aetiology of children diarrhea in tripoli-libya
TRANSCRIPT
-
8/7/2019 Aetiology of Children Diarrhea in Tripoli-Libya
1/23
Aetiology of Children Diarrhoea in
Tripoli, Libya
Khalifa Sifaw Ghenghesh1,
Salaheddin Shaban Abeid1,
Fauzi Bara2, and
Belqis Bukris2.
Dept. of Medical Microbiology1, Faculty of Medicine and
Aljala Children Hospital2,
Tripoli - Libya
Correspondence:
Dr. Khalifa Sifaw Ghenghesh, MSc, PhD, DipBact
Dept. of Medical Microbiology,
Faculty of Medicine,
P.O. Box 80013
Tripoli - Libya
Fax: +218 21 333 4474Tel: +218 21 444 7343
To cite this paper:Ghenghesh KS., Abeid SS., Bara F., and Bukris B. 2001. Aetiology of Childhood
Diarrhea in Tripoli-Libya. Jamahiriya Med J; 1 (2): 23-29.
-
8/7/2019 Aetiology of Children Diarrhea in Tripoli-Libya
2/23
SUMARRY:
During a one year period stool samples from 157 children (72 females) with
diarrhoea (cases) and 157 age-and sex-matched controls were examin-ed for
enteropathogens. The age of the children ranged from a few days to 3 years.
Enteropathogens were detected in 61.1% of cases and 31.2% controls, single pathogen
in 41.4% and 25.5%, rotavirus in 31.9% and 2.2%, Salmonella in 10.8% and 3.8%,
Shigella in 5.7% and 1.3%, Yersinia entero-colitica in 0.6% and 0.0%,
enteropathogenic Escherichia coli (EPEC) in 11.4% and 7.0%, E. coli O157 in 7.0%
and 4.4%, Aeromonas in 14.6% and 17.8% and Campylobacter in 6.3% and 3.1%
respectively. Of these entero-pathogens only Shigella spp. were isolated significantly
more from chidren >12 months and EPEC serogroups were isolated significantly
more from children
-
8/7/2019 Aetiology of Children Diarrhea in Tripoli-Libya
3/23
INTRODUCTION:
Diarrhoea in children is a major health problem. It is the leading cause of
illness and death and an important cause of malnutrition among children in
developing countries (1,2). Diarrhoeal disease also represents an economic burden for
these countries. A number of classical agents are known as causes of diarrhoea in
children. These include rotavirus, Salmonella spp., Shigella spp., enteropathogenic
Escherichia coli, and enterotoxigenic E. coli. Recently, newer agents were added to
the list and include Aeromonas spp., Yersinia enterocolitica and E. coli O157:H7.
Although very few studies were carried out in Libya on the causes of diarrhoeal
disease in children, these studies suffered from a number of drawbacks that include
the search for a single agent only in the population studied, lack of controls and
detailed clinical data (3,4). Therefore, the main objective of this study was to
determine the viral and bacterial agents (including the newly emerging agents) of
diarrhoea and the related clinical features in children with acute diarrhoea and in age-
and sex-matched controls.
-
8/7/2019 Aetiology of Children Diarrhea in Tripoli-Libya
4/23
MATERIALS AND METHODS:
1. Study population:
Included in the study 157 children with diarrhoea (cases) attending the out-
patients clinic in Aljala Children Hospital in the city of Tripoli ( population ~1.250
000) and 157 age- and sex-matched controls. The controls were age-matched within
six months of age. The age of the children ranged from a few days to 3 years. Most
(86%) of children were less than one year of age. The study was carried out between
September, 1992 and August, 1993. Acute diarrhoea was defined as diarrhoea that
started 3 liquid or semi-
liquid stools per day. Stool sample from each control was collected within 5 days
from that of the corresponding case.
Paediatricians of the investigation staff (FB, BB) collected the faecal samples,
noted the consistency and the presence of frank blood or mucus or both, performed
the clinical examination of the patients and controls and obtained the medical history
from the child's parents.
