Enterodiaper: bringing the lab to your child’s diaper
by Carlos Johnson
Coauthors: Acknowledgements: A very special thank you to Ashley Knebel and Annika Grover for their leadership and feedback during my time with MI3 and on this project, to Dr. Sharief Taraman for his invaluable criticism and support, to Dr. Anthony Chang for his philanthropic and visionary leadership of this program, and to Dr. Antonio Arrieta for his knowledge, guidance, and time.
Medical Devices & Digital Health
Background:
Enteropathogens are a common cause of illness and diarrheal diseases account for about 11% of deaths among children <5 years of age worldwide. In developing countries, enteropathogen related diseases are a leading cause of death in children. In the United States and developed countries, certain enteropathogen related diseases are dangerous if not treated early. 90% of all enteropathogens are viral with the remainder bacterial or parasitic making it difficult to treat. Mostly all cases present with diarrheal symptoms. Being that the cause of mortality is not the pathogen itself, but the resulting dehydration, the focus of care is on rehydration and fluid retention. However, certain endo/exotoxins such as Shiga toxins (Stx) are concerning and require early medical attention. Hydration is fundamental and where intervention is aimed, but oftentimes difficult to maintain resulting in dire outcomes. Staying vigilant of certain endotoxins, early detection of these endotoxins, and monitoring hydration levels are invaluable for treating children and their prognosis. An efficient, cheap, and effective way to surveil hydration and enteropathogens of concern in stools/urine of infants is needed.
Methods:
While treating diarrheal diseases at home fluid loss is the first concern, however, if not controlled, dehydration can quickly lead to organ failure, shock, and other complications. During at-home treatment it is important to monitor hydration levels and intervene before severe fluid loss is reached. Standard tests to assess hydration in patients use osmolality and specific gravity levels in blood, urine, and stool. Tests that target urine osmol levels such as Cl-, K+ , Na+, glucose, and urea which influence the specific gravity can be used in a colorimetric assay to detect hazardous levels of possible dehydration in children. These colorimetric indicators could be inserted in the layers of a diaper to assess if a child is reaching a point of dehydration where at-home fluid treatments are failing, needing medical intervention. Normal specific gravity levels in children range from 1.005-1.030. The colorimetric test would signal hazardous levels above that range, indicative of dehydration or hypovolemia.
For pathogens of high concern which prompt early medical intervention, an assay inserted into the rear of the diaper could be used to effectively detect when and if a concerning pathogen or toxin is present in stool. Stx of different subtypes can be produced by enteropathogens such as Shigella dysenteriae and some Escherichia coli serogroups. These endotoxins can lead to severe diarrhea, hemorrhagic colitis, or hemolytic uremic syndrome which all require medical treatment. Freeze-dried cell-free assays are a relatively new technology used in rapid and convenient testing of pathogens. Recently, an article describing the use of a face mask with a FDCF assay to detect SARS-CoV2 in respiratory droplets while wearing the mask proved promising in rapid and convenient detection. These relatively cost effective and user-friendly assays would also be placed into the layers of diapers allowing for quick, easy, and cheap testing for children with diarrhea who may be infected with deadly enteropathogens. The assay would not require priming, temperature requirements, or complicated usage as it is activated by the presence of water which could be found in the diarrhea or urine.
These diapers would be ideal for young children in both developing regions of the world where these infections afflict children frequently and first world countries such as the United States and European nations where monitoring and early intervention is also necessary. ‘Enterodiaper’ would be cheaply available both in stores for at-home usage or inpatient facilities for surveillance.
Conclusion:
These incorporations to the at-home setting give parents a way to assess the level of hydration of their child and detect pathogens that require intervention; a diaper that brings the lab home straight to the source of the samples would decrease morbidity and mortality. Likewise, in a hospital setting a detection system on these wearables would lessen the burden on medical staff and provide frequent assessment of hydration and pathogens. With the expansion and adoption of technologies like FDCF systems and cheap colorimetric tests for specific gravity, the cost of these assays could also become cheap enough for access to regions of the world where enteropathogens in children of diaper-wearing age are a serious issue.
Author:
Carlos Antonio Johnson
Orange Coast College | cjohnson335@student.cccd.edu
References:
https://bmcbiol.biomedcentral.com/articles/10.1186/s12915-019-0685-x
https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(19)30541-8/fulltext
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4270005/
https://www.ucsfbenioffchildrens.org/medical-tests/urine-concentration-test
https://www.cdc.gov/healthywater/global/diarrhea-burden.html
https://www.nature.com/articles/s41587-021-00950-3