Numbers of gene clusters significantly associated with clinical outcome.

<p>^a Type A indicates the number of gene clusters for which there were significantly (P<0.05, McNemar's exact test) more discordant pairs in which the gene cluster was present in the strain from the child with LI and absent from the child with NSI or AI, type B is the reverse.</p><p>^b Comparisons of strains from a subgroup of LI and NSI or LI and NI subjects limited to pairs that were closely matched as defined in the text and Supporting Information.</p><p>^c Some gene clusters were identified as discordant between LI and NSI and between LI and AI only in subgroups but not among all strains.</p><p>Numbers of gene clusters significantly associated with clinical outcome.</p

Flow diagram depicting deposition of strains for this study.

<p>For each available tEPEC strain from a LI, the closest matching strain from a NSI in a child of the same gender from the same location and from an AI in a child of the same gender from the same location were selected. When no matching tEPEC strain was available, an aEPEC strain with the same constraints was chosen. The same NSI strain served as the control for two LI strains and the same AI strain served as a control for two different LI strains.</p

Clinical, environmental, and behavioral characteristics associated with <i>Cryptosporidium</i> infection among children with moderate-to-severe diarrhea in rural western Kenya, 2008–2012: The Global Enteric Multicenter Study (GEMS)

<div><p>Background</p><p><i>Cryptosporidium</i> is a leading cause of moderate-to-severe diarrhea (MSD) in young children in Africa. We examined factors associated with <i>Cryptosporidium</i> infection in MSD cases enrolled at the rural western Kenya Global Enteric Multicenter Study (GEMS) site from 2008-2012.</p><p>Methodology/Principal findings</p><p>At health facility enrollment, stool samples were tested for enteric pathogens and data on clinical, environmental, and behavioral characteristics collected. Each child’s health status was recorded at 60-day follow-up. Data were analyzed using logistic regression. Of the 1,778 children with MSD enrolled as cases in the GEMS-Kenya case-control study, 11% had <i>Cryptosporidium</i> detected in stool by enzyme immunoassay; in a genotyped subset, 81% were <i>C</i>. <i>hominis</i>. Among MSD cases, being an infant, having mucus in stool, and having prolonged/persistent duration diarrhea were associated with being <i>Cryptosporidium-</i>positive. Both boiling drinking water and using rainwater as the main drinking water source were protective factors for being <i>Cryptosporidium-</i>positive. At follow-up, <i>Cryptosporidium</i>-positive cases had increased odds of being stunted (adjusted odds ratio [aOR] = 1.65, 95% CI: 1.06–2.57), underweight (aOR = 2.08, 95% CI: 1.34–3.22), or wasted (aOR = 2.04, 95% CI: 1.21–3.43), and had significantly larger negative changes in height- and weight-for-age z-scores from enrollment.</p><p>Conclusions/Significance</p><p><i>Cryptosporidium</i> contributes significantly to diarrheal illness in young children in western Kenya. Advances in point of care detection, prevention/control approaches, effective water treatment technologies, and clinical management options for children with cryptosporidiosis are needed.</p></div

Water, sanitation, and hygiene characteristics of GEMS-Kenya cases (N = 1,778) by <i>Cryptosporidium</i> status, western Kenya, 2008–2012.

<p>Water, sanitation, and hygiene characteristics of GEMS-Kenya cases (N = 1,778) by <i>Cryptosporidium</i> status, western Kenya, 2008–2012.</p

GEMS-Kenya cases (N = 1,778) with <i>Cryptosporidium</i> status and follow-up status/anthropometric measurements, western Kenya, 2008–2012.

<p>GEMS-Kenya cases (N = 1,778) with <i>Cryptosporidium</i> status and follow-up status/anthropometric measurements, western Kenya, 2008–2012.</p

Bivariate analysis of baseline characteristics of children with rotavirus-positive and rotavirus negative non-dysenteric MSD (n = 1637), western Kenya, 2008–2012.

<p>Bivariate analysis of baseline characteristics of children with rotavirus-positive and rotavirus negative non-dysenteric MSD (n = 1637), western Kenya, 2008–2012.</p

The seasonal distribution of rotavirus-positive compared with negative cases among children with non-dysenteric moderate-to-severe diarrhea (MSD) in western Kenya, January, 2008- February, 2011.

<p>The seasonal distribution of rotavirus-positive compared with negative cases among children with non-dysenteric moderate-to-severe diarrhea (MSD) in western Kenya, January, 2008- February, 2011.</p

Anthropometric indicators of malnutrition for GEMS-Kenya cases (N = 1,778), by <i>Cryptosporidium</i> status, western Kenya, 2008–2012.

<p>Anthropometric indicators of malnutrition for GEMS-Kenya cases (N = 1,778), by <i>Cryptosporidium</i> status, western Kenya, 2008–2012.</p