2. Microbiological methods:
To isolate salmonellae, shigellae, yersiniae, enteropathogenic Escherichia coli
(EPEC), E. coli O157:H7, Plesiomonas shigelloides, aeromonads and campylobacters,
stool specimens were cultured directly on the following media: Salmonella-Shigella
Agar (SSA), Yersinia-Selective Medium (YSM), MacConkey Agar, Sorbitol
MacConkey Agar for E. coli O157:H7, Blood Agar (BA), Blood Agar supplemented
with 15mg/L ampicillin (ABA), and Skirrow-Selective Medium (SKM). Specimens
were also inoculated into alkaline peptone water, pH 8.6 (APW), tetrathionate broth
(Tb) and phosphate buffer saline (PBS). With the exception of PBS and the YSM all
media were incubated overnight at 37oC. A loopful from APW was inoculated onto
ABA and a loopful from Tb onto brilliant green agar and both media were incubated
-
8/7/2019 Aetiology of Children Diarrhea in Tripoli-Libya
5/23
for 18-24 hours at 37oC. PBS was incubated at 4oC and loopfuls were taken after 1, 2
and 3 weeks and inoculated onto YSM. The YSM plates were always incubated at
30oC for 48 hours. Suspected colonies from all the media were identified using
standard microbiological procedures (5,6) and the API 20E System (bioMerieux,
France) were appropriate. Strains identified biochemically as Salmonella and Shigella
were serotyped by antisera to O- and H-antigens of Salmonella and Shigella spp.
(Wellcome Diagnostics, UK)
Five-lactose positive and up to 5-lactose negative colonies from each faecal
specimen identified as E. coli were serogrouped using antisera (Eurobio, France) to
the O-antigens of EPEC as recommended by the manufacturer. Sorbitol non-
fermenting strains of E. coli were submitted for agglutination with O157:H7
antiserum (Unipath, UK). Rotavirus was identified with a monoclonal latex
agglutination test (bioMerieux, France). Rotavirus and campylobacters were studied
in 147 and 95 cases and in 90 and 95 controls respectively.
-
8/7/2019 Aetiology of Children Diarrhea in Tripoli-Libya
6/23
RESULTS:
Prevalence of enteropathogens: During a one year period, enteropathogens were
detected in 95 (61.1%) children with diarrhoea (cases) and in 49 (31.2%) controls (P12 months (P< 0.05). On the other hand, enteropathogenic E. coli
serogroups were isolated significantly more from children
-
8/7/2019 Aetiology of Children Diarrhea in Tripoli-Libya
7/23
significantly higher in males [14 of 85 (16.5%)] than in females [3 of 72 (4.2%)]
(P 60 for bacterial infections. Other clinical features were not helpful in predicting
the aetiology of diarrhoea.
Asking the parents of the children with diarrhoea what type of medication or
treatment was given to their child at home showed that 53(33.7%) were given
antibiotics (mainly ampicillin or related antibiotics), 25(15.9%) a combination of
homatropinemethylbromide and phenobarbitone (for the treatment of gastrointestinal
spasms), 36(22.9%) paracetamol and 14(8.9%) were given oral rehydration salts
(ORS).
Parents of children less than 12 months were also asked about the type of
feeding of their children visa-viz breast, artificial or mixed (breast plus artificial
feeding). The results obtained showed a statistically significant association of breast
-
8/7/2019 Aetiology of Children Diarrhea in Tripoli-Libya
8/23
feeding with children without diarrhoea and artificial feeding with diarrhoeic children
(Table 6).
-
8/7/2019 Aetiology of Children Diarrhea in Tripoli-Libya
9/23
DISCUSSION:
The aetiology of childhood diarrhoea in industrialized and developing
countries have been reported by several investigators over the years (7,8,9,10,11).
Nearly all these studies agree on the importance of rotavirus as a major cause of
diarrhoea in children. Our results confirm the findings of these studies and show that
rotavirus is the leading causative agent of diarrheoa in Libyan children. It has been
reported that rotavirus-associated diarrhoea occurs at higher rates in winter in
temperate regions, in the rainy season and in the tropics and subtropics (8,12).
Although, in the present study, rotavirus as well as other infections (i.e. Salmonella,
Shigella, Aeromonas and EHEC) occured at a slightly higher rate in autumn, we
found no significant seasonal variations in the isolation rates of these agents. The
reason for this may be due to the mild winter in our region. However, similar findings
have been reported by others (12).
Of the bacterial agents associated with diarrhoea only Salmonella spp. and
Shigella spp. were isolated significantly more from cases than from controls. A study
on Salmonella isolations from human faecal samples obtained between 1975-1980
from cases of diarrhoea in hospitals and clinics in Tripoli identified 34 different
Salmonella serotypes, by far the most common being S. wein and S. muenchen (4). In
our study only 8 serotypes were detected with the predominance of S. saintpaul.
Furthermore, S. hadar was not among the 34 serotypes identified in the above
mentioned study. These differences could be due to differences in the age of the
populations studied and in the duration of the both studies. However, we have no
explaination to the isolation ofSallmonella from males at a rate significantly higher
than that of females.
