The epidemiology and impact of persistent Campylobacter infections on childhood growth among children 0-24 months of age in resource-limited settings

Authors: SCHIAFFINO, FRANCESCA - Universidad Peruana; COLSTON, JOSH - University Of Virginia; PAREDES-OLORTEGUI, MARIBEL - Prisma Charitable Association; PEÑATARO-YORI, PABLO - University Of Virginia; MOURKAS, EVANGELOS - Oxford University; PASCOE, BEN - Oxford University; LIMA, ALDO - Universidade Federal Do Ceara (UFC); MASON, CARL - Armed Forces Research Institute Of Medical Sciences; AHMED, TAHMEED - International Centre For Diarrhoeal Disease Research; KANG, GAGANDEEP - Christian Medical College Vellore; MDUMA, ESTOMIH - Haydom Lutheran Hospital; SAMIE, AMIDOU - University Of Venda; ZAIDI, ANITA - Aga Khan University; LIU, JIE - Qingdao University; COOPER, KERRY - University Of Arizona; HOUPT, ERIC - University Of Virginia; Parker, Craig; LEE, GWENYTH - Rutgers University; KOSEK, MARGARET - University Of Virginia

Submitted to: eClinicalMedicine
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 8/9/2024
Publication Date: 9/28/2024
Citation: Schiaffino, F., Colston, J.M., Paredes-Olortegui, M., Peñataro-Yori, P., Mourkas, E., Pascoe, B., Lima, A.A., Mason, C.J., Ahmed, T., Kang, G., Mduma, E., Samie, A., Zaidi, A., Liu, J., Cooper, K.K., Houpt, E.R., Parker, C.T., Lee, G.O., Kosek, M.N. 2024. The epidemiology and impact of persistent Campylobacter infections on childhood growth among children 0-24 months of age in resource-limited settings. eClinicalMedicine. 76. Article 102841. https://doi.org/10.1016/j.eclinm.2024.102841.
DOI: https://doi.org/10.1016/j.eclinm.2024.102841

Interpretive Summary: Campylobacter is a leading cause of bacterial gastroenteritis worldwide. It is generally associated with an acute gastrointestinal infection causing a short diarrheal episode before being cleared. However, there is evidence that persistent carriage of Campylobacter also occurs in infants of hyperendemic settings. In these contexts, the epidemiology and consequences of persistent Campylobacter enteric infections remains poorly studied. In this study, we used data from multiplex PCR diagnostics across an eight-site cohort study to characterize the risk factors for and growth consequences of persistent Campylobacter infections in children 0-24 months of age in 8 resource-limited sites in Asia, Africa and South America. Across all study sites, 36.9% (781/2116) of children experienced at least one persistent Campylobacter episode. The average cumulative duration of days in which children with persistent Campylobacter were positive for Campylobacter spp. was 150 days. Children who experienced a persistent Campylobacter episode had an attained 24-month length for age Z score that was 0.20 less than children who did not experience a Campylobacter persistent episode. Among children who had at least one episode of Campylobacter over a 3-month or 9-month window, persistent episodes were associated with poorer 3-month weight gain and poorer 9-month linear growth compared to children with an episode that resolved within 31 days. Persistent Campylobacter infection is common among children and has a measurable negative impact on child growth. Thus, clinical guidelines should consider retesting for Campylobacter after treatment in settings where it is feasible to do so.

Technical Abstract: Campylobacter is a leading cause of bacterial gastroenteritis worldwide. It is generally associated with an acute gastrointestinal infection causing a self-limiting diarrheal episode. However, there is evidence that persistent carriage of Campylobacter also occurs in pediatric populations of hyperendemic settings. In these contexts, the epidemiology and consequences of persistent Campylobacter enteric infections remains poorly studied. This study used data from multiplex PCR diagnostics across an eight-site cohort study to characterize the risk factors for and growth consequences of persistent Campylobacter infections in children 0-24 months of age. Across all study sites, 36.9% (781/2116) of children experienced at least one persistent Campylobacter episode. The average cumulative duration of days in which children with persistent Campylobacter were positive for Campylobacter spp. was 150 days (median 114 days, IQR: 28-236 days). Children who experienced a persistent Campylobacter episode had an attained 24-month LAZ score that was 0.20 (95% CI: -0.29, -0.10) less than children who did not experience a Campylobacter persistent episode. Among children who had at least one episode of Campylobacter over a 3-month or 9-month window, persistent episodes were associated with poorer 3-month weight gain (-29.1g, 95% CI: -61.1g, 3.0g) and poorer 9-month linear growth (-0.091cm 95% CI: -0.256, -0.043) compared to children with an episode that resolved within 31 days. Persistent Campylobacter infection is common among children and has a measurable negative impact on child growth. Clinical guidelines should consider retesting after treatment in settings where it is feasible to do so.