Browsing by Subject "DIARRHEA"

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  • Siikamäki, Heli; Kivela, Pia; Fotopoulos, Mikael; Kantele, Anu (2017)
    Background: Although infections represent the most common health problem of travellers abroad, data on morbidity and incidences of various infections are scarce. Method: Data on infections of Finnish travellers during 2010-2012 were retrieved from the database of SOS International, an assistance organization covering 95% of Finns requiring aid abroad. The study included 30,086 cases. For incidence calculation, the data were linked to the numbers of Finns visiting these regions during the same period as recorded by the Official Statistics of Finland. Results: The incidence of infections was particularly high in Africa, southern Europe plus the eastern Mediterranean, and Asia plus Oceania. The most frequent diagnoses were acute gastroenteritis (38.0%) and respiratory-tract infections (RTI) (34.5%), followed by infections of the ear (12.6%), skin or subcutaneous tissue (5.1%), urogenital tract (4.2%), eye (3.1%), and systemic febrile infections (2.2%). Vaccinepreventable diseases (VPD) accounted for 0.8% of cases, with varicella as most (49%) and influenza as second-most (27%) common. Conclusions: Incidence of infections was higher in southern than in eastern and western Europe. Gastroenteritis and RTI proved the most frequent diagnoses, whereas systemic febrile infections were uncommon. Despite pre-travel immunizations, VPDs still occurred; pre-travel consultation should cover both varicella and influenza. (C) 2016 Elsevier Ltd. All rights reserved.
  • Kort, Remco; Westerik, Nieke; Serrano, L. Mariela; Douillard, Francois P.; Gottstein, Willi; Mukisa, Ivan M.; Tuijn, Coosje J.; Basten, Lisa; Hafkamp, Bert; Meijer, Wilco C.; Teusink, Bas; de Vos, Willem M.; Reid, Gregor; Sybesma, Wilbert (2015)
    Background: The lactic acid bacterium Lactobacillus rhamnosus GG is the most studied probiotic bacterium with proven health benefits upon oral intake, including the alleviation of diarrhea. The mission of the Yoba for Life foundation is to provide impoverished communities in Africa increased access to Lactobacillus rhamnosus GG under the name Lactobacillus rhamnosus yoba 2012, world's first generic probiotic strain. We have been able to overcome the strain's limitations to grow in food matrices like milk, by formulating a dried starter consortium with Streptococcus thermophilus that enables the propagation of both strains in milk and other food matrices. The affordable seed culture is used by people in resource-poor communities. Results: We used S. thermophilus C106 as an adjuvant culture for the propagation of L. rhamnosus yoba 2012 in a variety of fermented foods up to concentrations, because of its endogenous proteolytic activity, ability to degrade lactose and other synergistic effects. Subsequently, L. rhamnosus could reach final titers of 1E+09 CFU ml(-1), which is sufficient to comply with the recommended daily dose for probiotics. The specific metabolic interactions between the two strains were derived from the full genome sequences of L. rhamnosus GG and S. thermophilus C106. The piliation of the L. rhamnosus yoba 2012, required for epithelial adhesion and inflammatory signaling in the human host, was stable during growth in milk for two rounds of fermentation. Sachets prepared with the two strains, yoba 2012 and C106, retained viability for at least 2 years. Conclusions: A stable dried seed culture has been developed which facilitates local and low-cost production of a wide range of fermented foods that subsequently act as delivery vehicles for beneficial bacteria to communities in east Africa.
  • Kantele, Anu; Laaveri, Tinja; Mero, Sointu; Vilkman, Katri; Pakkanen, Sari H.; Ollgren, Jukka; Antikainen, Jenni; Kirveskari, Juha (2015)
    Background. More than 300 million travelers visit regions with poor hygiene annually. A significant percentage of them become colonized by resistant intestinal bacteria such as extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-PE) and may transmit the strains to others and to medical care settings when they return home. Despite the threats to global healthcare caused by an upsurge in antimicrobial resistance, no effort has been centered on prevention of colonization while traveling. Methods. Stool samples were collected from 430 Finns before and after traveling outside Scandinavia. All specimens were analyzed for ESBL-and carbapenemase-producing Enterobacteriaceae (CPE). Questionnaires were used to survey volunteers about use of antimicrobials as well as other potential risk factors. The results were subjected to multivariable analysis. Results. Twenty-one percent (90/430) of the travelers became colonized by ESBL-PE and none by CPE. Geographic region, occurrence of travelers' diarrhea (TD), age, and use of antimicrobial (AB) for TD were identified as independent risk factors predisposing to contracting ESBL-PE. Eleven percent of those in subgroup TD-AB-, 21% in TD+AB-, and 37% in TD+AB+ acquired ESBL-PE. The risk proved to be highest in South Asia (46%); 23% became colonized in subgroup TD-AB-, 47% in TD+AB-, and 80% in TD+AB+. In Southeast Asia, the rates were 14%, 37%, and 69%, respectively. Conclusions. TDand antimicrobials for TD proved to be independent risk factors, with up to 80% of TD+AB+ travelers contracting ESBL-PE. Inmodernpre-travel counseling for those visiting high-risk regions, travelers should be advised against taking antibiotics for mild or moderate TD.
  • Ilyas, Maria; Mietzsch, Mario; Kailasan, Shweta; Väisänen, Elina; Luo, Mengxiao; Chipman, Paul; Smith, J. Kennon; Kurian, Justin; Sousa, Duncan; McKenna, Robert; Söderlund-Venermo, Maria; Agbandje-McKenna, Mavis (2018)
    Bufavirus strain 1 (BuV1), a member of the Protoparvovirus genus of the Parvoviridae, was first isolated from fecal samples of children with acute diarrhea in Burkina Faso. Since this initial discovery, BuVs have been isolated in several countries, including Finland, the Netherlands, and Bhutan, in pediatric patients exhibiting similar symptoms. Towards their characterization, the structures of virus-like particles of BuV1, BuV2, and BuV3, the current known genotypes, have been determined by cryo-electron microscopy and image reconstruction to 2.84, 3.79, and 3.25 angstrom, respectively. The BuVs, 65-73% identical in amino acid sequence, conserve the major viral protein, VP2, structure and general capsid surface features of parvoviruses. These include a core -barrel (B-I), -helix A, and large surface loops inserted between these elements in VP2. The capsid contains depressions at the icosahedral 2-fold and around the 5-fold axes, and has three separated protrusions surrounding the 3-fold axes. Structure comparison among the BuVs and to available parvovirus structures revealed capsid surface variations and capsid 3-fold protrusions that depart from the single pinwheel arrangement of the animal protoparvoviruses. These structures provide a platform to begin the molecular characterization of these potentially pathogenic viruses.
