Intestinal Bacteria and Parasites Associated with Diarrhea in Infants and Children in Zakho City, Kurdistan Region, Iraq

Abstract


 Intestinal parasites and bacteria especially enteropathogenic Escherichia coli (EPEC) are important causative agents responsible for persistent diarrhea in infants and children worldwide due to their high occurrence in both the hospitals and community settings. However, sporadic outbreaks by these microorganisms occur globally. This study was conducted from August 2021 to January 2022, during which 500 diarrheic stool samples were collected from both genders and various ages (6 month to 12 years) from outpatient in Zakho hospital. In this study the total rate of infection was 64.2% (321/500), considerable number of samples were positive for more than one species of microorganisms, elevating the rate to 89%, with the highest rate (62%) being with bacteria among which E. coli was the dominant species (74.84%), while the rate with parasites was 27%, with E. histolytica being the dominant species (45.93%). Other recorded bacterial species with their rates are: Klebsiella (15.16%) Pseudomonas spp. and Shigella spp. at rates of 6.13% and 3.87%, respectively. While other parasites included: Cryptosporidium spp. (34.07%), Blastocystis spp. (13.33%), G. lamblia (5.93%) and H. nana (0.74%). Single infections were reported in 61.68% (198/321) of the positive cases with the highest rate (49.53%) of bacteria and only 12.15% with parasites. The dominant organisms in single infections were E. coli and the oocysts of Cryptosporidium spp. at rates of 81.13% and 61.54%, respectively. The mixed infections were documented in 38.32% (123/321). Among these, 67.48% (83/123) showed a combination between bacteria and parasites. The most frequent microorganisms encountered in mixed infections were E. coli and E. histolytica at rate of 33.33%. The total rate of infection in females was higher than that in males (59.19 vs 40.81%), with the highest (77.89%) being among the age group 6 months-2 years. In each gender separately, males of the age group 6 months to 2 years showed the highest rate (62.16%,) whereas females of the age group 9-12 years had the highest rate (51.16%). Statistically the relationships between the rate of infection, age and gender were non-significant (P < 0.294). In conclusions it's obvious that 89 % of diarrheal cases were associated with bacteria, and parasites, with E. coli, Klebsiella, E. histolytica, and Cryptosporidium spp. oocysts as leading microorganisms. About 61.68% were infected with one microorganism and 38.32% with two different species of microorganisms and the prevalence rate of microbes was found to be sex and age independent. Therefore, it is recommended to disseminate the health education and sanitary application programs among the community.