Usefulness of fecal lactoferrin in predicting and monitoring the clinical severity of infectious diarrhea

AIM: To explore the value of fecal lactoferrin in predicting and monitoring the clinical severity of infectious diarrhea. METHODS: Patients with acute infectious diarrhea ranging from 3 mo to 10 years in age were enrolled, and one to three stool samples from each subject were collected. Certain parameters, including white blood cells /differential count, C-reactive protein, fecal mucus, fecal pus cells, duration of fever, vomiting, diarrhea and severity (indicated by Clark and Vesikari scores), were recorded and analyzed. Fecal lactoferrin was determined by enzyme-linked immunosorbent assay and compared in different pathogen and disease activity. Generalized estimating equations (GEE) were also used for analysis. RESULTS: Data included 226 evaluations for 117 individuals across three different time points. Fecal lactoferrin was higher in patients with Salmonella (11.17 μg/g ± 2.73 μg/g) or Campylobacter (10.32 μg/g ± 2.94 μg/g) infections and lower in patients with rotavirus (2.82 μg/g ± 1.27 μg/g) or norovirus (3.16 μg/g ± 1.18 μg/g) infections. Concentrations of fecal lactoferrin were significantly elevated in patients with severe (11.32 μg/g ± 3.29 μg/g) or moderate (3.77 μg/g ± 2.08 μg/g) disease activity compared with subjects with mild (1.51 μg/g ± 1.36 μg/g) disease activity (P < 0.05). GEE analysis suggests that this marker could be used to monitor the severity and course of gastrointestinal infections and may provide information for disease management. CONCLUSION: Fecal lactoferrin increased during bacterial infection and with greater disease severity and may be a good marker for predicting and monitoring intestinal inflammation in children with infectious diarrhea.