Table 2.
Clinical Presentation of Attributable Cryptosporidium Moderate-to-Severe Diarrhea Cases Compared With All Other Watery Diarrhea
|
Cryptosporidium-Attributed MSD (n = 465) |
All Watery MSDa (n = 3680) |
P | |
|---|---|---|---|
| Demographic features | |||
| Age, median (IQR), months | 12 (9, 20) | 15 (9, 25) | <0.001* |
| ȃSex, n (%) | |||
| Female | 204 (43.9%) | 1724 (46.8%) | 0.245 |
| ȃȃMale | 261 (56.1%) | 1956 (53.2%) | |
| Findings at enrollment | |||
| ȃNo. of median (IQR)diarrhea days prior to SHC visit | 3 (2–4) | 3 (2–3) | <0.001* |
| ȃMental status, n (%) | |||
| ȃȃNormal | 355 (76.3%) | 2608 (70.9%) | 0.048* |
| ȃȃRestless/irritable | 96 (20.6%) | 936 (25.4%) | |
| ȃȃLethargic/unconscious | 14 (3%) | 136 (3.7%) | |
| ȃFever (temperature >38°C or parental perception), n (%) | 284 (61.1%) | 2068 (56.2%) | 0.048* |
| ȃVomiting, n (%) | 267 (57.4%) | 1722 (46.8%) | <0.001* |
| ȃSunken eyes, more than normal, n (%) | 449 (96.6%) | 3580 (97.3%) | 0.458 |
| ȃOral mucosa, n (%) | |||
| ȃȃNormal | 92 (19.8%) | 734 (19.9%) | 0.996 |
| ȃȃSomewhat dry | 351 (75.5%) | 2774 (75.4%) | |
| ȃȃVery dry | 22 (4.7%) | 172 (4.7%) | |
| ȃSkin pinch, n (%) | |||
| ȃȃNormal | 319 (68.6%) | 2542 (69.1%) | .551 |
| ȃȃSlow return | 141 (30.3%) | 1114 (30.3%) | |
| ȃȃVery slow return | 5 (1.1%) | 24 (0.7%) | |
| ȃWHO-defined dehydration, n (%) | |||
| ȃȃNone | 33 (7.1%) | 175 (4.8%) | 0.013* |
| ȃȃSome | 380 (81.7%) | 2955 (80.3%) | |
| ȃȃSevere | 52 (11.2%) | 550 (14.9%) | ȃ |
| ȃModified Vesikari score, n (%) | ȃ | ȃ | ȃ |
| ȃȃMild | 109 (23.4%) | 1205 (32.8%) | <.001* |
| ȃȃModerate | 179 (38.5%) | 1479 (40.2%) | ȃ |
| ȃȃSevere | 177 (38.1%) | 992 (27.0%) | ȃ |
| ȃȃMedian (IQR) | 9 (7, 11) | 8 (6,11) | <.001* |
| ȃStunted, n (%) | ȃ | ȃ | ȃ |
| ȃȃHAZ ≥ –2 | 357 (76.8%) | 2867 (77.9%) | 0.621 |
| ȃȃHAZ < –2 | 108 (23.2%) | 813 (22.1%) | ȃ |
| ȃUndernourished (wasted/very thin), n (%) | 109 (23.4%) | 541 (14.7%) | <0.001* |
| ȃSevere acute malnutrition, n (%) | ȃ | ȃ | |
| ȃMUAC ≥115 mm | 429 (92.3%) | 3581 (97.3%) | <.001* |
| ȃMUAC <115 mm | 36 (7.7%) | 99 (2.7%) | ȃ |
| ȃAbnormal hair (sparse, loose, straight), n (%) | 26 (5.6%) | 111 (3%) | .005* |
| ȃ“Flaky paint” appearance of the skin, n (%) | 5 (1.1%) | 20 (0.5%) | .191 |
| ȃRequired rehydration, n (%) | ȃ | ȃ | ȃ |
| ȃȃNo | 8 (1.7%) | 3 (0.1%) | <0.001* |
| ȃȃYes, oral alone | 403 (86.7%) | 3396 (92.3%) | ȃ |
| ȃȃYes, oral and IV | 54 (11.6%) | 281 (7.6%) | ȃ |
| ȃAdmitted to the hospital, n (%) | 33 (7.1%) | 182 (5.0%) | 0.064 |
| Findings at follow-up | n = 445 (95.7%) | n = 3538 (96.1%) | ȃ |
| ȃTotal no. of days with diarrhea | 6 (4–9) | 5 (3–8) | <.001* |
| ȃDiarrhea duration stratum, n (%) | ȃ | ȃ | ȃ |
| ȃȃAcute (1–6 days) | 253 (56.9%) | 2380 (67.3%) | <.001* |
| ȃȃProlonged (7–13 days) | 137 (30.8%) | 835 (23.6%) | ȃ |
| ȃȃPersistent (≥14 days) | 55 (12.4%) | 323 (9.1%) | ȃ |
| ȃChange in HAZ | −0.29 (−0.52, 0.00) | −0.17 (−0.42, 0.03) | <0.001* |
| ȃUndernourished (wasted/very thin), n (%) | 6 (1.3%) | 234 (6.6%) | 0.337 |
| ȃMUAC <115 mm, n (%) | 4 (0.9%) | 26 (0.7%) | 0.320 |
| ȃStunted, n (%) | ȃ | ȃ | ȃ |
| ȃȃHAZ ≥ –2 | 332 (71.4%) | 2749 (74.7%) | 0.128 |
| ȃȃHAZ < –2 | 133 (28.6%) | 931 (25.3%) | ȃ |
| ȃDied, n (%) | 6 (1.3%) | 26 (0.7%) | 0.162 |
Statistically significant. Abbreviations: HAZ, height-for-age z score; IQR, interquartile range; IV, intravenous, MSD, moderate-to-severe diarrhea; MUAC, mid-upper arm circumference; PCR, polymerase chain reaction; SHC, sentinel health center; WHO, World Health Organization.
Episodes with positive PCR for Cryptosporidium that did not meet criteria for attributed were excluded from this analysis.