Enteric Pathogens Associated with Childhood Diarrhea in Tripoli-Libya

Abstract

Abstract. Stool samples from children < 5 years of age with diarrhea ( N = 239) were examined for enteric pathogens using a combination of culture, enzyme-immunoassay, and polymerase chain reaction methods. Pathogens were detected in 122 (51%) stool samples; single pathogens were detected in 37.2% and co-pathogens in 13.8% of samples. Norovirus, rotavirus, and diarrheagenic Escherichia coli (DEC) were the most frequently detected pathogens (15.5%, 13.4%, and 11.2%, respectively); Salmonella , adenovirus, and Aeromonas were detected less frequently (7.9%, 7.1%, and 4.2%). The most commonly detected DEC was enteroaggregative E. coli (5.4%). Resistance to ≥ 3 antimicrobials was observed in 60% (18/30) of the bacterial pathogens. Salmonella resistance to ciprofloxacin (63.1%) has become a concern . Enteric viral pathogens were the most significant causative agents of childhood diarrhea in Tripoli. Bacterial pathogens were also important contributors to pediatric diarrhea. The emergence of ciprofloxacin-resistant Salmonella represents a serious health problem that must be addressed by Libyan health authorities * Address correspondence to Khalifa Sifaw Ghenghesh, Department of Microbiology and Immunology, Faculty of Medicine, Alfateh University, Tripoli, Libya. E-mail: ghenghesh@yahoo.com 887 DIARRHEA IN LIBYAN CHILDREN VA) were used to detect antigens of Cryptosporidium , Entamoeba histolytica , and Giardia lamblia in all specimens.Epi Info, version 3.5.1 software (Centers for Disease Control and Prevention, Atlanta, GA) was used to analyze the data. P values were calculated using the χ 2 test; P values < 0.05 were considered statistically significant. RESULTSEnteric pathogens were detected in 122 (51%) stool samples examined; single pathogens in 37.2%, and multiple pathogens in 13.9% ( Table 2 ). The most common pathogens detected were enteric viruses (82/239; 34.3%) followed by bacterial pathogens (64/239; 26.8%); parasitic pathogens (10/239; 4.2%) were the minority of detected pathogens.Overall, the most common individual pathogens detected were norovirus, rotavirus, and DEC. Among the DEC, pCVD432 (EAggEC) predominated at 5.4% (13/239) followed by eaeA (EPEC/EHEC) at 4.6% (11/239). No est and eltB genes (ETEC) were detected in this work. Salmonella species were detected in 7.9%; the majority of these were group C2. Cryptosporidium was the primary parasitic diarrheal pathogen detected (2.1%) ( Table 2 ).Total enteric pathogens were detected more frequently among diarrheic children ≤ 2 years of age (55.2%, 100/181; P < 0.03, odds ratio [OR] = 2.02) compared with children > 2 years of age (37.9%, 22/58). Although total enteric pathogens were detected at a higher rate in male (54%, 74/137) than in female (47.1%, 48/102) diarrheic children, the difference was not statistically significant ( P > 0.05).Of the 239 diarrheic children included in the study 202 (84.5%) had vomiting, 176 (73.6%) had fever, and 82 (34.3%) had dehydration. Vomiting, fever, and dehydration were significantly associated with children ≤ 2 years o...

Molecular Characterization of Diarrheagenic Escherichia coli from Libya

“…Similarly, Rahouma and others 26 reported that EAEC (5.4%) is the main pathotype of DEC in diarrheic Libyan children in Tripoli. Several studies from developing countries reported high detection rates (20-38%), whereas other investigators reported low detection rates (5 -6%) for EAEC from children with diarrhea.…”

“…Recently, we have found DEC among the leading enteric pathogens, in addition to rotavirus and norovirus, associated with childhood diarrhea in Tripoli, Libya, with the predominance of EAEC. 26 The aims of this work were to determine the frequency of DEC among children with diarrhea and from Zliten and Alkhomes city water sources; furthermore, the phylogenetic grouping and virulence-encoding Stool specimens from enrolled children were collected using wide-mouthed sterile plastic containers and transported immediately to the microbiology laboratory for analysis within two hours of collection.…”

Practical Guidance for Clinical Microbiology Laboratories: Diagnosis of Bacterial Gastroenteritis

“…The incidence of Aeromonas-associated gastroenteritis on a global basis varies dramatically in association with geographic and socioeconomic factors. In developing countries where sanitary conditions are substandard, the reported incidence of Aeromonas diarrhea can be high, ranging from approximately 4% to 22% (13)(14)(15)(16). In industrialized countries, regardless of patient population and sample size, Aeromonas-associated gastroenteritis has been reported at frequencies of 0% to 10% (17,18).…”

A Survey of the Epidemiology and Antibiotic Resistance Patterns of Enteropathogens Isolates in an Iranian Hospital

“…Eighty percent of these deaths are among children under two years of age. Predisposing factors such as malnutrition, low socioeconomic conditions, and poor hygiene are the major risk factors for such deaths in developing countries (3)(4)(5)(6)(7)(8). Among the bacteria responsible for diarrhea, Salmonella spp., Shigella spp., E. coli, Campylobacter spp., Vibrio cholerae, Aeromonas hydrophila, and Plesiomonas spp.…”

“…Among the bacteria responsible for diarrhea, Salmonella spp., Shigella spp., E. coli, Campylobacter spp., Vibrio cholerae, Aeromonas hydrophila, and Plesiomonas spp. are the most common agents of diarrhea (2,5,6). In spite of fluid and electrolyte replacement as a method of choice for the treatment of diarrheal diseases, antimicrobial therapy is recommended for suspected cases of Salmonella, Shigella and V. cholerae (7).…”