Kwashiorkor and
marasmus are considered to be two different clinical diseases resulting from severe
malnutrition, but this distinction has been questioned. In a previous study comparing children with
kwashiorkor and healthy children from Niger and Senegal, we found a dramatic gut microbiota alteration with a predominant depletion of anaerobes and enrichment in Proteobacteria and Fusobacteria in
kwashiorkor. However, it remained unknown whether this association was related to
malnutrition or was a specific feature of
kwashiorkor. In this continuation study, we added 7 new
marasmus subjects and 71,162 new colonies from the same countries. Our results showed that, compared to
marasmus, the
kwashiorkor gut microbiota was characterized by an increased proportion of Proteobacteria (culturomics,
Marasmus 5.0%,
Kwashiorkor 16.7%, p < 0.0001; metagenomics,
Marasmus 14.7%,
Kwashiorkor 22.0%, p = 0.001), but there was a decreased proportion of Bacteroidetes in
marasmus (culturomics,
Marasmus 0.8%,
Kwashiorkor 6.5%, p = 0.001; metagenomics,
Marasmus 5.4%,
Kwashiorkor 7.0%, p = 0.03). Fusobacterium was more frequently cultured from
kwashiorkor. All detected potential pathogenic species were enriched in the
kwashiorkor gut microbiota. These results provide a biological basis to support the usage of an
antibiotic therapy more effective in suppressing the overgrowth of bacterial communities resistant to
penicillin, combined with
antioxidants and probiotics for nutritional recovery
therapies, particularly for
kwashiorkor.