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Background  Diarrheal diseases are an important cause of morbidity and mortality among children in developing countries. We aimed to study the etiology and severity of diarrhea in children living in the low-income semiarid region of Brazil.    Methodology  This is a cross-sectional, age-matched case-control study of diarrhea in children aged 2–36 months from six cities in Brazil’s semiarid region. Clinical, epidemiological, and anthropometric data were matched with fecal samples collected for the identification of enteropathogens.    Results  We enrolled 1,200 children, 596 cases and 604 controls. By univariate analysis, eight enteropathogens were associated with diarrhea: Norovirus GII (OR 5.08, 95% CI 2.10, 12.30), Adenovirus (OR 3.79, 95% CI 1.41, 10.23), typical enteropathogenic  Escherichia coli  (tEPEC), (OR 3.28, 95% CI 1.39, 7.73), enterotoxigenic  E .  coli  (ETEC LT and ST producing toxins), (OR 2.58, 95% CI 0.99, 6.69), rotavirus (OR 1.91, 95% CI 1.20, 3.02), shiga toxin-producing  E .  coli  ( STEC ; OR 1.77, 95% CI 1.16, 2.69), enteroaggregative  E .  coli  (EAEC), (OR 1.45, 95% CI 1.16, 1.83) and  Giardia  spp. (OR 1.39, 95% CI 1.05, 1.84). By logistic regression of all enteropathogens, the best predictors of diarrhea were norovirus, adenovirus, rotavirus, STEC,  Giardia  spp. and EAEC. A high diarrhea severity score was associated with EAEC.    Conclusions  Six enteropathogens: Norovirus, Adenovirus, Rotavirus, STEC,  Giardia  spp., and EAEC were associated with diarrhea in children from Brazil’s semiarid region. EAEC was associated with increased diarrhea severity.

Etiology and severity of diarrheal diseases in infants at the semiarid region of Brazil: A case-control study