{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T20:04:32Z","timestamp":1780085072694,"version":"3.54.0"},"reference-count":50,"publisher":"American Society of Tropical Medicine and Hygiene","issue":"1","license":[{"start":{"date-parts":[[2025,7,2]],"date-time":"2025-07-02T00:00:00Z","timestamp":1751414400000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,7,2]]},"abstract":"<jats:title>ABSTRACT.<\/jats:title>\n<jats:p>Enterotoxigenic <jats:italic>Escherichia<\/jats:italic> (<jats:italic>E.<\/jats:italic>) <jats:italic>coli<\/jats:italic> (ETEC) and enteropathogenic <jats:italic>E. coli<\/jats:italic> (EPEC) are major bacterial causes of childhood diarrhea. We explored the clinico-epidemiological characteristics of children aged &lt;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 <jats:italic>t<\/jats:italic>-test was used to investigate the impact of infection on nutritional status. Children aged 12\u201323 months were more affected by ETEC-positive MSD compared with 0\u201311 months, whereas children aged 0\u201311 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 <jats:italic>Campylobacter<\/jats:italic> in the analyzed stool sample had higher likelihood to be associated with symptomatic MSD (adjusted odds ratio [aOR] 1.42, 95% CI 1.17\u20131.71) and asymptomatic children with ETEC infection (aOR 1.42, 95% CI 1.16\u20131.73) and asymptomatic EPEC infection (aOR 1.22, 95% CI 1.04\u20131.43). Significant growth faltering was noted in MSD children with ETEC (mean difference 0.22, 95% CI 0.10\u20130.34) and EPEC (mean difference 0.15, 95% CI 0.03\u20130.27) from baseline to \u223c60 days (50\u201390 days). Our findings highlight the need to implement preventative strategies to reduce the risk of diarrheal illnesses.<\/jats:p>","DOI":"10.4269\/ajtmh.24-0347","type":"journal-article","created":{"date-parts":[[2025,5,13]],"date-time":"2025-05-13T14:45:39Z","timestamp":1747147539000},"page":"120-133","source":"Crossref","is-referenced-by-count":1,"title":["Clinico-Epidemiological Characteristics of Symptomatic and Asymptomatic Enterotoxigenic and Enteropathogenic Escherichia Coli Diarrhea and Impact on Child Growth"],"prefix":"10.4269","volume":"113","author":[{"given":"Al-Afroza","family":"Sultana","sequence":"first","affiliation":[{"name":"Nutrition Research Division, International Centre for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rina","family":"Das","sequence":"additional","affiliation":[{"name":"Nutrition Research Division, International Centre for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh;"},{"name":"Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Md Nasif","family":"Hossain","sequence":"additional","affiliation":[{"name":"Environmental Institute, University of Virginia, Charlottesville, Virginia;"},{"name":"Division of Infectious Diseases and International Health, University of Virginia School of Medicine, Charlottesville, Virginia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rukaeya","family":"Amin Sobi","sequence":"additional","affiliation":[{"name":"Nutrition Research Division, International Centre for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Farina","family":"Naz","sequence":"additional","affiliation":[{"name":"Nutrition Research Division, International Centre for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Soroar Hossain","family":"Khan","sequence":"additional","affiliation":[{"name":"Nutrition Research Division, International Centre for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sabiha","family":"Nasrin","sequence":"additional","affiliation":[{"name":"Nutrition Research Division, International Centre for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh;"},{"name":"Department of Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts, Amherst, Massachusetts;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sharika","family":"Nuzhat","sequence":"additional","affiliation":[{"name":"Nutrition Research Division, International Centre for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammod Jobayer","family":"Chisti","sequence":"additional","affiliation":[{"name":"Nutrition Research Division, International Centre for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pradip K.","family":"Bardhan","sequence":"additional","affiliation":[{"name":"Nutrition Research Division, International Centre for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Protim","family":"Sarker","sequence":"additional","affiliation":[{"name":"Nutrition Research Division, International Centre for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tahmeed","family":"Ahmed","sequence":"additional","affiliation":[{"name":"Nutrition Research Division, International Centre for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh;"},{"name":"James P. Grant School of Public Health, BRAC University, Dhaka, Bangladesh;"},{"name":"Department of Global Health, University of Washington, Seattle, Washington;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Subhra","family":"Chakraborty","sequence":"additional","affiliation":[{"name":"Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"ASG","family":"Faruque","sequence":"additional","affiliation":[{"name":"Nutrition Research Division, International Centre for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2795","reference":[{"key":"b1","series-title":"PLoS One","first-page":"e29151","article-title":"Estimating diarrhea mortality among young children in low- and middle-income 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