Only Sh. sonnei and Sh. flexneri were isolated in the present work with the
later predominating. Similar findings were reported from Algeria and other Arab
countries (13, 14, 15). An outbreak of shigellosis occured recently in a Libyan family
of 8 members, we isolated Sh. flexneri from 5 members and from the contaminated
water used for drinking by all members of this family (16). The isolation of Y.
-
8/7/2019 Aetiology of Children Diarrhea in Tripoli-Libya
10/23
enterocolitica from one case only indicates that this organism may have no role in
children dirrhoea in Tripoli area.
Contrary to developing countries diarrhoeagenic E. coli are not an important
causes of diarrhoea in industralized countries (17,18). In a recent study from Italy E.
coli O157:H7 was not deteced and EPEC serogroups were isolated from a small
number (1.3%) of stool samples from children with diarrhoea (7). The isolation ofE.
coli O157:H7 and EPEC serogroups from 7% and 11.4 of cases respectively confirms
the importance of these organisms in the causation of children diarrhoea in our region.
Furthermore, the predominance of EPEC serogroups O119 and O126 is in contrast to
reports from other developing countries were other serogroups (e.g. O111) dominates
(19).
The findings of the present study of EPEC serogroups in diarrhoeic children 12 months are similar to reports from other
developing countires (19, 20).
Aeromonas spp. are being increasingly recognized as agents of children
diarrhoea (21,22). As in other studies (7) we isolated Aeromonas spp. more frequently
from controls than from cases. This could be due to the presence of these organisms in
sources of water used for drinking in Tripoli area (23). The finding that A. caviae as
the predominant species in Libyan children with and without diarrhoea is in line with
other reports (21,24).
It is widely accepted that ORS is the corner stone in the treatment of mild
childhood diarrhoea. Furthermore, the World Health Organization is promoting the
use of ORS in all cases of severe diarrhoea including that due to Vibrio cholerae (25).
Studies have also shown that antibiotics are not indicated in uncomplicated, non-
typhoid salmonellosis and may prolong the excretion of salmonellae (26). The low
rate (< 9%) of Libyan parents using ORS and their high rate (>30%) of using
antibiotics in the treatment of diarrhoeic children demonstrates the seriousness of the
problem of diarrhoeal disease in our area. Furthermore, the problem is aggrevated still
more by the use of artificial feeding by mothers of diarrhoeic children aged less than
-
8/7/2019 Aetiology of Children Diarrhea in Tripoli-Libya
11/23
one year as shown by our findings (Table 6).
As it has been reported previously (7) the presence of blood in stools of
children with diarrhoea had a high positive predictive value for bacterial infections.
With the exception of seizures, clinical presentation was not sufficiently
characterisitic to assist in the presumptive diagnosis of a specific pathogen. These
findings confirm those reported by others (7).
In conclusion, this study is the first of its kind to be carried out in Libya. It
confirms the role of the well known agents (rotavirus, Salmonella, Shigella) in
children diarrhoea in Tripoli area. The isolation ofE. coli O157:H7 and Aeromonas
spp. has not been reported previously in children in Libya and will serve as a basis for
comparison with future studies in this country and elsewhere. The misuse of
antibiotics and the lack of using ORS in the treatment of children diarrhoea in the
population studied demonstrates the need for a vigorous educational programme that
promotes the benefits of using ORS and breast feeding. More studies are needed to
determine the role of other enteric agents (e.g. enterotoxigenic E. coli, Giardia
lamblia, etc.) in childhood diarrhoea. Furthermore, studies are also needed to
determine the virulence factors of new enteric agents (e.g. Aeromonas spp. and E. coli
O157:H7) to clarify their role in diarrhoeal disease in developing countries.
-
8/7/2019 Aetiology of Children Diarrhea in Tripoli-Libya
12/23
ACKNOWLEDGEMENT:
Dr. K.S. Ghenghesh would like to thank Dr. F. El-Sager for his encouragment in
putting this work in writing.
-
8/7/2019 Aetiology of Children Diarrhea in Tripoli-Libya
13/23
REFERENCES:
1. Guerrant RL., Hughes JM., Lima NL., Crane J. Dirrhoea in developed and
developing countries: magnitude, special setting, and etiologies. Rev. Infect. Dis.
1990; 12 (Suppl.): 41-50.
2. Bern C., Martines J., de Zojsa I., Glass RI. The magnitude of the global problem of
diarrhoeal disease: a ten-year update. Bull World Health Organ. 1992; 70: 705-714.