  • Agarwal, Arnav; Johnston, Bradley C.; Vemooij, Robin W. M.; Carrasco-Labra, Alonso; Brignardello-Petersen, Romina; Neumann, Ignacio; Akl, Elie A.; Sun, Xin; Briel, Matthias; Busse, Jason W.; Ebrahim, Shanil; Granados, Carlos E.; Iorio, Alfonso; Irfan, Affan; Martinez Garcia, Laura; Mustafa, Reem A.; Ramirez-Morera, Anggie; Selva, Anna; Sola, Ivan; Sanabrai, Andrea J.; Tikkinen, Kari A. O.; Vandviks, Per O.; Zhang, Yuqing; Zazueta, Oscar E.; Zhou, Qi; Schunemann, Holger J.; Guyatt, Gordon H.; Alonso-Coello, Pablo (2017)
    Objectives: Explicit reporting of absolute measures is important to ensure treatment effects are correctly interpreted. We examined the extent to which authors report absolute effects for patient-important outcomes in abstracts of systematic review (SR). Study Design and Setting: We searched OVID MEDLINE and Cochrane Database of Systematic Reviews to identify eligible SRs published in the year 2010. Citations were stratified into Cochrane and non-Cochrane reviews, with repeated random sampling in a 1:1 ratio. Paired reviewers screened articles and recorded abstract characteristics, including reporting of effect measures for the most patient-important outcomes of benefit and harm. Results: We included 96 Cochrane and 94 non-Cochrane reviews. About 117 (77.5%) relative measures were reported in abstracts for outcomes of benefit, whereas only 34 (22.5%) absolute measures were reported. Similarly, for outcomes of harm, 41 (87.2%) relative measures were provided in abstracts, compared with only 6 (12.8%) absolute measures. Eighteen (9.5%) abstracts reported both absolute and relative measures for outcomes of benefit, whereas only two (1.1%) abstracts reported both measures for outcomes of harm. Results were similar between Cochrane and non-Cochrane reviews. Conclusion: SR abstracts seldom report measures of absolute effect. Journal editors should insist that authors report both relative and absolute effects for patient-important outcomes. (C) 2016 Elsevier Inc. All rights reserved.
  • Vitikainen, Krista; Haapamaki, Johanna; Farkkila, Martti; Anttila, Veli-Jukka; Arkkila, Perttu (2018)
    Objective: Characterization of predisposing factors for Clostridium difficile infection recurrence (rCDI) and outcome in inflammatory bowel disease (IBD) patients.Methods: Clinical characteristics of 167 inflammatory bowel disease patients with Clostridium difficile infection (IBD-CDI cohort) treated in Helsinki University Central Hospital were gathered. Medical history of the last three months preceding a toxin positive CDI test was recorded. Parameters, including ribotype of C. difficile, mortality and recurrence were compared with age and gender-matched C. difficile patients (CDI cohort).Results: No difference was found in rCDI between IBD-CDI and CDI cohorts. As compared with IBD subtypes, rCDI was least common among patients with Crohn's disease. The use of immunosuppressant therapy was higher in IBD patients with two or more CDI episodes. C. difficile ribotype 027 increased the rates for rCDI in IBD patients but not in non-IBD-CDI patients. The prevalence of 027 ribotype and mortality rates did not differ significantly among the cohorts. None of the IBD patients underwent colectomy upon CDI.Conclusion: IBD patients are not more susceptible for rCDI than non-IBD patients. Predisposing factors for rCDI among IBD patients are associated with immunosuppressant treatments, colon affecting IBD and CDI caused by ribotype 027. CDI does not worsen the prognosis of IBD patients.
  • Giaretta, Paula R; Rech, Raquel R; Guard, Blake C; Blake, Amanda B; Blick, Anna K; Steiner, Jörg M.; Lidbury, Jonathan A; Cook, Audrey K; Hanifeh, Mohsen; Spillmann, Thomas; Kilpinen, Susanne; Syrjä, Pernilla; Suchodolski, Jan (2018)
    Background Objective Intestinal absorption of bile acids is mediated by the apical sodium-dependent bile acid transporter (ASBT). Fecal bile acid dysmetabolism has been reported in dogs with chronic inflammatory enteropathy (CIE). Characterization of ASBT distribution along the intestinal tract of control dogs and comparison to dogs with CIE. Animals Methods Twenty-four dogs with CIE and 11 control dogs. The ASBT mRNA and protein expression were assessed using RNA in situ hybridization and immunohistochemistry, respectively. The concentrations of fecal bile acids were measured by gas chromatography-mass spectrometry. The fecal microbiota dysbiosis index was assessed with a quantitative polymerase chain reaction panel. Results Conclusions and Clinical Importance In control dogs, ASBT mRNA expression was observed in enterocytes in all analyzed intestinal segments, with highest expression in the ileum. The ASBT protein expression was restricted to enterocytes in the ileum, cecum, and colon. Dogs with CIE had significantly decreased expression of ASBT protein in the ileum (P = .001), which was negatively correlated with histopathological score (rho = -0.40; P-corr = .049). Additionally, dogs with CIE had a significantly increased percentage of primary bile acids in feces compared to controls (P = .04). The fecal dysbiosis index was significantly higher in dogs with CIE than in control dogs (P = .01). These findings indicate that ileal protein expression of ASBT is downregulated in dogs with CIE. This change may be linked to the inflammatory process, intestinal dysbiosis, and fecal bile acid dysmetabolism observed in these patients.
