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Abstract
Diarrheal disease is a major public health problem for children in developing countries. Knowledge of etiology that causes diarrheal illness is essential to implement public health measures to prevent and control this disease. Published studies regarding the situation of childhood diarrhea in Sudan is scanty. This study aims to investigate viral and bacterial etiology and related clinical and epidemiological factors in children with acute diarrhea in Khartoum State, Sudan. A total of 437 fecal samples were collected from hospitalized children <5 years old with acute diarrhea, viral and bacterial pathogens were investigated by using two-tube multiplex RT-PCR. The genotypes of adenovirus and bocavirus were determined by sequencing. Viral diarrhea was identified in 79 cases (62 single and 17 co-infections) (18%), and bacterial diarrhea in 49 cases (37 single and 12 co-infections) (11.2%). Mixed infections in both groups totaled 19 samples (4.3%) with more than one pathogen, they were viral co-infections (n = 7, 36.8%) bacterial co-infections (n = 2, 10.5%) and viral bacterial co-infection (n = 10, 52.6%). Rotavirus (10.2%) was predominantly detected, followed by norovirus G2 (4.0%), adenovirus (1.6%), bocavirus (1%), and norovirus G1 (0.9%). Infection with astrovirus was not detected in this study. The Shigella –Enteroinvasive E.coli (EIEC) (8.9%) was the predominantly found bacterial pathogen, followed by Vibrio parahaemolyticus (0.9%), enterohaemorrhagic E.coli (EHEC) –Enteropathogenic E. coli (EPEC) (0.6%) and Salmonella enteritidis (0.6%). V. cholerae, Yersinia enterocolitica and Campylobacter jejuni were not detected in this study. The phylogenetic tree identified adenovirus belonged to genotype 41 and bocavirus belonged to two different clades within human bocavirus 1. Our findings represent the first report that adenovirus 41 is a cause of diarrhea in Sudan and that human bocavirus 1 is the principal bocavirus strain circulating in Sudan. In conclusion, this is the first comprehensive report to elaborate the pathogen spectrum associated with childhood diarrhea in Khartoum State, Sudan. The results obtained in the present study highlighted the current epidemic situation, the diverse pathogens related to childhood diarrhea, and the importance and the urgency of taking appropriate intervention measures in Khartoum State, Sudan.
Highlights
Diarrhea has been defined as the passing of watery stool more than three times in 24 h, usually caused by consumption of contaminated food or drinks containing any of various pathogens (Vargas et al, 2004)
Published studies regarding the problem of childhood diarrhea in Sudan are scanty, with only two reports had indicated that rotaviruses and diarrheagenic Escherichia coli (DEC) were common causes of childhood diarrhea (Mustafa et al, 2012; Elhag et al, 2013)
The aim of the present study is to identify the occurrence of viral agents and bacterial agents (Shigella, DEC, Vibrio parahaemolyticus, Salmonella, Yersinia, Vibrio cholerae, and Campylobacter) in children with diarrhea
Summary
Diarrhea has been defined as the passing of watery stool more than three times in 24 h, usually caused by consumption of contaminated food or drinks containing any of various pathogens (Vargas et al, 2004). More than 1 billion diarrhea episodes and approximately 2.5 million deaths occur in children under 5 years of age in developing countries (Vargas et al, 2004; Chen et al, 2012; Kotloff ’s et al.,2013; Ngosso et al, 2015). Bacterial pathogens come as the second common causes of diarrhea in developing countries, and such bacteria include Escherichia coli, Shigella spp., Campylobacter spp., Salmonella spp., and Vibrio parahaemolyticus (Somily et al, 2014; Wang et al, 2014). The aim of the present study is to identify the occurrence of viral agents (rotavirus, norovirus G1, norovirus G2, adenovirus, astrovirus, and human bocavirus) and bacterial agents (Shigella, DEC, Vibrio parahaemolyticus, Salmonella, Yersinia, Vibrio cholerae, and Campylobacter) in children with diarrhea. The study aims to investigate the association of particular risk factors, such as age and gender of the patient, the use of antibiotic, and clinical features with the occurrence of the enteropathogens detected
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