3. Giasuddin ASM., Boryswick G., Abusedra A. Rotavirus-associated diarrhoeal
disease in Libyan infants up to one year of age. J. Islamic Academy Sci. 1990; 3: 218-
220.
4. El-Nageh MM. Salmonella isolations from human faeces in Tripoli, Libya. Trans.
R. Soc. Trop. Med. Hyg. 1988; 82: 324-326.
5. Collee JG., Duguid JP., Fraser AG., Marmion BP. Practical Medical Microbiology
(13 ed). Churchill Livingstone, Edinburgh 1989.
6. Carnahan AM., Behram S., Joseph SW. Aerokey II: a flexible key for identifying
clinical Aeromonas species. J. Clin. Microbiol. 1991; 29: 2843-2849.
7. Caprioli A., Pezzella C., Morelli R., et al. Enteropathogens associated with
childhood diarrhoea in Italy. Pediatr. Infec. Dis. J. 1996; 15: 876-883.
8. Kapikian AZ., Hyun WK., Wyatt RG., et al. Human reovirus-like as the major
pathogen associated with "winter" gastroenteritis in hospitalized infants and young
children. N. Eng J Med. 1976; 294: 965-972.
9. Ogunsanya TI., Rotimi VO., Adenuga A. A study of the aetiological agents of
childhood diarrhoea in Lagos, Nigeria. J. Med. Micobiol. 1994; 40: 10-14.
10. San Pedro MC., Walz SE. A comprehensive survey of pediatric diarrhoea at a
private hospital in Metro Manila. Southeast Asean J. Trop. Med. Public Health 1991;
22: 203-210.
11. Uhnoo I., Wadell G., Svensson L., Olding-Stenkvist E., Ekwall E., Mollby R.
Aetiology and epidemiology of acute gastroenteritis in Swedish children. J. Infec.
1986; 13: 73-89.
12. WHO Scientific Working Group on Viral Diarrhoeas. Report of the scientific
-
8/7/2019 Aetiology of Children Diarrhea in Tripoli-Libya
14/23
working group on viral diarrhoeas: active and passive immunity to viral diarrhoeas
with special reference to rotavirus diarrhoea. WHO/CDD/VID/84.2, 1984.
13. Shkarin VV, Ouchfoun A, Minaev VI, Naceur D. Epidemiology of bacillary
dysentery in Algeria. I. The epidemiological aspects of dysentery in Algeria (in
Russian). Zh. Mikrobiol. Epidemiol. Immunobiol. 1983; 3: 49-53.
14. al-Eissa y, al-Zamil F, al-Kharashi M, Kambal A, Chowdhury M, al-Ayed I. The
relative importance of Shigella in the aetiology of gastroenteritis in Saudi Arabia.
Scand. J. Infect. Dis. 1992; 24: 347-351.
15. Rawashdeh MO, Ababneh AM, Shurman AA. Shigellosis in Jordanian children: a
clinico - epidemiologic prospective study and susceptibility to antibiotics. J Trop
Pediatr1994; 40: 355-359.
16. Ghenghesh KS., Abeid SS., Zelitini M. A family outbreak of bacillary dysentry
due to untreated sewage from a hospital. J. Hosp. Infec. 1998; 40 (Suppl. A): Abstract
P.3.6.3.3.
17. Morelli R., Baldassari L., Falbo V., Donelli G., Capriolo A. Detection of
enteroadherant Escherichia coli associated with diarrhoea in Italy. J. Med. Microbiol.
1994; 41: 399-404.
18. Rademaker CMA., Fluit AC., Jansze M., Jansen WH., Glerum JH., Verhoef J.
Frequency of enterovirulent Escherichia coli in diarrhoeal disease in the Netherlands.
Eur. J. Clin. Microbiol. Infec. Dis. 1993; 12: 93-97.
19. Regua Mangia AH., Duarte AN., Duarte R., Silva LA., Bravo VLR., Leal MC.
Aetiology of acute diarrhoea in hospitalized children in Rio de Janeiro City, Brazil. J.
Trop. Pediatr. 1993; 39: 365-367.
20. World Health Organization Scientific Working Group. Escherichia coli diarrhoea.
Bull World Health Organ. 1980; 58: 23-36.
21. San Joaquin VH., Pickett DA. Aeromonas-associated gastroenteritis in children.
Pediatr. Infect. Dis. J. 1988; 7: 53-57.
22. Wilcox MH., Cook AM., Eley A., Spencer RC. Aeromonas spp. as a potential
cause of diarrhoea in children. J. Clin. Pathol. 1992; 45: 959-963.