  • Väisänen, Elina; Fu, Yu; Koskenmies, Sari; Fyhrquist, Nanna; Wang, Yilin; Keinonen, Anne; Mäkisalo, Heikki; Väkevä, Liisa; Pitkänen, Sari; Ranki, Annamari; Hedman, Klaus; Söderlund-Venermo, Maria (2019)
  • Pietilä, Jukka-Pekka; Meri, Taru; Siikamäki, Heli; Tyyni, Elisabet; Kerttula, Anne-Marie; Pakarinen, Laura; Jokiranta, T. Sakari; Kantele, Anu (2019)
    Despite the global distribution of the intestinal protozoan Dientamoeba fragilis, its clinical picture remains unclear. This results from underdiagnosis: microscopic screening methods either lack sensitivity (wet preparation) or fail to reveal Dientamoeba (formalin-fixed sample). Aim: In a retrospective study setting, we characterised the clinical picture of dientamoebiasis and compared it with giardiasis. In addition, we evaluated an improved approach to formalin-fixed samples for suitability in Dientamoeba diagnostics. Methods: This study comprised four parts: (i) a descriptive part scrutinising rates of Dientamoeba findings; (ii) a methodological part analysing an approach to detect Dientamoebalike structures in formalin samples; (iii) a clinical part corn paring demographics and symptoms between patients with dientamoebiasis (n = 352) and giardiasis (n = 272), and (iv) a therapeutic part (n = 89 patients) investigating correlation between faecal eradication and clinical improvement. Results: The rate of Dientamoeba findings increased 20-fold after introducing criteria for Dientamoeba-like structures in formalin-fixed samples (88.9% sensitivity and 83.3% specificity). A further increase was seen after implementing faecal PCR. Compared with patients with giardiasis, the symptoms in the Dientamoeba group lasted longer and more often included abdominal pain, cramping, faecal urgency and loose rather than watery stools. Resolved symptoms correlated with successful faecal eradication (p<0.001). Conclusions: Previously underdiagnosed, Dientamoeba has become the most frequently recorded pathogenic enteroparasite in Finland. This presumably results from improved diagnostics with either PCR or detection of Dientamoeba-like structures in formalin-fixed samples, an approach applicable also in resource-poor settings. Symptoms of dientamoebiasis differ slightly from those of giardiasis; patients with distressing symptoms require treatment.
  • Zeller, Mark; Heylen, Elisabeth; Damanka, Susan; Pietsch, Corinna; Donato, Celeste; Tamura, Tsutomu; Kulkarni, Ruta; Arora, Ritu; Cunliffe, Nigel; Maunula, Leena; Potgieter, Christiaan; Tamim, Sana; De Coster, Sarah; Zhirakovskaya, Elena; Bdour, Salwa; O'Shea, Helen; Kirkwood, Carl D.; Seheri, Mapaseka; Nyaga, Martin Monene; Mphahlele, Jeffrey; Chitambar, Shobha D.; Dagan, Ron; Armah, George; Tikunova, Nina; Van Ranst, Marc; Matthijnssens, Jelle (2015)
    The majority of human group A rotaviruses possess the P[8] VP4 genotype. Recently, a genetically distinct subtype of the P[8] genotype, also known as OP354-like P[8] or lineage P[8]-4, emerged in several countries. However, it is unclear for how long the OP354-like P[8] gene has been circulating in humans and how it has spread. In a global collaborative effort 98 (near-) complete OP354-like P[8] VP4 sequences were obtained and used for phylogeographic analysis to determine the viral migration patterns. During the sampling period, 1988-2012, we found that South and East Asia acted as a source from which strains with the OP354-like P[8] gene were seeded to Africa, Europe, and North America. The time to the most recent common ancestor (TMRCA) of all OP354-like P[8] genes was estimated at 1987. However, most OP354-like P[8] strains were found in three main clusters with TMRCAs estimated between 1996 and 2001. The VP7 gene segment of OP354-like P[8] strains showed evidence of frequent reassortment, even in localized epidemics, suggesting that OP354-like P[8] genes behave in a similar manner on the evolutionary level as other P[8] subtypes. The results of this study suggest that OP354-like P[8] strains have been able to disperse globally in a relatively short time period. This, in combination with a relatively large genetic distance to other P[8] subtypes, might result in a lower vaccine effectiveness, underscoring the need for a continued surveillance of OP354-like P[8] strains, especially in countries where rotavirus vaccination programs are in place.
  • Rossen, Noortje G.; MacDonald, John K.; de Vries, Elisabeth M.; D'Haens, Geert R.; de Vos, Willem M.; Zoetendal, Erwin G.; Ponsioen, Cyriel Y. (2015)
    AIM: To study the clinical efficacy and safety of Fecal microbiota transplantation (FMT). We systematically reviewed FMT used as clinical therapy. METHODS: We searched MEDLINE, EMBASE, the Cochrane Library and Conference proceedings from inception to July, 2013. Treatment effect of FMT was calculated as the percentage of patients who achieved clinical improvement per patient category, on an intention-to-treat basis. RESULTS: We included 45 studies; 34 on Clostridium difficile-infection (CDI), 7 on inflammatory bowel disease, 1 on metabolic syndrome, 1 on constipation, 1 on pouchitis and 1 on irritable bowel syndrome (IBS). In CDI 90% resolution of diarrhea in 33 case series (n = 867) was reported, and 94% resolution of diarrhea after repeated FMT in a randomized controlled trial (RCT) (n = 16). In ulcerative colitis (UC) remission rates of 0% to 68% were found (n = 106). In Crohn's disease (CD) (n = 6), no benefit was observed. In IBS, 70% improvement of symptoms was found (n = 13). 100% Reversal of symptoms was observed in constipation (n = 3). In pouchitis, none of the patients (n = 8) achieved remission. One RCT showed significant improvement of insulin sensitivity in metabolic syndrome (n = 10). Serious adverse events were rare. CONCLUSION: FMT is highly effective in CDI, and holds promise in UC. As for CD, chronic constipation, pouchitis and IBS data are too limited to draw conclusions. FMT increases insulin sensitivity in metabolic syndrome.
  • Kantele, Anu; Mero, Sointu; Kirveskari, Juha; Laaveri, Tinja (2017)
    Background: One third of travellers to the poor regions of the (sub) tropics become colonized by extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-PE). Co-resistance to non-betalactam antibiotics complicates the treatment of potential ESBL-PE infections. Methods: We analysed co-resistance to non-beta-lactams among travel-acquired ESBL-PE isolates of 90 visitors to the (sub) tropics with respect to major risk factors of colonization: destination, age, travellers' diarrhoea (TD) and antibiotic (AB) use. Results: Of the ESBL-PE isolates, 53%, 52%, 73%, and 2% proved co-resistant to ciprofloxacin, tobramycin, co-trimoxazole, and nitrofurantoin, respectively. The rates were similar among those with (TD+) or without (TD-) travellers' diarrhoea. Among fluoroquinolone-users vs. AB non-users, the co-resistance rates for ciprofloxacin were 95% versus 37% (p = 0.001), for tobramycin 85% versus 43% (p = 0.005), co-trimoxazole 85% versus 68% (p = 0.146), and nitrofurantoin 5% versus 2% (p = 0.147). In multivariable analysis co-resistance to ciprofloxacin was associated with increasing age, fluoroquinolone use, and tobramycin resistance. Conlusions: While TD predisposes to ESBL-PE non-selectively, antimicrobial use favours strains resistant to drug taken and, simultaneously, any drug with resistance genetically linked to the drug used. Antibiotics taken during travel predispose to ESBL-PE with a high co-resistance rate. (C) 2017 The Author(s). Published by Elsevier Ltd.
