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©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
Pathogens causing diarrhoea among Bangladeshi children with malignancy: Results from two pilot studies
Sabina Karim, Ferdousi Begum, Afiqul Islam, Monowar Ahmad Tarafdar, Mamtaz Begum, Md Johirul Islam, Bushra Malik, Md Shamim Ahsan, Ameneh Khatami, Harunor Rashid
Sabina Karim, Ferdousi Begum, Mamtaz Begum, Department of Paediatric Haematology and Oncology, National Institute of Cancer Research and Hospital, Mohakhali, Dhaka 1212, Bangladesh
Afiqul Islam, Department of Pediatric Hematology and Oncology, Bangabandhu Sheikh Mujib Medical University, Dhaka 1212, Bangladesh
Monowar Ahmad Tarafdar, Department of Community Medicine, Z. H. Sikder Women’s Medical College, Dhaka 1212, Bangladesh
Md Johirul Islam, Department of Cancer Epidemiology, National Institute of Cancer Research and Hospital, Mohakhali, Dhaka 1212, Bangladesh
Bushra Malik, Harunor Rashid, National Centre for Immunisation Research and Surveillance, The Children’s Hospital at Westmead, Westmead, NSW 2145, Australia
Md Shamim Ahsan, Medical Services, Rangpur Cantonment, Rangpur 5400, Bangladesh
Ameneh Khatami, Department of Infectious Diseases and Microbiology, The Children’s Hospital at Westmead, NSW 2145, Australia
Ameneh Khatami, Harunor Rashid, Discipline of Child and Adolescent Health, Faculty of Medicine and Health, University of Sydney, NSW 2145, Australia
Author contributions: Karim S, Begum F, Begum M, and Islam A contributed to the study conception and design; Karim S, Begum F, Tarafdar MA, Islam MJ, and Ahsan MS contributed to data acquisition, collation, and curation; Rashid H, Malik B, and Khatami A contributed to the data analysis and interpretation; All authors contributed to the drafting, editing, reviewing, and final approval of the article. Karim S and Begum F have made equal contributions to the manuscript.
Institutional review board statement: This study was reviewed and approved by the Institutional Review Board of Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh (Study 1 Ref: BSMMU/2012/11867, Study 2 Ref: BSMMU/ 2016/4711).
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrolment.
Conflict-of-interest statement: There are no conflicts of interest to disclose in relation to this manuscript.
Data sharing statement: No additional data are available. These data, in part, were presented at the 46th Congress of the International Society of Paediatric Oncology Toronto, Canada on 22nd–25th October, 2014, and at the 50th Congress of the International Society of Paediatric Oncology Kyoto, Japan on November 16-19, 2018.
STROBE statement: The guidelines of the STROBE Statement have been adopted.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Harunor Rashid, MD, Associate Professor, Senior Researcher, National Centre for Immunisation Research and Surveillance, Kids Research at The Children’s Hospital at Westmead, Cnr Hawkesbury Road and Hainsworth Street, Locked Bag 4001, Westmead, NSW 2145, Australia.
harunor.rashid@health.nsw.gov.au
Received: August 28, 2019
Peer-review started: August 28, 2019
First decision: November 19, 2019
Revised: November 27, 2019
Accepted: December 13, 2019
Article in press: December 13, 2019
Published online: January 26, 2020
Processing time: 141 Days and 18.4 Hours
BACKGROUND
Diarrhoea is a frequent symptom in children with cancer, and occurs due to a composite effect of underlying disease and immunosuppression consequent to therapy, malnutrition, and non-infective aetiologies such as mucositis. In a large proportion of cases, the aetiology of diarrhoea remains unknown but is often attributed to multiple pathogens including parasites.
AIM
To identify and describe the pathogens causing diarrhoea in Bangladeshi children with cancer.
METHODS
Two cross-sectional pilot studies were conducted involving paediatric oncology patients with diarrhoea. Stool samples were collected from children who were hospitalised with or without being treated with chemotherapy during the study period, and had diarrhoea at any stage during their admission. In the first study, stool samples were tested by conventional microbiological methods and by polymerase chain reaction for parasites, and by immunoassays for Clostridium difficile. In the second study, conventional microbiology was conducted for bacteria and parasites including an enzyme-linked immunosorbent assay for Cryptosporidium antigen, and in a subset, immunoassays for Clostridium
difficile.
RESULTS
In the first study Giardia lamblia was detected in 68.5% of samples, Entamoeba histolytica in 13%, Cryptosporidium in 5.6%, non-toxigenic C. difficile in 22.4%, and other bacteria in 5.2%. In the second study, E. histolytica was detected in 10% of samples, Cryptosporidium in 4.3%, G. lamblia in 1.4%, C. difficile in 5.1%, and other bacteria in 5.7% of samples.
CONCLUSION
These pilot data suggest that parasites are important aetiologies of diarrhoea in Bangladeshi children with malignancy. While molecular diagnostic tools detect an array of stool pathogens with greater sensitivity, conventional diagnostic methods are also useful.
Core tip: In these two pilot studies, pathogens responsible for causing diarrhoea in Bangladeshi children with cancer were explored. In both studies, there were an abundance of parasites including Giardia lamblia, Entamoeba histolytica, and Cryptosporidium, as well as some bacteria, notably non-toxigenic Clostridium difficile.
