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.
Highlights
Diarrheal diseases accounted for 8% of all deaths in children under five years of age in 2016, and this translates to over 1300 young children dying each day, or approximately 480,000 childrenInt
The analysis examined the correlation between the predictor variables and each of adenovirus, Salmonella spp., Campylobacter spp., and Entamoeba spp
The utilization of molecular tools in the present study shed light on the potential occurrence of mixed infection between the bacterial pathogens Salmonella spp. and Campylobacter spp., and the same was revealed between various enteric viruses (Table 3)
Summary
Diarrheal diseases accounted for 8% of all deaths in children under five years of age in 2016, and this translates to over 1300 young children dying each day, or approximately 480,000 childrenInt. Diarrheal diseases accounted for 8% of all deaths in children under five years of age in 2016, and this translates to over 1300 young children dying each day, or approximately 480,000 children. Res. Public Health 2019, 16, 1573; doi:10.3390/ijerph16091573 www.mdpi.com/journal/ijerph. Res. Public Health 2019, 16, 1573 a year [1]. In Iraq, the impact of war, sanctions, and sectarian violence left a dysfunctional health system and an on-going public health emergency impacting vulnerable sections of the population, children. Bacterial, and parasitic infections are among the most common causes of acute diarrheal cases in children [2]. Published studies on childhood diarrhea are lacking in
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