  • Sprenger, Norbert; Odenwald, Hannah; Kukkonen, Anna Kaarina; Kuitunen, Mikael; Savilahti, Erkki; Kunz, Clemens (2017)
    Purpose Manifestation of allergic disease depends on genetic predisposition, diet and commensal microbiota. Genetic polymorphism of mothers determines their breast milk glycan composition. One major determinant is the fucosyltransferase 2 (FUT2, secretor gene) that was shown to be linked to commensal microbiota establishment. We studied whether FUT2-dependent breast milk oligosaccharides are associated with allergic disease in breast-fed infants later in life. Methods We analyzed FUT2-dependent oligosaccharides in breast milk samples of mothers (n = 266) from the placebo group of a randomized placebo-controlled trial of prebiotics and probiotics as preventive against allergic disease in infants with high allergy risk (trial registry number: NCT00298337). Using logistic regression models, we studied associations between FUT2-dependent breast milk oligosaccharides and incidence of allergic disease at 2 and 5 years of age. Results At 2 years, but not at 5 years of age, we observed a presumed lower incidence (p <0.1) for IgE-associated eczema manifestation in C-section-born infants who were fed breast milk containing FUT2-dependent oligosaccharides. By logistic regression, we observed a similar relation (p <0.1) between presence of FUT2-dependent breast milk oligosaccharides and IgE-associated disease and IgE-associated eczema in C-section-born infants only. When testing with the levels of breast milk oligosaccharide 2'-fucosyllactose as proxy for FUT2 activity, we observed significant (p <0.05) associations in the C-section-born infants with 'any allergic disease,' IgE-associated disease, eczema and IgE-associated eczema. Conclusion The data indicate that infants born by C-section and having a high hereditary risk for allergies might have a lower risk to manifest IgE-associated eczema at 2 years, but not 5 years of age, when fed breast milk with FUT2-dependent milk oligosaccharides. Further studies with larger cohorts and especially randomized controlled intervention trials are required to build on these preliminary observations.
  • Ran, Li; Wan, Xing; Takala, Timo; Saris, Per (2021)
    The yeastSaccharomyces boulardiiis well known for its probiotic effects such as treating or preventing gastrointestinal diseases. Due to its ability to survive in stomach and intestine,S. boulardiicould be applied as a vehicle for producing and delivering bioactive substances of interest to human gut. In this study, we cloned the genelecCencoding the antilisterial peptide leucocin C from lactic acid bacteriumLeuconostoc carnosuminS. boulardii. The constructedS. boulardiistrain secreted a peptide, which had molecular weight corresponding to leucocin C in SDS-PAGE. The peptide band inhibitedListeria monocytogenesin gel overlay assay. Likewise, concentratedS. boulardiiculture supernatant inhibited the growth ofL. monocytogenes. The growth profile and acid tolerance of the leucocin C secretingS. boulardiiwere similar as those of the strain carrying the empty vector. We further demonstrated that the cells of the leucocin C producingS. boulardiiefficiently killedL. monocytogenes, also without antibiotic selection pressure. These results showed that antilisterial activity could be added to the arsenal of probiotic activities ofS. boulardii, demonstrating its potential as a carrier for therapeutics delivery.
  • Maleta, Kenneth; Fan, Yue-Mei; Luoma, Juho; Ashorn, Ulla; Bendabenda, Jaden; Dewey, Kathryn G.; Hyöty, Heikki; Knip, Mikael; Kortekangas, Emma; Lehto, Kirsi-Maarit; Matchado, Andrew; Nkhoma, Minyanga; Nurminen, Noora; Parkkila, Seppo; Purmonen, Sami; Veijola, Riitta; Oikarinen, Sami; Ashorn, Per (2021)
    Background: Insulin-like growth factor I (IGF-I) is the most important hormonal promoter of linear growth in infants and young children. Objectives: The objectives of this study were to compare plasma IGF-I concentration in a low- compared with a high-income country and characterize biological pathways leading to reduced IGF-I concentration in children in a low-income setting. Methods: We analyzed plasma IGF-I concentration from 716 Malawian and 80 Finnish children at 6-36 mo of age. In the Malawian children, we studied the association between IGF-I concentration and their environmental exposures; nutritional status; systemic and intestinal inflammation; malaria parasitemia and viral, bacterial, and parasitic enteric infections; as well as growth at 18 mo of age. We then conducted a pathway analysis to identify direct and indirect associations between these predictors and IGF-I concentration. Results: The mean IGF-I concentrations were similar in Malawi and Finland among 6-mo-old infants. At age 18 mo. the mean +/- SD concentration was almost double among the Finns compared with the Malawians [24.2 +/- 11.3 compared with 12.5 +/- 7.7 ng/mL., age- and sex-adjusted difference in mean (95% CI): 11.8 (9.9. 13.7) ng/mL; P <0.01]. Among 18-mo-old Malawians, plasma IGF-I concentration was inversely associated with systemic inflammation, malaria parasitemia, and intestinal Shigella. Campylobacter, and enterovirus infection and positively associated with the children's weight-for-length z score (WLZ), female sex, maternal height, mother's education, and dry season. Seasonally, mean plasma IGF-I concentration was highest in June and July and lowest in December and January, coinciding with changes in children's length gain and preceded by similar to 2 mo by the changes in their WLZ. Conclusions: The mean plasma IGF-I concentrations are similar in Malawi and Finland among 6-mo-old infants. Thereafter, mean concentrations rise markedly in Finland but not in Malawi. Systemic inflammation and clinically nonapparent infections are strongly associated with lower plasma IGF-I concentrations in Malawi through direct and indirect pathways.
  • Watson, Victoria E.; Jacob, Megan E.; Bruno-Bárcena, José M.; Amirsultan, Sophia; Stauffer, Stephen H.; Píqueras, Victoria O.; Frias, Rafael; Gookin, Jody L. (2019)
    Typical enteropathogenic E. coli (tEPEC) carries the highest hazard of death in children with diarrhea and atypical EPEC (aEPEC) was recently identified as significantly associated with diarrheal mortality in kittens. In both children and kittens there is a significant association between aEPEC burden and diarrheal disease, however the infection can be found in individuals with and without diarrhea. It remains unclear to what extent, under what conditions, or by what mechanisms aEPEC serves as a primary pathogen in individuals with diarrhea. It seems likely that a combination of host and bacterial factors enable aEPEC to cause disease in some individuals and not in others. The purpose of this study was to determine the impact of aEPEC on intestinal function and diarrhea in kittens following experimentally-induced carriage and the influence of a disrupted intestinal microbiota on disease susceptibility. Results of this study identify aEPEC as a potential pathogen in kittens. In the absence of disruption to the intestinal microbiota, kittens are resistant to clinical signs of aEPEC carriage but demonstrate significant occult changes in intestinal absorption and permeability. Antibiotic-induced disruption of the intestinal microbiota prior to infection increases subsequent intestinal water loss as determined by % fecal wet weight. Enrichment of the intestinal microbiota with a commensal member of the feline mucosa-associated microbiota, Enterococcus hirae, ameliorated the effects of aEPEC experimental infection on intestinal function and water loss. These observations begin to unravel the mechanisms by which aEPEC infection may be able to exploit susceptible hosts.
