Epidemiology and clinical profile of diarrhea associated with enterotoxigenic Escherichia coli and Vibrio cholerae in Bangladesh: Findings from a hospital-based surveillance system, 2008–2023
Bibliographic record
Abstract
BACKGROUND: Enterotoxigenic Escherichia coli (ETEC) and Vibrio cholerae are notable enteric bacterial pathogens that cause diarrheal illnesses in resource-limited settings (e.g., Bangladesh). We aimed to explore the epidemiology and the clinical presentation of diarrhea caused by either V. cholerae or ETEC as a single-pathogen, or as a co-infection with both pathogens among patients requiring hospitalization. METHODS: We conducted the study using data from the Diarrheal Diseases Surveillance System of Dhaka Hospital, icddr,b from 2008 to 2023. A multivariable logistic regression model was used to characterize association of identified bacterial pathogens with specific clinical features. RESULTS: Among 43,483 diarrheal patients who received hospital care, 11% (4540/43,483) tested positive for V. cholerae, 8% (3070/43,483) had ETEC, and 1.5% (630/43,483) had co-infection. In 2023, the frequencies of ETEC, V. cholerae, and co-infection with both pathogens among patients were 7.5%, 4.5%, and 7.5%, respectively. After adjusting for covariates, co-infected cases showed significantly higher odds of severe outcomes, including watery stools (aOR: 12.33), high stooling frequency (>10/day, aOR: 1.50), vomiting (aOR: 3.16), and intravenous rehydration (aOR: 8.70) compared to single-pathogen infections. Clinical features among patients infected with single pathogens also varied. V. cholerae-positive cases were associated with dehydration [aOR:5.64;95%CI:(4.94,6.43)] and length of hospital stay [aOR:1.81;95%CI:(1.68,1.94)] relative to V. cholerae-negative cases. ETEC-positive cases were more likely to present with watery stools [aOR:1.26;95%CI:(1.04,1.53)], dehydration [aOR:1.23;95%CI:(1.12,1.35)], and the requirement for intravenous fluid rehydration [aOR:1.15;95%CI:(1.04,1.27)] relative to ETEC-negative cases. Overall, the clinical presentations of patients with ETEC single infection were less severe compared to patients with V. cholerae as a single infection or co-infection. CONCLUSIONS: Co-infection with V. cholerae and ETEC results in more severe clinical manifestations requiring intensive medical management compared to single-pathogen infections. These findings highlight the need for enhanced clinical preparedness and consideration of testing for both pathogens to optimize patient care. Our findings highlight the potential value of vaccines targeting ETEC and V. cholerae to improve protection.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".