Acute diarrhea in children less than 3 years of age: Enteropathogens isolated in patients’ stools, compared with a control group

Abstract

Objectives: To observe the occurrence of different etiological agents of acute diarrhea (AD) in stool specimens of patients and children in a control group.Material and Methods: 100 children less than three years of age with AD were studied as well as 100 controls, between November 1993 and May 1994. Stool specimens were collected in both groups and the following enteropathogens were searched for: Rotavirus, Escherichia coli (EPEC, ETEC, EIEC, EHEC), Salmonella sp, Shigella sp, Campylobacter jejuni, Campylobacter coli, Yersinia enterocolitica, Cryptosporidium sp, Giardia lamblia, Entamoeba histolytica. Statistical analysis using the exact Fisher test (at significance level p<0,05) was done. The mean age was 12,5 months, with more cases in patients less than 6 months (35%). Children were seen at the emergency section on an average fifth day after the start of the diarrhea. Most came from homes with basical sanitary conditions. Watery diarrhea was more frequent than bloody diarrhea with mucus, at a proportion of 4:1.Results: Rotavirus was the most frequent agent: 21% in the AD group and 3% in the control group (p= 0,0001). Shigella sp was isolated in 7% of the AD group and none of the control group (p= 0,0140). EPEC was detected in 13% of AD cases and 7% in the control group (p= 0,2381) but the classical subgroups O55, O111, O119 were only isolated from the patients with AD. The other enteropathogens were infrequently detected or in equal proportion in both groups. Rotavirus and EPEC were the more frequently isolated agents in watery diarrhea, while Shigella sp was the predominant agent found in bloody stools with mucus.Conclusions: Rotavirus was the most common causative agent in AD. The detection of Rotavirus and Shigella sp nearly exclusively in patients with AD confirms the high patogenicity of these etiological agents when compared to the others. Escherichia coli (EPEC) diagnosed by polyvalent sera does not confirm its respective diarrheogenic property due to isolation in the same proportion among patients with AD and controls. Monovalent antisera made possible the detection of classical subgroups of EPEC O111, O119, O55 isolated only from AD patients, confirming the already known high patogenicity of these strains. Resultados: O Rotavirus foi o agente mais detectado, 21% no grupo com diarréia e 3% nos controles (p = 0,0001). A Shigela sp foi isolada em 7% no grupo com diarréia e em nenhum caso nos controles (p = 0,0140). A Escherichia coli enteropatogênica (EPEC) foi detectada em 13% dos casos de DA e em 7% nos controles (p = 0,2381), porém os sorogrupos clássicos O55,0111,0119 foram isolados apenas nos portadores de diarréia. Os demais enteropatógenos não atingiram freqüências elevadas, ou foram detectados na mesma proporção em ambos os grupos. O Rotavirus e EPEC foram os agentes mais detectados nas diarréias aquosas, enquanto a Shigella sp foi o agente predominante nas diarréias mucossanguinolentas. J. pediatr. (Rio J.Conclusões: O Rotavirus foi o agente mais comum determinante de DA. A detecção de...

Rotavirus type A and other enteric pathogens in stool samples from children with acute diarrhea on the Colombian northern coast

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