  • Ringel-Kulka, Tamar; Cheng, Jing; Ringel, Yehuda; Salojarvi, Jarkko; Carroll, Ian; Palva, Airi; de Vos, Willem M.; Satokari, Reetta (2013)
  • Korpela, Katri; Salonen, Anne; Virta, Lauri J.; Kumpu, Minna; Kekkonen, Riina A.; de Vos, Willem M. (2016)
    Antibiotic use is considered among the most severe causes of disturbance to children's developing intestinal microbiota, and frequently causes adverse gastrointestinal effects ranging from mild and transient diarrhoea to life-threatening infections. Probiotics are commonly advocated to help in preventing antibiotic-associated gastrointestinal symptoms. However, it is currently unknown whether probiotics alleviate the antibiotic-associated changes in children's microbiota. Furthermore, it is not known how long-term probiotic consumption influences the developing microbiota of children. We analysed the influence of long-term Lactobacillus rhamnosus GG intake on preschool children's antibiotic use, and antibiotic-associated gastrointestinal complaints in a double blind, randomized placebo-controlled trial with 231 children aged 2-7. In addition, we analysed the effect of L. rhanmosus GG on the intestinal microbiota in a subset of 88 children. The results show that long-term L. rhamnosus GG supplementation has an influence on the composition of the intestinal microbiota in children, causing an increase in the abundance of Prevotella, Lactococcus, and Ruminococcus, and a decrease in Escherichia. The treatment appeared to prevent some of the changes in the microbiota associated with penicillin use, but not those associated with macrolide use. The treatment, however, did reduce the frequency of gastrointestinal complaints after a macrolide course. Finally, the treatment appeared to prevent certain bacterial infections for up to 3 years after the trial, as indicated by reduced antibiotic use.
  • Deshpande, Aniruddha; Miller-Petrie, Molly K.; Lindstedt, Paulina A.; Baumann, Mathew M.; Johnson, Kimberly B.; Blacker, Brigette F.; Abbastabar, Hedayat; Abd-Allah, Foad; Abdelalim, Ahmed; Abdollahpour, Ibrahim; Abegaz, Kedir Hussein; Abejie, Ayenew Negesse; Abreu, Lucas Guimaraes; Abrigo, Michael R. M.; Abualhasan, Ahmed; Accrombessi, Manfred Mario Kokou; Adamu, Abdu A.; Adebayo, Oladimeji M.; Adedeji, Isaac Akinkunmi; Adedoyin, Rufus Adesoji; Adekanmbi, Victor; Adetokunboh, Olatunji O.; Adhikari, Tara Ballav; Afarideh, Mohsen; Agudelo-Botero, Marcela; Ahmadi, Mehdi; Ahmadi, Keivan; Ahmed, Muktar Beshir; Ahmed, Anwar E.; Akalu, Temesgen Yihunie; Akanda, Ali S.; Alahdab, Fares; Al-Aly, Ziyad; Alam, Samiah; Alam, Noore; Alamene, Genet Melak; Alanzi, Turki M.; Albright, James; Albujeer, Ammar; Alcalde-Rabanal, Jacqueline Elizabeth; Alebel, Animut; Alemu, Zewdie Aderaw; Ali, Muhammad; Alijanzadeh, Mehran; Alipour, Vahid; Aljunid, Syed Mohamed; Almasi, Ali; Almasi-Hashiani, Amir; Al-Mekhlafi, Hesham M.; Altirkawi, Khalid A.; Alvis-Guzman, Nelson; Alvis-Zakzuk, Nelson J.; Amini, Saeed; Amit, Arianna Maever L.; Amul, Gianna Gayle Herrera; Andrei, Catalina Liliana; Anjomshoa, Mina; Ansariadi, Ansariadi; Antonio, Carl Abelardo T.; Antony, Benny; Antriyandarti, Ernoiz; Arabloo, Jalal; Aref, Hany Mohamed Amin; Aremu, Olatunde; Armoon, Bahram; Arora, Amit; Aryal, Krishna K.; Arzani, Afsaneh; Asadi-Aliabadi, Mehran; Asmelash, Daniel; Atalay, Hagos Tasew; Athari, Seyyede Masoume; Athari, Seyyed Shamsadin; Atre, Sachin R.; Ausloos, Marcel; Awasthi, Shally; Awoke, Nefsu; Quintanilla, Beatriz Paulina Ayala; Ayano, Getinet; Ayanore, Martin Amogre; Aynalem, Yared Asmare; Azari, Samad; Azman, Andrew S.; Babaee, Ebrahim; Badawi, Alaa; Bagherzadeh, Mojtaba; Bakkannavar, Shankar M.; Balakrishnan, Senthilkumar; Banach, Maciej; Banoub, Joseph Adel Mattar; Barac, Aleksandra; Barboza, Miguel A.; Barnighausen, Till Winfried; Basu, Sanjay; Vo Dinh Bay,; Bayati, Mohsen; Bedi, Neeraj; Beheshti, Mahya; Behzadifar, Meysam; Behzadifar, Masoud; Ramirez, Diana Fernanda Bejarano; Bell, Michelle L.; Bennett, Derrick A.; Benzian, Habib; Berbada, Dessalegn Ajema; Bernstein, Robert S.; Bhat, Anusha Ganapati; Bhattacharyya, Krittika; Bhaumik, Soumyadeep; Bhutta, Zulfiqar A.; Bijani, Ali; Bikbov, Boris; Bin Sayeed, Muhammad Shahdaat; Biswas, Raaj Kishore; Bohlouli, Somayeh; Boufous, Soufiane; Brady, Oliver J.; Briko, Andrey Nikolaevich; Briko, Nikolay Ivanovich; Britton, Gabrielle B.; Brown, Alexandria; Nagaraja, Sharath Burugina; Butt, Zahid A.; Camera, Luis Alberto; Campos-Nonato, Ismael R.; Rincon, Julio Cesar Campuzano; Cano, Jorge; Car, Josip; Cardenas, Rosario; Carvalho, Felix; Castaneda-Orjuela, Carlos A.; Castro, Franz; Cerin, Ester; Chalise, Binaya; Chattu, Vijay Kumar; Chin, Ken Lee; Christopher, Devasahayam