Symptomatic and Asymptomatic Campylobacter Infections Associated with Reduced Growth in Peruvian Children

Abstract

Although diarrheal illnesses are recognized as both a cause and effect of undernutrition, evidence for the effect of specific enteropathogens on early childhood growth remains limited. We estimated the effects of undernutrition as a risk factor for campylobacteriosis, as well as associations between symptomatic and asymptomatic Campylobacter infections and growth. Using data from a prospective cohort of 442 children aged 0–72 months, the effect of nutritional status on the incidence of Campylobacter infection was estimated using uni- and multivariate Poisson models. Multivariate regression models were developed to evaluate the effect of Campylobacter infection on weight gain and linear growth. Overall, 8.3% of diarrheal episodes were associated with Campylobacter (crude incidence rate = 0.37 episodes/year) and 4.9% of quarterly asymptomatic samples were Campylobacter positive. In univariate models, the incidence of Campylobacter infection was marginally higher in stunted than non-stunted children (IRR 1.270, 95% CI (0.960, 1.681)(p = 0.095). When recent diarrheal burdens were included in the analysis, there was no difference in risk between stunted and unstunted children. Asymptomatic and symptomatic Campylobacter infections were associated with reduced weight gain over a three-month period (65.5 g (95% CI: −128.0, −3.0)(p = 0.040) and 43.9 g (95% CI:−87.6, −1.0)(p = 0.049) less weight gain, respectively). Symptomatic Campylobacter infections were only marginally associated with reduced linear growth over a nine month period (−0.059 cm per episode, 95% CI: −0.118, 0.001)(p = 0.054), however relatively severe episodes were associated with reduced linear growth (−0.169 cm/episode, 95% CI −0.310, −0.028)(p = 0.019). Our findings suggest that Campylobacter is not as benign as commonly assumed, and that there is evidence to support expanding the indications for antibiotic therapy in campylobacteriosis in children. Campylobacter is a common cause of diarrheal disease among children at risk for growth failure in the developing world. We evaluated risk factors for Campylobacter infection as well as the association between symptomatic and asymptomatic Campylobacter infections and child growth over three and nine-month periods. Undernourished (stunted) children were more likely to experience a Campylobacter infection, but adjusting for a recent history of diarrheal disease attenuated this relationship. Both symptomatic and asymptomatic infections were associated with poorer weight gain and symptomatic Campylobacter infections were marginally associated with poorer linear growth on an order similar to what has been reported for other bacterial pathogens and less than what has been reported for some protozoal and parasitic infections. In a subset of severe infections that made up about twenty percent of total illnesses, the associations were poorer growth were of greater magnitude. Campylobacter infections are frequently viewed as benign, but our study suggests that this is not always the case. Rapid diagnostics for Campylobacter jejuni and coli could attenuate acquired linear growth deficits in populations where campylobacteriosis is highly endemic by facilitating improved case management.