Molecular Detection and Epidemiological Features of Selected Bacterial, Viral, and Parasitic Enteropathogens in Stool Specimens from Children with Acute Diarrhea in Thi-Qar Governorate, Iraq

Abstract

Knowledge of etiology causes of diarrheal illness is essential for development and implementation of public health measures to prevent and control this disease syndrome. There are few published studies examining diarrhea in children aged <5 years in Iraq. This study aims to investigate the occurrences and epidemiology of selected bacterial (Salmonella spp. and Campylobacter spp.), viral (adenovirus, norovirus GI and GII, and astrovirus), and parasitic (Entamoeba spp. and Giardia spp.) agents in stool samples from 155 child diarrheal cases enrolled between March and August 2017, in a hospital-based cross-sectional study in Thi-Qar, southeastern Iraq. Using molecular techniques and sequence-based characterization, adenovirus was the most frequently detected enteropathogen (53/155 (34.2%)), followed by Salmonella spp. (23/155 (14.8%)), Entamoeba spp. (21/155 (13.5%)), and Campylobacter spp. (17/155 (10.9%)). Mixed infection with Salmonella spp. and Campylobacter spp. was evident, and the same was revealed between various enteric viruses, particularly adenovirus and norovirus. The most frequent co-infection pattern was between adenovirus and Campylobacter spp., in seven cases (7/155 (4.5%)). Whole-genome sequencing-derived typing data for Salmonella isolates (n = 23) revealed that sequence type 49 was the most prevalent in this sample set (15/23 (65.2%)). To the best of our knowledge, this study provides the first report on detection and identification of floR, blaCARB-2, and mphA antimicrobial resistance genes in Salmonella isolated from children in the Middle East region. Logistic regression analysis pointed to few enteropathogen-specific correlations between child age, household water source, and breastfeeding patterns in relation to the outcome of detection of individual enteropathogens. This study presents the first published molecular investigation of multiple enteropathogens among children <5 years of age in Iraq. Our data provide supporting evidence for planning of childhood diarrhea management programs. It is important to build on this study and develop future longitudinal case-control research in order to elaborate the epidemiology of enteropathogens in childhood diarrhea in Iraq.

The effect of age, gender, type of feeding and receiving a treatment on the distribution of Enterovirus infection among children in Al-Diwaniyah city, Iraq

“…This result coincided with the result of the researcher, AL-Jeboury [26] in Babylon Governorate, where the highest incidence of intestinal viruses was recorded among children aged (2-3 years). It also coincided with the results of the researcher ,Allayeh et al [27] in Egypt, who found in their results that the highest incidence of viral intestinal infection in relation to (Rota, Astro and Adenovirus) was in the age group of less than one year, as well as consistent with the results of the researcher in Thi Qar, where the highest incidence of injury in the age group was less than two years, which was estimated at (60%) [28].…”

Challenges and Opportunities towards the Development of Risk Assessment at the Consumer Phase in Developing Countries—The Case of Campylobacter Cross-Contamination during Handling of Raw Chicken in Two Middle Eastern Countries

“…In Thi-Qar (Iraq), a recent study pointed that Campylobacter spp. (17/155 (10.9%)) were the third most common pathogen to be isolated from diarrhoeal children aged less than 5 years old [10]. Hence, with the objective of developing a quantitative consumer phase risk assessment model for Campylobacter, this study aims to fill the gap in the knowledge regarding the variability in consumer purchase preferences, frequency of consumption of raw chicken meat and cross-contamination practices when handling raw chicken in two settings, Alexandria (Egypt) and Thi-Qar (Iraq).…”

Socio-demographic determinants of health-care seeking options and alternative management practices of childhood diarrhoeal illness: A household survey among mothers in Iraq

“…Among socio-demographic variables, place of residence, education, and age were important predictors associated with occurrence of diarrhoeal illness in the household in the two weeks before the study. In the multivariate analyses (Table 2) water, versus households utilizing reverse osmosis water, in Thi-Qar [37]. A community crosssectional study in Mbour, Senegal by Thiam et al [38] observed children living in better-off families were less likely to have diarrhoea compared to their lower income counterparts.…”

“…These results are in agreement with what was reported from studies conducted in neighboring countries such as Turkey [40], Iran [33] and Jordan [27], where children belonging to mothers with a higher education level (university or diploma) were less likely to have diarrhoea compared to those whose mothers had a lower level education (primary or secondary) or were illiterate. This finding might indicate that those mothers who have a higher education level are attaining more awareness on good child feeding practices, hygiene behaviors and safe handling of water which in turn are important factors for reducing the risks associated with childhood diarrhoea [21,[22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39]. In addition to mothers' education level, the present study observed that the reported occurrence of diarrhoea is likely to be less in children belonging to mothers aged >25 years compared to mothers aged ≤25 years.…”

“…This finding is not surprising as antibiotics, especially in developing countries like Iraq, are both widely prescribing and obtained directly without a prescription [43]. This high utilization of medicines without prescriptions from a pharmacy is alarming from a public health perspective [43,44] for multiple reasons including failure to administer the correct antibiotic, the probability that diarrhoeal disease is not due to an bacterial agent [37], likelihood that the majority of cases require ORT rather than antibiotics and of course the promotion of antimicrobial resistance.…”