J.; Chu, Dinh-Toi; Cormier, Natalie Maria; Costa, Vera Marisa; Cromwell, Elizabeth A.; Dadi, Abel Fekadu Fekadu; Dahiru, Tukur; Dahlawi, Saad M. A.; Dandona, Rakhi; Dandona, Lalit; Dang, Anh Kim; Daoud, Farah; Darwesh, Aso Mohammad; Darwish, Amira Hamed; Daryani, Ahmad; Das, Jai K.; Das Gupta, Rajat; Dash, Aditya Prasad; Davila-Cervantes, Claudio Alberto; Weaver, Nicole Davis; De la Hoz, Fernando Pio; De Neve, Jan-Walter; Demissie, Dereje Bayissa; Demoz, Gebre Teklemariam; Denova-Gutierrez, Edgar; Deribe, Kebede; Desalew, Assefa; Dharmaratne, Samath Dhamminda; Dhillon, Preeti; Dhimal, Meghnath; Dhungana, Govinda Prasad; Diaz, Daniel; Dipeolu, Isaac Oluwafemi; Hoa Thi,; Dolecek, Christiane; Doyle, Kerrie E.; Dubljanin, Eleonora; Duraes, Andre Rodrigues; Edinur, Hisham Atan; Effiong, Andem; Eftekhari, Aziz; El Nahas, Nevine; Zaki, Maysaa El Sayed; El Tantawi, Maha; Elhabashy, Hala Rashad; El-Jaafary, Shaimaa; El-Khatib, Ziad; Elkout, Hajer; Elsharkawy, Aisha; Enany, Shymaa; Endalew, Daniel Adane; Eshrati, Babak; Eskandarieh, Sharareh; Etemadi, Arash; Ezekannagha, Oluchi; Faraon, Emerito Jose A.; Fareed, Mohammad; Faro, Andre; Farzadfar, Farshad; Fasil, Alebachew Fasil; Fazlzadeh, Mehdi; Feigin, Valery L.; Fekadu, Wubalem; Fentahun, Netsanet; Fereshtehnejad, Seyed-Mohammad; Fernandes, Eduarda; Filip, Irina; Fischer, Florian; Flohr, Carsten; Foigt, Nataliya A.; Folayan, Morenike Oluwatoyin; Foroutan, Masoud; Franklin, Richard Charles; Frostad, Joseph Jon; Fukumoto, Takeshi; Gad, Mohamed M.; Garcia, Gregory M.; Gatotoh, Augustine Mwangi; Gayesa, Reta Tsegaye; Gebremedhin, Ketema Bizuwork; Geramo, Yilma Chisha Dea; Gesesew, Hailay Abrha; Gezae, Kebede Embaye; Ghashghaee, Ahmad; Sherbaf, Farzaneh Ghazi; Gill, Tiffany K.; Gill, Paramjit Singh; Ginindza, Themba G.; Girmay, Alem; Gizaw, Zemichael; Goodridge, Amador; Gopalani, Sameer Vali; Goulart, Barbara Niegia Garcia; Goulart, Alessandra C.; Grada, Ayman; Green, Manfred S.; Gubari, Mohammed Ibrahim Mohialdeen; Gugnani, Harish Chander; Guido, Davide; Guimaraes, Rafael Alves; Guo, Yuming; Gupta, Rajeev; Gupta, Rahul; Ha, Giang Hai; Haagsma, Juanita A.; Hafezi-Nejad, Nima; Haile, Dessalegn H.; Haile, Michael Tamene; Hall, Brian J.; Hamidi, Samer; Handiso, Demelash Woldeyohannes; Haririan, Hamidreza; Hariyani, Ninuk; Hasaballah, Ahmed; Hasan, Mehedi; Hasanzadeh, Amir; Hassen, Hamid Yimam; Hayelom, Desta Haftu; Hegazy, Mohamed; Heibati, Behzad; Heidari, Behnam; Hendrie, Delia; Henok, Andualem; Herteliu, Claudiu; Heydarpour, Fatemeh; de Hidru, Hagos Degefa; Hird, Thomas R.; Chi Linh Hoang,; Hollerich, Gillian; Hoogar, Praveen; Hossain, Naznin; Hosseinzadeh, Mehdi; Househ, Mowafa; Hu, Guoqing; Humayun, Ayesha; Hussain, Syed Ather; Hussen, Mamusha Aman A.; Ibitoye, Segun Emmanuel; Ilesanmi, Olayinka Stephen; Ilic, Milena D.; Imani-Nasab, Mohammad Hasan; Iqbal, Usman; Irvani, Seyed Sina Naghibi; Islam, Sheikh Mohammed Shariful; Ivers, Rebecca Q.; Iwu, Chinwe Juliana; Jahanmehr, Nader; Jakovljevic, Mihajlo; Jalali, Amir; Jayatilleke, Achala Upendra; Jenabi, Ensiyeh; Jha, Ravi Prakash; Jha, Vivekanand; Ji, John S.; Jonas, Jost B.; Jozwiak, Jacek Jerzy; Kabir, Ali; Kabir, Zubair; Kanchan, Tanuj; Karch, Andre; Karki, Surendra; Kasaeian, Amir; Kasahun, Gebremicheal Gebreslassie; Kasaye, Habtamu Kebebe; Kassa, Gebrehiwot G.; Kassa, Getachew Mullu; Kayode, Gbenga A.; Kebede, Mihiretu M.; Keiyoro, Peter Njenga; Ketema, Daniel Bekele; Khader, Yousef Saleh; Khafaie, Morteza Abdullatif; Khalid, Nauman; Khalilov, Rovshan; Khan, Ejaz Ahmad; Khan, Junaid; Khan, Nuruzzaman; Khatab, Khaled; Khater, Mona M.; Khater, Amir M.; Khayamzadeh, Maryam; Khazaei, Mohammad; Khosravi, Mohammad Hossein; Khubchandani, Jagdish; Kiadaliri, Ali; Kim, Yun Jin; Kimokoti, Ruth W.; Kisa, Sezer; Kisa, Adnan; Kochhar, Sonali; Kolola, Tufa; Komaki, Hamidreza; Kosen, Soewarta; Koul, Parvaiz A.; Koyanagi, Ai; Krishan, Kewal; Defo, Barthelemy Kuate; Kugbey, Nuworza; Kumar, Pushpendra; Kumar, G. Anil; Kumar, Manasi; Kusuma, Dian; La Vecchia, Carlo; Lacey, Ben; Lal, Aparna; Lal, Dharmesh Kumar; Lam, Hilton; Lami, Faris Hasan; Lansingh, Van Charles; Lasrado, Savita; Lebedev, Georgy; Lee, Paul H.; LeGrand, Kate E.; Leili, Mostafa; Lenjebo, Tsegaye Lolaso; Leshargie, Cheru Tesema; Levine, Aubrey J.; Lewycka, Sonia; Li, Shanshan; Linn, Shai; Liu, Shiwei; Lopez, Jaifred Christian F.; Lopukhov, Platon D.; Abd El Razek, Muhammed Magdy; Prasad, D. R. Mahadeshwara; Mahasha, Phetole Walter; Mahotra, Narayan B.; Majeed, Azeem; Malekzadeh, Reza; Malta, Deborah Carvalho; Mamun, Abdullah A.; Manafi, Navid; Mansournia, Mohammad Ali; Mapoma, Chabila Christopher; Martinez, Gabriel; Martini, Santi; Martins-Melo, Francisco