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- Title
Shigella and childhood stunting: Evidence, gaps, and future research directions.
- Authors
Bagamian, Karoun H.; Anderson IV, John D.; Blohm, Gabriela; Scheele, Suzanne
- Abstract
Early childhood growth deficits have been shown to have lifelong health and economic impacts, yet their connection to one of their underlying causes, diarrheal diseases, has remained difficult to characterize. Identifying the processes and mechanisms that underlie this link has remained a challenge due to the complexity of the relationship and limitations in access to more advanced laboratory methods. In recent years, however, several large-scale, multisite studies have extensively investigated and reported the prevalence, etiology, and impacts of diarrheal diseases in children under 5 years (CU5) in low- to middle-income countries (LMICs). These studies, in combination with several single-site studies, have applied more advanced laboratory methods to uncover the etiology, true prevalence, infection mechanisms, and inflammation biomarkers of diarrheal disease. Of the multiple pathogens that have been shown to be strongly associated with diarrheal disease in CU5, Shigella is one of the more prevalent and impactful of these pathogens. In this narrative review, we highlight key insights from these studies and identify knowledge gaps and directions for future research. According to these studies, Shigella is most commonly detected in toddlers and young children; however, it can cause more severe disease and has a greater impact on linear growth for infants. Shigella often has a stronger relationship to linear growth faltering (LGF) than other enteropathogens, with higher Shigella loads resulting in greater growth deficits. Future studies should employ more Shigella-specific molecular assays and identify diarrheal etiologies using standardized diagnostics to improve child anthropometric and Shigella surveillance. Also, they should focus on uncovering the mechanisms of the relationship underlying Shigella and growth faltering to better characterize the role of asymptomatic infections and intestinal inflammation in this relationship. Author summary: For decades, research has shown that growth deficits in early childhood can have long-term impacts on human health and economic potential. Shigella spp are a group of bacterial pathogens that commonly cause diarrhea in children under 5 years of age. Early studies suggest that infection with Shigella can reduce childhood growth, but the biological and developmental processes underlying this link remain uncharacterized. Since the early 2000s, there has been a global effort to investigate the prevalence, geographic distribution, and impacts of diarrheal infectious agents on early childhood growth. With the introduction of advanced molecular laboratory methods and the completion of several international collaborative studies, these efforts have yielded important insights. The studies have identified that, of these agents, Shigella spp often have a stronger relationship to early childhood growth than other pathogens. Our review distills the evidence for this relationship to identify key discoveries, knowledge gaps, and future research avenues. According to these studies, Shigella often has a stronger relationship to early childhood growth than other pathogens, and most children from high-risk populations have been infected with Shigella by age 5. The severity of the illness is greater in infants, though Shigella incidence is highest in toddlers and in children closer to 5 years old. Asymptomatic cases of Shigella can also give rise to stunting, highlighting the need to refine existing tools for clinical and laboratory surveillance. Shigella is also linked to intestinal inflammation indicators, warranting further research on how this biological pathway may influence growth. Addressing these research gaps may help better characterize the Shigella–child growth connection, thus enabling the potential reduction of early childhood growth deficits linked to Shigella infection.
- Subjects
SHIGELLOSIS; SHIGELLA; EVIDENCE gaps; INFANT growth; STUNTED growth; INTESTINAL infections
- Publication
PLoS Neglected Tropical Diseases, 2023, Vol 18, Issue 9, p1
- ISSN
1935-2727
- Publication type
Article
- DOI
10.1371/journal.pntd.0011475