Enteroaggregative E. coli Subclinical Infection and co-Infections and Impaired Child Growth in the MAL-ED Cohort Study

OBJECTIVE:We evaluated the impact of subclinical enteroaggregative Escherichia coli (EAEC) infection alone and in combination with other pathogens in the first six months of life on child growth. METHODS:Non-diarrheal samples from 1,684 children across eight Multisite Birth Cohort Study, Malnutrition and Enteric Diseases (MAL-ED) sites in Asia, Africa, and Latin America were tested monthly; over 90% of children were followed-up twice weekly for the first six months of life. RESULTS:Children with subclinical EAEC infection did not show altered growth between enrollment and six months. Conversely, EAEC co-infection with any other pathogen was negatively associated with delta weight-for-length (WLZ) (p 0.05) z-scores between 0 and 6 months. The presence of two or more pathogens without EAEC was not significantly associated with delta WLZ and WAZ. The most frequent EAEC co-infections included Campylobacter spp. heat-labile toxin-producing enterotoxigenic E. coli, Cryptosporidium spp., and atypical enteropathogenic E. coli. Myeloperoxidase levels were increased with EAEC co-infection (p