Enteropathogens associated with acute diarrhea in children from households with high socioeconomic level in uruguay.

Gustavo Varela,Lara Batthyány,Lorena Pardo,María Catalina Pírez,Luciana Robino,Felipe Schelotto,Walter Pérez,Gabriela Algorta,Armando Navarro,Ramón Suárez,María Noel Bianco

doi:10.1155/2015/592953

Abstract

Infectious diarrhea, a common disease of children, deserves permanent monitoring in all social groups. To know the etiology and clinical manifestations of acute diarrhea in children up to 5 years of age from high socioeconomic level households, we conducted a descriptive, microbiological, and clinical study. Stools from 59 children with acute community-acquired diarrhea were examined, and their parents were interviewed concerning symptoms and signs. Rotavirus, adenovirus, and norovirus were detected by commercially available qualitative immunochromatographic lateral flow rapid tests. Salmonella, Campylobacter, Yersinia, and Shigella were investigated by standard bacteriological methods and diarrheagenic E. coli by PCR assays. We identified a potential enteric pathogen in 30 children. The most frequent causes of diarrhea were enteropathogenic E. coli (EPEC), viruses, Campylobacter, Salmonella, and Shiga-toxin-producing E. coli (STEC). Only 2 patients showed mixed infections. Our data suggest that children with viral or Campylobacter diarrhea were taken to the hospital earlier than those infected with EPEC. One child infected with STEC O26 developed “complete” HUS. The microbiological results highlight the importance of zoonotic bacteria such as atypical EPEC, Campylobacter, STEC, and Salmonella as pathogens associated with acute diarrhea in these children. The findings also reinforce our previous communications about the regional importance of non-O157 STEC strains in severe infant food-borne diseases.

Highlights

Infectious diarrhea continues to be a health burden worldwide, especially in children living in developing countries
Our data suggest that children with viral or Campylobacter diarrhea were taken to the hospital earlier than those infected with enteropathogenic E. coli (EPEC)
The microbiological results highlight the importance of zoonotic bacteria such as atypical EPEC, Campylobacter, Shiga-toxin-producing E. coli (STEC), and Salmonella as pathogens associated with acute diarrhea in these children

Summary

Introduction

Infectious diarrhea continues to be a health burden worldwide, especially in children living in developing countries. It is estimated that in these regions it is responsible for 2.5 million infant deaths annually, with a mortality rate of 4.9 per 1,000 children and an annual incidence of 3 episodes per child among children under 5 years of age [1, 2]. In developed countries the mortality from diarrhea is relatively low but morbidity is not so different from that seen in developing countries. Due to the relatively high incidence, the social impact and health costs are similar in both situations [3, 4]. Salmonella; Shigella; Yersinia enterocolitica; Campylobacter; Vibrio cholerae; diarrheagenic Escherichia coli pathotypes (DEPs), and viruses represent leading causes of infantile acute diarrhea in both developing and developed countries. DEPs comprise several categories: enteropathogenic E. coli (EPEC), that can be further classified into typical EPEC (tEPEC) and atypical EPEC (aEPEC) depending on the presence or absence of the EAF plasmid (E. coli adherence factor); Shiga-toxin-producing E. coli (STEC); enterotoxigenic E. coli

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Discussion

Conclusion