":"Haque","year":"2007"},{"key":"R26","series-title":"Appl Environ Microbiol","first-page":"5178","article-title":"Real-time PCR for quantification of Giardia and Cryptosporidium in environmental water samples and sewage","volume":"69","author":"Guy","year":"2003"},{"key":"R27","series-title":"Am J Gastroenterol","first-page":"1309","article-title":"Fecal lactoferrin is a sensitive and specific marker in identifying intestinal inflammation","volume":"98","author":"Kane","year":"2003"},{"key":"R28","series-title":"Am J Clin Nutr","first-page":"1012","article-title":"Growth patterns of breast-fed infants in affluent (United States) and poor (Peru) communities: implications for timing of complementary feeding","volume":"56","author":"Dewey","year":"1992"},{"key":"R29","series-title":"Ann Trop Paediatr","first-page":"157","article-title":"Exclusive breast feeding versus supplementation: a prospective study in a rural south Indian community","volume":"3","author":"Sathian","year":"1983"},{"key":"R30","series-title":"World hunger\u2014Ghana","author":"World Food Programme WFP","year":"2006"},{"key":"R31","series-title":"Trans R Soc Trop Med Hyg","first-page":"504","article-title":"Carriage of diarrhoeagenic Escherichia coli by older children and adults in Accra, Ghana","volume":"104","author":"Opintan","year":"2010"},{"key":"R32","series-title":"Ghana Med J","first-page":"4","article-title":"Distribution of serogroups and serotypes of multiple drug resistant Shigella isolates","volume":"41","author":"Opintan","year":"2007"},{"key":"R33","series-title":"Lancet","first-page":"735","article-title":"Cryptosporidiosis in diarrhoeal children in Kumasi, Ghana","volume":"1","author":"Addy","year":"1986"},{"key":"R34","series-title":"Jpn J Infect Dis","first-page":"216","article-title":"Cryptosporidium spp., a frequent cause of diarrhea among children at the Korle-Bu Teaching Hospital, Accra, Ghana","volume":"57","author":"Adjei","year":"2004"},{"key":"R35","series-title":"J Clin Microbiol","first-page":"1109","article-title":"Cryptosporidium spp., a frequent cause of diarrhea in Liberian children","volume":"23","author":"Hojlyng","year":"1986"},{"key":"R36","series-title":"Am J Trop Med Hyg","first-page":"322","article-title":"Cryptosporidium parvum in children with diarrhea in Mexico","volume":"51","author":"Miller","year":"1994"},{"key":"R37","series-title":"Ann Trop Paediatr","first-page":"313","article-title":"Seven years' experience with Cryptosporidium parvum in Guinea-Bissau, West Africa","volume":"21","author":"Perch","year":"2001"},{"key":"R38","series-title":"Exp Parasitol","first-page":"80","article-title":"Entamoeba histolytica: genetic diversity of clinical isolates from Bangladesh as demonstrated by polymorphisms in the serine-rich gene","volume":"99","author":"Ayeh-Kumi","year":"2001"},{"key":"R39","series-title":"Trop Med Int Health","first-page":"1153","article-title":"Short communication: prevalence of Entamoeba histolytica and Entamoeba dispar in northern Ghana","volume":"8","author":"Verweij","year":"2003"},{"key":"R40","series-title":"East Afr Med J","first-page":"353","article-title":"Prevalence of pathogenic Escherichia coli and parasites in infants with diarrhoea in Kumasi, Ghana","volume":"81","author":"Addy","year":"2004"},{"key":"R41","series-title":"Diagn Microbiol Infect Dis","first-page":"81","article-title":"The dispersin-encoding gene (aap) is not restricted to enteroaggregative Escherichia coli","volume":"65","author":"Monteiro","year":"2009"},{"key":"R42","series-title":"Mol Microbiol","first-page":"1267","article-title":"Proteomic and microarray characterization of the AggR regulon identifies a pheU pathogenicity island in enteroaggregative Escherichia coli","volume":"61","author":"Dudley","year":"2006"},{"key":"R43","series-title":"Am J Trop Med Hyg","first-page":"506","article-title":"Association of virulence factor-positive and -negative enteroaggregative Escherichia coli and occurrence of clinical illness in travelers from the United States to Mexico","volume":"69","author":"Huang","year":"2003"},{"key":"R44","series-title":"Curr Opin Gastroenterol","first-page":"4","article-title":"Enteroaggregative Escherichia coli pathogenesis","volume":"21","author":"Nataro","year":"2005"},{"key":"R45","series-title":"Infect Immun","first-page":"1247","article-title":"The Escherichia coli efflux pump TolC promotes aggregation of enteroaggregative E. coli 042","volume":"76","author":"Imuta","year":"2008"},{"key":"R46","series-title":"J Clin 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