Death By Diarrhoea: Four Pathogens To Watch Out For

Diarrhoeal mortality is decreasing by about 4 per cent per year, although the disease remains unacceptably rife, resulting in about 800,000 child fatalities worldwide annually. New research has found that the majority of cases are caused by just four pathogen types — Rotavirus, Cryptosporidium, ETEC and Shigella.

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Researchers from the University of Maryland School of Medicine in the US enrolled 9439 children with moderate-to-severe diarrhoea (MSD) and 13,129 control children without diarrhoea, with a focus on patients from developing countries who are less than five years old.

The researchers found that most attributable cases of MSD across all sites were due to four pathogens: rotavirus, Cryptosporidium, enterotoxigenic Escherichia coli (ETEC) producing heat-stable toxin (ST), and Shigella. Globally, these pathogens cause the deaths of one in ten children due to diarrhoeal illness each year.

ST-ETEC and typical enteropathogenic E coli were associated with increased risk of death in infants aged 0–11 months while Cryptosporidium increased risk of death in toddlers aged 12–23 months.

Rotavirus, meanwhile, dominated during the first two years of life, with an incidence of moderate-to-severe diarrhoea during infancy that was more than double that of any other pathogen.

"Our findings suggest that moderate-to-severe diarrhoea might contribute to the causal pathway to death, probably influenced by its associated nutritional derangement," the paper stated.

The researchers conclude that concentrating preventive strategies on these four pathogens could potentially reduce the disease and its sequelae by as much as 40 per cent during the first two years of life:

Targeting these pathogens with existing interventions, such as the rotavirus vaccine, as well as developing new therapies and treating the malnutrition that follows MSD, could have a large impact on the mortality and morbidity caused by this debilitating condition.

Severe diarrhoea can be contracted in a number of ways, including the consumption of contaminated food or water, person-to-person contact with someone who is already infected, touching contaminated surfaces and "living rough" while travelling in foreign countries. Swimming in water with insufficient sanitation is another obvious no-no.

While there's no fool-proof way to avoid getting MSD, you can minimise the risk by washing your hands rigorously multiple times a day (preferably with liquid soap) and avoiding finger contact with your mouth, nose or eyes after your hands have come into contact with a shared surface. Infants, meanwhile, should get plenty of breast milk, which has been known to be protective against the disease.

If you get a severe case of diarrhoea, medical professionals recommend ingesting plenty of fluids to prevent dehydration, oral rehydration drinks to replace lost salts and minerals and anti-diarrhoeal medications (but only if suggested by your doctor).

See also: Brace Yourselves: Winter Flu Is Coming!

Burden and aetiology of diarrhoeal disease in infants and young children in developing countries (the Global Enteric Multicenter Study, GEMS): a prospective, case-control study [The Lancet]


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