Epidemiology of bacterial pathogens associated with infectious diarrhea in Djibouti

Abstract

During a survey examining the causes of diarrhea in the East African country of Djibouti, 140 bacterial pathogens were recovered from 209 diarrheal and 100 control stools. The following pathogens were isolated at comparable frequencies from both diarrheal and control stools: enteroadherent Escherichia coli (EAEC) (10.6 versus 13%), enterotoxigenic E. coli (ETEC) (11 versus 10%), enteropathogenic E. coli (EPEC) (7.7 versus 12%), Salmonella spp. (2.9 versus 3%), and Campylobacterjejuni-C. coli (3.3 versus 5%). Surprisingly, the EAEC strains isolated did not correspond to well-recognized EPEC serogroups. No Yersinia spp., enteroinvasive E. coli, or enterohemorrhagic E. coli were isolated during the course of this study. Only the following two genera were recovered from diarrheal stools exclusively: Shigella spp. (7.7%) and Aeromonas hydrophila group organisms (3.3%). Shigella flexneri was the most common Shigella species isolated. Patients with Shigella species were of a higher average age than were controls (27 versus 13 years), while subjects with Campylobacter or Salmonella species belonged to younger age groups (2.6 and 1.6 years, respectively). Salmonella cases were more often in females. Shigella diarrhea was associated with fecal blood or mucus and leukocytes. ETEC was not associated with nausea or vomiting. Anorexia, weight loss, and fever were associated with the isolation of Salmonella and Aeromonas species. EAEC, ETEC, EPEC, and Shigella species were resistant to most drugs used for treating diarrhea in Africa, while the antibiotic most active against all bacteria tested was norfloxacin. We conclude that in Djibouti in 1989, Shigella and Aeromonas species must be considered as potential pathogens whenever they are isolated from diarrheal stools and that norfloxacin should be considered the drug of choice in adults for treating severe shigellosis and for diarrhea prophylaxis in travelers.

Epidemiological Study on Infectious Diarrheal Diseases in Children in a Coastal Rural Area of Kenya

“…However, the current difficult economic situation poses an obstacle. The etiological agents associated with diarrhea were not remarkably different from those of other African countries (1,(9)(10)(11)(12)15). Cases of endemic diarrhea in the study population were not found.…”

“…Epidemiological studies on diarrhea have been reported from several African countries including South Africa (6,8,14), Djibouti (9), Gambia (12), Somalia (1), Ethiopia (15), Guinea-Bissau (10), and Nigeria (11). However, there is no published information on Kenya.…”

Frequency and Virulence Properties of Diarrheagenic Escherichia Coli in Children With Diarrhea in Gabon

“…Although EAEC have been associated with diarrhea in children in Africa, the role of EAEC in diarrhea has been controversial. 9,17,18 In studies from Djibouti and Bangladesh, EAEC were not significantly associated with diarrhea. 17,19 However, in children between six months and 12 years of age, EAEC were significantly associated with diarrhea.…”

“…9,17,18 In studies from Djibouti and Bangladesh, EAEC were not significantly associated with diarrhea. 17,19 However, in children between six months and 12 years of age, EAEC were significantly associated with diarrhea. 9,18 In the present study, EAEC were detected in 57 of 150 children with diarrhea.…”

Shigella and Salmonella strains isolated from children under 5 years in Gaborone, Botswana, and their antibiotic susceptibility patterns

“…The emergence of antimicrobial resistance in enteric bacterial pathogens is a major problem associated with the control of diarrhoea. Various authors have reported high rates of resistance to commonly used, inexpensive, oral antimicrobial agents such as ampicillin, tetracycline, and trimethoprim‐sulphamethaxozole ( Mikhail et al . 1990 ).…”