Rogerlandio; Mathur, Manu Raj; Mayala, Benjamin K.; Mazidi, Mohsen; McAlinden, Colm; Meharie, Birhanu Geta; Mehndiratta, Man Mohan; Nasab, Entezar Mehrabi; Mehta, Kala M.; Mekonnen, Teferi; Mekonnen, Tefera Chane; Meles, Gebrekiros Gebremichael; Meles, Hagazi Gebre; Memiah, Peter T. N.; Memish, Ziad A.; Mendoza, Walter; Menezes, Ritesh G.; Mereta, Seid Tiku; Meretoja, Tuomo J.; Mestrovic, Tomislav; Metekiya, Workua Mekonnen; Miazgowski, Bartosz; Miller, Ted R.; Mini, G. K.; Mirrakhimov, Erkin M.; Moazen, Babak; Mohajer, Bahram; Mohammad, Yousef; Mohammad, Dara K.; Mezerji, Naser Mohammad Gholi; Mohammadibakhsh, Roghayeh; Mohammed, Shafiu; Mohammed, Jemal Abdu; Mohammed, Hassen; Mohebi, Farnam; Mokdad, Ali H.; Moodley, Yoshan; Moradi, Masoud; Moradi, Ghobad; Moradi-Joo, Mohammad; Moraga, Paula; Morales, Linda; Mosapour, Abbas; Mosser, Jonathan F.; Mouodi, Simin; Mousavi, Seyyed Meysam; Mozaffor, Miliva; Munro, Sandra B.; Muriithi, Moses K.; Murray, Christopher J. L.; Musa, Kamarul Imran; Mustafa, Ghulam; Muthupandian, Saravanan; Naderi, Mehdi; Nagarajan, Ahamarshan Jayaraman; Naghavi, Mohsen; Naik, Gurudatta; Nangia, Vinay; Nascimento, Bruno Ramos; Nazari, Javad; Ndwandwe, Duduzile Edith; Negoi, Ionut; Netsere, Henok Biresaw; Ngunjiri, Josephine W.; Cuong Tat Nguyen,; Huong Lan Thi Nguyen,; Nguyen, QuynhAnh P.; Nigatu, Solomon Gedlu; Ningrum, Dina Nur Anggraini; Nnaji, Chukwudi A.; Nojomi, Marzieh; Norheim, Ole F.; Noubiap, Jean Jacques; Oancea, Bogdan; Ogbo, Felix Akpojene; Oh, In-Hwan; Olagunju, Andrew T.; Olusanya, Jacob Olusegun; Olusanya, Bolajoko Olubukunola; Onwujekwe, Obinna E.; Ortega-Altamirano, Doris; Osarenotor, Osayomwanbo; Osei, Frank B.; Owolabi, Mayowa O.; Mahesh, P. A.; Padubidri, Jagadish Rao; Pakhale, Smita; Pana, Adrian; Park, Eun-Kee; Patel, Sangram Kishor; Pathak, Ashish; Patle, Ajay; Paulos, Kebreab; Pepito, Veincent Christian Filipino; Perico, Norberto; Pervaiz, Aslam; Pescarini, Julia Moreira; Pesudovs, Konrad; Pham, Hai Quang; Pigott, David M.; Pilgrim, Thomas; Pirsaheb, Meghdad; Poljak, Mario; Pollock, Ian; Postma, Maarten J.; Pourmalek, Farshad; Pourshams, Akram; Prada, Sergio; Preotescu, Liliana; Quintana, Hedley; Rabiee, Navid; Rabiee, Mohammad; Radfar, Amir; Rafiei, Alireza; Rahim, Fakher; Rahimi, Siavash; Rahimi-Movaghar, Vafa; Rahman, Muhammad Aziz; Rahman, Mohammad Hifz Ur; Rajati, Fatemeh; Ranabhat, Chhabi Lal; Rao, Puja C.; Rasella, Davide; Rath, Goura Kishor; Rawaf, Salman; Rawal, Lal; Rawasia, Wasiq Faraz; Remuzzi, Giuseppe; Renjith, Vishnu; Renzaho, Andre M. N.; Resnikoff, Serge; Riahi, Seyed Mohammad; Ribeiro, Ana Isabel; Rickard, Jennifer; Roever, Leonardo; Ronfani, Luca; Rubagotti, Enrico; Rubino, Salvatore; Saad, Anas M.; Sabour, Siamak; Sadeghi, Ehsan; Moghaddam, Sahar Saeedi; Safari, Yahya; Sagar, Rajesh; Sahraian, Mohammad Ali; Sajadi, S. Mohammad; Salahshoor, Mohammad Reza; Salam, Nasir; Saleem, Ahsan; Salem, Hosni; Salem, Marwa Rashad; Salimi, Yahya; Salimzadeh, Hamideh; Samy, Abdallah M.; Sanabria, Juan; Santos, Itamar S.; Santric-Milicevic, Milena M.; Sao Jose, Bruno Piassi; Saraswathy, Sivan Yegnanarayana Iyer; Sarrafzadegan, Nizal; Sartorius, Benn; Sathian, Brijesh; Sathish, Thirunavukkarasu; Satpathy, Maheswar; Sawhney, Monika; Sayyah, Mehdi; Sbarra, Alyssa N.; Schaeffer, Lauren E.; Schwebel, David C.; Senbeta, Anbissa Muleta; Senthilkumaran, Subramanian; Sepanlou, Sadaf G.; Servan-Mori, Edson; Shafieesabet, Azadeh; Shaheen, Amira A.; Shahid, Izza; Shaikh, Masood Ali; Shalash, Ali S.; Shams-Beyranvand, Mehran; Shamsi, MohammadBagher; Shamsizadeh, Morteza; Shannawaz, Mohammed; Sharafi, Kiomars; Sharma, Rajesh; Sheikh, Aziz; Shetty, B. Suresh Kumar; Shiferaw, Wondimeneh Shibabaw; Shigematsu, Mika; Shin, Jae Il; Shiri, Rahman; Shirkoohi, Reza; Shivakumar, K. M.; Si, Si; Siabani, Soraya; Siddiqi, Tariq Jamal; Silva, Diego Augusto Santos; Singh, Virendra; Singh, Narinder Pal; Singh, Balbir Bagicha Singh; Singh, Jasvinder A.; Singh, Ambrish; Sinha, Dhirendra Narain; Sisay, Malede Mequanent; Skiadaresi, Eirini; Smith, David L.; Filho, Adauto Martins Soares; Sobhiyeh, Mohammad Reza; Sokhan, Anton; Soriano, Joan B.; Sorrie, Muluken Bekele; Soyiri, Ireneous N.; Spurlock, Emma Elizabeth; Sreeramareddy, Chandrashekhar T.; Sudaryanto, Agus; Sufiyan, Mu'awiyyah Babale; Suleria, Hafiz Ansar Rasul; Sykes, Bryan L.; Tabares-Seisdedos, Rafael; Tabuchi, Takahiro; Tadesse, Degena Bahrey; Tarigan, Ingan Ukur; Taye, Bineyam; Tefera, Yonatal Mesfin; Tehrani-Banihashemi, Arash; Tekelemedhin, Shishay Wahdey; Tekle, Merhawi Gebremedhin; Temsah, Mohamad-Hani; Tesfay, Berhe Etsay; Tesfay, Fisaha Haile; Tessema, Zemenu Tadesse; Thankappan, Kavumpurathu Raman; ThekkePurakkal, Akhil