Etiologic profile of acute diarrhea in children in São Paulo

Souza, E C; Martinez, Marina Baquerizo; Taddei, Carla R.; Mukai, Lilian; Gilio, Alfredo Elias; Rácz, Maria Lucia; Silva, Luzinete; Ejzenberg, Bernardo; Okay, Yassuhiko

doi:10.2223/jped.662

Cited by 31 publications

(22 citation statements)

References 16 publications

(12 reference statements)

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“…Conversely, a study undertaken in Rio de Janeiro found the months of May and June as those with higher rates of ADD-related hospitalization and death (17) . A large proportion of literature data relates seasonality to the etiologic agent, with a preponderance of bacteria in the hotter months and viruses in fall and winter (32) .…”

Section: Discussionmentioning

confidence: 99%

“…Although viruses, with rotavirus in particular (13) , are widely recognized as responsible for diarrhea-related hospitalizations among children under 5 years of age, studies undertaken by Souza et al (32) , Brandão et al (4) and Andrade et al (9) in São Paulo, have pointed otherwise, reporting classic enteropathogenic Escherichia coli (EPEC), as the main cause of diarrhea in children under 5 years of age, especially those under 6 months and as a risk factor for death. A study undertaken by the International Center for Diarrheal Disease Research, in Bangladesh (34) isolated Shigella flexneri in about 60% of children under the age of 5 years, with acute diarrhea.…”

Section: Discussionmentioning

confidence: 99%

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Acute diarrhea in hospitalized children of the municipality of juiz de fora, MG, Brazil: prevalence and risk factors associated with disease severity

Rocha

Carminate

Tibiriçá

et al. 2012

Arq. Gastroenterol.

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CONTEXT: Acute diarrhea is a common cause of hospitalization among children under 5 years of age. Knowing the prevalence and risk factors associated with the severity of acute diarrhea is essential to control morbidity and mortality. OBJECTIVE: Describe the prevalence of demographic, epidemiologic and clinical features of children under 6 years of age hospitalized for acute diarrhea, and investigate the association between these determinants and the severity of the diarrheic episode. METHOD: Retrospective, cross-sectional study, during the period from January, 2005 through December, 2008, in the municipality of Juiz de Fora, MG, Brazil. Files from 6,201 children from 0 to 6 years of age, hospitalized in two public teaching institutions (which account for 84% of all the hospitalizations in the municipality), were assessed. Acute diarrhea was defined as the presence of at least three evacuations of liquid or loose stools, within 24 hours, for a maximum period of 14 days. The patients with acute diarrhea were divided in two groups, according to disease severity, severe diarrhea being considered whenever hospitalization lasted for at least 4 days. Epidemiologic and clinical data were assessed and compared through the application of the chi-squared test and the binomial logistic regression model. RESULTS: The prevalence rate for admission due to acute diarrhea was 8.4%. The factors significantly associated with the severity of the diarrheic episode were: age under 6 months (P = 0.01, OR = 2.762); disease onset during fall (P = 0.033, OR = 1.742), presence of fever (P = 0.017, OR = 1.715) and antibiotic use during hospitalization (P = 0.000, OR = 3.872). CONCLUSIONS: Diarrhea is the third most common cause of hospitalization among children under 6 years of age in Juiz de Fora. Young age (under or equal to 6 months), fever, antibiotic use during hospitalization and disease onset during fall are risk factors associated with longer hospital stay.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Acute diarrhea in hospitalized children of the municipality of juiz de fora, MG, Brazil: prevalence and risk factors associated with disease severity

Rocha

Carminate

Tibiriçá

et al. 2012

Arq. Gastroenterol.

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“…In the clinical studies, children with a mixed (rotavirus and bacterial) infection had the highest incidence of severe vomiting and dehydration (10,11). In a study carried out in Iran on 197 children under the age of 3 years with diarrhea and enterotoxigenic E.coli infection duration of diarrhea was longer than in patients with E.coli or rotovirus infection alone (12).…”

Section: Introductionmentioning

confidence: 99%

Incidence of Coinfection between Rotavirus and Some Enteropathogenic Agents in Children Referred to Children Medical Center Hospital, Tehran, 2009

2011

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Background and Aims: One of the major causes of acute diarrhea in children during the cold season in Iran is infection by rotavirus. Children infected with rotavirus often require hospitalization. Several studies on human and animals have shown that enterotoxigenic Escherichia.coli and rotavirus are the most common coinfection causing diarrhea. There are other reports indicating occurrence of rotavirus coinfection with some other enteric agents such as Salmonella, Giardia, and Shigella flexeneri. In this study the rate of rotavirus infection and its coinfection with some other enteropathogenic agents in children which could influence the severity of the disease was investigated. Methods: Approximately 100 stool samples were collected from children with acute gastroenteritis. The specimens were cultured for bacteria isolation. They were also clarified and tested for rotavirus using the techniques of latex agglutination and negative staining electron microscopy. Results: Using negative staining, rotavirus particles were observed in 43 of the 100 stool specimen. The highest prevalence was observed in 6-12 months old children consisting 39.5% of the total specimens. Patients with mixed infection particularly rotavirus and E.coli had the highest incidence of severe vomiting and dehydration. Conclusion: Coinfection of children with rotavirus and other enteric agents can occur frequently. This coinfection has a synergistic effect which increases the severity of the clinical manifestation.

