Immune response of Bangladeshi children with acute diarrhea who subsequently have persistent diarrhea

Background: Because altered immune responses may be a risk factor for persi stent diarrhea, various aspects of the immune response were examined to elu cidate the underlying immune mechanisms that may be involved in the develop ment of persistent diarrhea. Methods: Children (7-12 months of age) with watery diarrhea for 6 to 8 days from the Dhaka Hospital of the International Centre for Diarrheal Disease Research, Bangladesh (ICDDR,B), were enrolled. Children were classified as having acute diarrhea (AD) or persistent diarrhea (PD) if diarrhea resolved within 14 days or persisted for more than 14 days, respectively. Uninfecte d control children (n = 13), from the Nutrition Follow-Up Unit of ICDDR,B w ere also enrolled. Of the 123 children with diarrhea who were enrolled, 85 had AD and 38 had PD. Comparisons were performed for clinical features, nut ritional status (weight for age, plasma transferrin, and serum albumin leve ls), and immune responses: neutrophil function; peripheral blood mononuclea r cell function, delayed-type hypersensitivity (DTH) responses, plasma leve ls of immunoglobulins, tumor necrosis factor-alpha, and interferon-gamma. U nivariate analyses were conducted to assess differences among the three gro ups of children and between children with AD and PD. Logistic regression wa s performed to determine risk factors for FD. Results: There were no differences in clinical features and nutritional sta tus among the groups of children studied, More children in whom PD develope d had a negative DTH response to tuberculin than those with AD (P = 0.021). Also, a negative DTH response to tuberculin was a significant risk factor for PD (odds ratio [OR] = 3.8, 95% confidence interval [CI] = 1.5-9.9). Conclusions: Children with acute diarrhea with a negative DTH response to t uberculin are more likely to have development of persistent diarrhea.