Enteric infection and dysfunction—A new target for PLOS Neglected Tropical Diseases

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The past decade has seen a dramatic increase in global attention to neglected tropical diseases, with remarkable momentum in policy, programs, funding, and research.As we look to the future, it is critical for PLOS Neglected Tropical Diseases to continue to reevaluate the scope of the journal and to define which syndromes and diseases continue to disproportionately impact neglected populations in low-resource settings.Many pathogens highlighted in PLOS Neglected Tropical Diseases have profound impacts on the gastrointestinal system.There is increasing recognition of the role of the intestine as the critical site where the human host encounters pathogens, initiates the immune response, protects from pathogen invasion, controls nutrient and calorie absorption, and modulates hormonal response.Enteric dysfunction-as a result of diarrheal disease, parasitic infections, alterations in the gut microbial environment, and other causes-has been linked to malnutrition, delayed cognitive development, increased susceptibility to other infectious diseases, poor oral vaccine response, and increased mortality risk.The collective long-term impacts of these conditions on the most marginalized communities are tremendous.Given the importance of these diseases and syndromes, PLOS Neglected Tropical Diseases has decided to include a new section focused on enteric infections and enteric dysfunction.Of course, many diseases and syndromes-including the soil-transmitted helminths, schistosomiasis, giardiasis, cholera, and other enteric pathogens that impact the physiology of the gut-are already included within the scope of PLOS Neglected Tropical Diseases and have been highlighted previously in this journal [1].It is our hope that by highlighting the shared impacts of enteric infection and dysfunction as a specific target for the journal, we can serve as a major platform to bring together valuable discoveries and innovations that will drive progress in this important field.Diarrhea remains a leading cause of child mortality globally.The Global Enteric Multicenter Study (GEMS) reported Shigella spp., rotavirus, adenovirus, heat-stable toxin enterotoxigenic Escherichia coli (ST-ETEC), Cryptosporidium spp., and Campylobacter spp. as the most common pathogens associated with moderate-to-severe diarrhea in infants and young children in lowresource settings [2,3].However, mounting evidence also suggests that infection with enteric pathogens need not cause diarrhea to pose threats to child health.Even in the absence of diarrhea, many pathogens can increase gut inflammation and permeability and may result in systemic inflammation [4].For example, high Campylobacter pathogen burden was associated with a significant decrease in height for age z-score among children enrolled in a multisite birth cohort study (MAL-ED), independent of diarrhea symptoms [5].In addition to negative growth impacts,

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