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“…Besides ETEC strains are also usually responsible for the acute diarrhea that affects visitors to the tropics (Ericsson 2003). In Brazil, these pathogens are responsible for up to 20% of cases of infantile diarrhea, region and season dependent (Reis et al 1982, Trabulsi et al 1985, Gomes et al 1991, Almeida et al 1998, Souza et al 2002, Fernandes-Filho et al 2003, Franzolin et al 2005, Barreto et al 2006 erogeneous family of lactose-fermenting E. coli, belonging to a wide variety of O antigenic types. These strains produce enterotoxins (heat labile and/or heat stable), and colonization factors, which allow the organisms to readily colonize the small intestine and in this way cause diarrhea (Sack 1980, Wolf 1997, Nataro & Kaper 1998.…”

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confidence: 99%

Production, characterization, and application of antibodies against heat-labile type-I toxin for detection of enterotoxigenic Escherichia coli

Menezes

Imamura

Trabulsi³

et al. 2006

Mem. Inst. Oswaldo Cruz

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Strains of enterotoxigenic Escherichia coli (ETEC) are responsible for significant rates of morbidity and mortality among children, particularly in developing countries. The majority of clinical and public health laboratories are capable of isolating and identifying Salmonella, Shigella, Campylobacter, and Escherichia coli O157:H7 from stool samples, but ETEC cannot be identified by routine methods. The method most often used to identify ETEC is polymerase chain reaction for heat-stable and heat-labile enterotoxin genes, and subsequent serotyping, but most clinical and public health laboratories do not have the capacity or resources to perform these tests. In this study, polyclonal rabbit and monoclonal mouse IgG2b antibodies against ETEC heat-labile toxin-I (LT) were characterized and the potential applicability of a capture assay was analyzed. IgG-enriched fractions from rabbit polyclonal and the IgG2b monoclonal antibodies recognized LT in a conformational shape and they were excellent tools for detection of LT-producing strains. These findings indicate that the capture immunoassay could be used as a diagnostic assay of ETEC LT-producing strains in routine diagnosis and in epidemiological studies of diarrhea in developing countries as enzyme linked immunosorbent assay techniques remain as effective and economical choice for the detection of specific pathogen antigens in cultures. Key words: detection -antibodies -heat-labile toxin -Escherichia coliDiarrhea caused approximately two million deaths per year worldwide in the last decade (WHO-UNICEF 2002), and was responsible for an estimated 16-32% (median 21%) of mortality in children aged 0-4 years in developing countries (Kosek et al. 2003). One of the major etiologic agents is enterotoxigenic Escherichia coli (ETEC), known to be endemic in essentially all developing countries. Besides ETEC strains are also usually responsible for the acute diarrhea that affects visitors to the tropics (Ericsson 2003). In Brazil, these pathogens are responsible for up to 20% of cases of infantile diarrhea, region and season dependent (Reis et al. 1982, Trabulsi et al. 1985, Gomes et al. 1991, Almeida et al. 1998, Souza et al. 2002, Fernandes-Filho et al. 2003, Franzolin et al. 2005, Barreto et al. 2006 erogeneous family of lactose-fermenting E. coli, belonging to a wide variety of O antigenic types. These strains produce enterotoxins (heat labile and/or heat stable), and colonization factors, which allow the organisms to readily colonize the small intestine and in this way cause diarrhea (Sack 1980, Wolf 1997, Nataro & Kaper 1998.Since ETEC can be recognized by the enterotoxins it produces, diagnosis must depend upon identifying either heat-labile toxins (LT) and/or heat-stable toxin (ST). One or both toxins may be expressed by ETEC. LT belongs to a structurally and functionally related AB 5 enterotoxin family, in which the A subunit has the toxic activity and B subunit is responsible for toxin binding to cell receptor.Enzyme-linked immunosorbent assay (ELISA) techniques emplo...

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Etiologic profile of acute diarrhea in children in São Paulo

Cited by 31 publications

References 16 publications

Acute diarrhea in hospitalized children of the municipality of juiz de fora, MG, Brazil: prevalence and risk factors associated with disease severity

Acute diarrhea in hospitalized children of the municipality of juiz de fora, MG, Brazil: prevalence and risk factors associated with disease severity

Incidence of Coinfection between Rotavirus and Some Enteropathogenic Agents in Children Referred to Children Medical Center Hospital, Tehran, 2009

Production, characterization, and application of antibodies against heat-labile type-I toxin for detection of enterotoxigenic Escherichia coli

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