Soman; Thomas, Nihal; Thompson, Robert L.; Thomson, Alan J.; Topor-Madry, Roman; Tovani-Palone, Marcos Roberto; Traini, Eugenio; Bach Xuan Tran,; Khanh Bao Tran,; Ullah, Irfan; Unnikrishnan, Bhaskaran; Usman, Muhammad Shariq; Uthman, Olalekan A.; Uzochukwu, Benjamin S. Chudi; Valdez, Pascual R.; Varughese, Santosh; Veisani, Yousef; Violante, Francesco S.; Vollmer, Sebastian; Whawariat, Feleke Gebremeskel; Waheed, Yasir; Wallin, Mitchell Taylor; Wang, Yuan-Pang; Wang, Yafeng; Wangdi, Kinley; Weiss, Daniel J.; Weldesamuel, Girmay Teklay; Werkneh, Adhena Ayaliew; Westerman, Ronny; Wiangkham, Taweewat; Wiens, Kirsten E.; Wijeratne, Tissa; Wiysonge, Charles Shey; Wolde, Haileab Fekadu; Wondafrash, Dawit Zewdu; Wonde, Tewodros Eshete; Worku, Getasew Taddesse; Yadollahpour, Ali; Jabbari, Seyed Hossein Yahyazadeh; Yamada, Tomohide; Yaseri, Mehdi; Yatsuya, Hiroshi; Yeshaneh, Alex; Yilma, Mekdes Tigistu; Yip, Paul; Yisma, Engida; Yonemoto, Naohiro; Younis, Mustafa Z.; Yousof, Hebat-Allah Salah A.; Yu, Chuanhua; Yusefzadeh, Hasan; Zadey, Siddhesh; Moghadam, Telma Zahirian; Zaidi, Zoubida; Bin Zaman, Sojib; Zamani, Mohammad; Zandian, Hamed; Zar, Heather J.; Zerfu, Taddese Alemu; Zhang, Yunquan; Ziapour, Arash; Zodpey, Sanjay; Zuniga, Yves Miel H.; Hay, Simon; Reiner, Robert C. (2020)
    Background Universal access to safe drinking water and sanitation facilities is an essential human right, recognised in the Sustainable Development Goals as crucial for preventing disease and improving human wellbeing. Comprehensive, high-resolution estimates are important to inform progress towards achieving this goal. We aimed to produce high-resolution geospatial estimates of access to drinking water and sanitation facilities. Methods We used a Bayesian geostatistical model and data from 600 sources across more than 88 low-income and middle-income countries (LMICs) to estimate access to drinking water and sanitation facilities on continuous continent-wide surfaces from 2000 to 2017, and aggregated results to policy-relevant administrative units. We estimated mutually exclusive and collectively exhaustive subcategories of facilities for drinking water (piped water on or off premises, other improved facilities, unimproved, and surface water) and sanitation facilities (septic or sewer sanitation, other improved, unimproved, and open defecation) with use of ordinal regression. We also estimated the number of diarrhoeal deaths in children younger than 5 years attributed to unsafe facilities and estimated deaths that were averted by increased access to safe facilities in 2017, and analysed geographical inequality in access within LMICs. Findings Across LMICs, access to both piped water and improved water overall increased between 2000 and 2017, with progress varying spatially. For piped water, the safest water facility type, access increased from 40.0% (95% uncertainty interval [UI] 39.4-40.7) to 50.3% (50.0-50.5), but was lowest in sub-Saharan Africa, where access to piped water was mostly concentrated in urban centres. Access to both sewer or septic sanitation and improved sanitation overall also increased across all LMICs during the study period. For sewer or septic sanitation, access was 46.3% (95% UI 46.1-46.5) in 2017, compared with 28.7% (28.5-29.0) in 2000. Although some units improved access to the safest drinking water or sanitation facilities since 2000, a large absolute number of people continued to not have access in several units with high access to such facilities (>80%) in 2017. More than 253 000 people did not have access to sewer or septic sanitation facilities in the city of Harare, Zimbabwe, despite 88.6% (95% UI 87.2-89.7) access overall. Many units were able to transition from the least safe facilities in 2000 to safe facilities by 2017; for units in which populations primarily practised open defecation in 2000, 686 (95% UI 664-711) of the 1830 (1797-1863) units transitioned to the use of improved sanitation. Geographical disparities in access to improved water across units decreased in 76.1% (95% UI 71.6-80.7) of countries from 2000 to 2017, and in 53.9% (50.6-59.6) of countries for access to improved sanitation, but remained evident subnationally in most countries in 2017. Interpretation Our estimates, combined with geospatial trends in diarrhoeal burden, identify where efforts to increase access to safe drinking water and sanitation facilities are most needed. By highlighting areas with successful approaches or in need of targeted interventions, our estimates can enable precision public health to effectively progress towards universal access to safe water and sanitation. Copyright (C) 2020 The Author(s). Published by Elsevier Ltd.