Abstract
IntroductionBacterial agents are among pathogens implicated to cause diarrhea in children resulting to huge mortality and morbidities. Bacterial etiologies causing diarrhea in children below five years are rarely investigated in Central Kenya, which would otherwise guide prescription and target health education.MethodsA cross-sectional study approach was applied on 163 randomly selected stool samples from children below five years who presented with diarrhea in Murang`a and Muriranja`s hospitals. The objective was to determine the bacterial agents of diarrhea. Enteric bacterial pathogens were cultured using appropriate media and identified. Statistical analyses were performed using STATA v.13. Chi-square or Fisher exact-test were used to check for evidence of relationship whenever applicable.ResultsThere were nearly equal distributions in gender 86 (52.8%) female vs. 77 (47.2%) male, majority (35.6%) aged between 0-12 months. Bacterial isolates were highly diverse in female than the male, children aged 49-60 months and least among those aged 0-12 months. A total of 188 bacterial isolates belonging to 11 genera were recovered. The predominant bacteria was nonpathogenic Escherichia coli 85 (45.2%), while 13 (6.9%) Escherichia coli were positive for virulence genes, including 8 (4.3%) positive for LT and STp Shiga-like or Enterotoxigenic Escherichia coli, 3 (1.6%) positive for eae and bfpA Enteropathogenic Escherichia coli and 2 (1.1%) positive for Enteroaggregative Escherichia coli gene. Others included: Salmonella 21 (11.2%), Pseudomonas 14 (7.4%), Shigella 14 (7.4%), Klebsiella 12 (6.4%), Aeromonas 8 (4.3%), Enterobacter 7 (3.7%), Proteus 8 (4.3%), Citrobactor 3 (1.6%), Yersinia 2 (1.1%) and Vibrio 1 (0.5%).ConclusionSalmonella was the major bacterial isolate and majority of the bacteria were statistically significant cause of diarrhea (p=0.001).
Highlights
Bacterial agents are among pathogens implicated to cause diarrhea in children resulting to huge mortality and morbidities
A total of 188 bacterial isolates belonging to 11 genera were recovered from stool samples of children under investigation
The predominant bacteria from stool samples was nonpathogenic E. coli 85 (45.2%), while 13 (6.9%) E. coli were positive for virulence genes, including 8 (4.3%) positive for both LT and STp Shiga-like or Enterotoxigenic E. coli (ETEC), 3 (1.6%) positive for eae Enteropathogenic E. coli (EPEC) and 2 (1.1%) positive for aatA enteroaggregative E. coli (EAEC) gene Enteroaggregative E. coli (EAEC)
Summary
Bacterial agents are among pathogens implicated to cause diarrhea in children resulting to huge mortality and morbidities. Conclusion: Salmonella was the major bacterial isolate and majority of the bacteria were statistically significant cause of diarrhea (p=0.001). Despite the efforts in controlling mortality, 9% of all deaths among children below 5 years globally in 2015 were due to diarrhea [2]. The major bacterial pathogens include Escherichia coli, Shigella, Campylobacter, Salmonella, and Vibrio species transmitted mainly through fecal-oral route [1] other enterobacteriaceae have been linked to cause diarrhea. It is crucial, to accurately identify the frequency of the broad range of bacterial diarrheal pathogens as well as their virulence genes to better understand bacterial diversity and pathogenicity. Limited continuous surveillance of bacterial etiologies has led to the narrowing arsenal of antibiotic use posing a devastating threat in treatment and management of bacterial-associated diarrhea
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