-
8/7/2019 Aetiology of Children Diarrhea in Tripoli-Libya
15/23
23. Ghenghesh KS., El-Gharai A., Altomi, AS., Dkakni RS., Abeid SS. Isolation and
haemolytic activity ofAeromonas species from untreated drinking water supplies. 7th
International Symposium on Microbial Ecology, Santos, Sao Paulo, Brazil 1995: 124.
24. Figura N., Marri L., Verdiani S., Ceccherini C., Barberi A. Prevalence, species
differentiation, and toxigenicity of Aeromonas strains in cases of childhood
gastroenteritis and in controls. J. Clin. Microbiol.1986; 23: 595-599.
25. WHO. Cholera in 1994. Weekly Epidemiological Record1995; 70: 201-211.
26. Browmer EJ. The challenge of sallmonellosis. Major public health problem. Am.
J. Med. Sci. 1964; 247: 467-501.
-
8/7/2019 Aetiology of Children Diarrhea in Tripoli-Libya
16/23
Table 1. Prevalence of potential enteropathogens in stools of 157
children with diarrhoea (cases) and in 157 controls
-----------------------------------------------------------------------------------------------------
No. (%) of isolates in
Enteropathogen Cases Controls P value
-----------------------------------------------------------------------------------------------------Single 65 (41.4) 40 (25.5) 0.004
Multiple 30 (19.1) 9 (5.7) 0.0003
any pathogen 95 (61.1) 49 (31.2) 0.0000003
Rotavirus* 47 (31.9) 2 (2.2) 0.0000000
Salmonella 17 (10.8) 6 (3.8) 0.017
Shigella 9 (5.7) 2 (1.3) 0.03
Yersinia enterocolitica 1 (0.6) 0.0 (0) NS**
Enteropathogenic E. coli 18 (11.4) 11 (7.0) NS
E. coli O157 11 (7.0) 7 (4.4) NS
Aeromonas 23 (14.6) 28 (17.8) NS
Campylobacter* 6 (6.3) 3 (3.1) NS-----------------------------------------------------------------------------------------------------
*Rotavirus and Campylobacterwere studied in 147 and 95 cases and
in 90 and 95 controls respectively.
** Not significant.
-
8/7/2019 Aetiology of Children Diarrhea in Tripoli-Libya
17/23
Table 2. Serotypes ofSalmonella isolated from 157 children
with diarrhoea (cases) and from 157 controls.
_______________________________________________
No. of each serotype isolated from
Serotype Cases Controls Total
-------------------------------------------------------------------------------------S. saintpaul 7 1 8
S. wein 3 1 4
S. newport 2 - 2
S. muenchen 1 1 2
S. hadar 1 1 2
S. reading 1 1 2
S. typhimurium 1 1 2
S. kottbus 1 - 1
-------------------------------------------------------------------------------------
Total 17 6 23
_______________________________________________
-
8/7/2019 Aetiology of Children Diarrhea in Tripoli-Libya
18/23
Table 3. Serogroups of enteropathogenic E. coli isolated
from children with diarrhoea (cases) and from controls
in Tripoli-Libya.
------------------------------------------------------------------------------
No. (%) of isolates in
Serogroup Cases Controls(n=157) (n=157)
------------------------------------------------------------------------------
O1 1 (0.6) 1 (0.6)
O18 1 (0.6) -
O44 - 1 (0.6)
O55 2 (1.3) -
O114 2 (1.3) -
O119 5 (3.2) 1 (0.6)
O125 1 (0.6) 1 (0.6)
O126 4 (2.5) 2 (1.3)
O127a - 1 (0.6)O128 2 (1.3) 1 (0.6)
O146 1 (0.6) 2 (1.3)
O166 - 1 (0.6)
------------------------------------------------------------------------------
Total 19 (12.1)* 11 (7.0)
------------------------------------------------------------------------------
*Two different serogroups were isolated from one case.
-
8/7/2019 Aetiology of Children Diarrhea in Tripoli-Libya
19/23
Table 4. Clinical features and stool characteristics of children with
diarrhoea according to age.
________________________________________________________
Feature/ < 6 months 6-11 months > 1 year Total
Character (n=83) (n=50) (n=24) (n=157)
-----------------------------------------------------------------------------------------------------Fever 28(33.7) 22(44) 12(50) 62(39.5)
Vomiting 32(38.6) 20(40) 11(45.8) 63(40.1)
Dehydration 10(12) 7(14) 0.0 17(10.8)
Seizures 2(2.4) 1(2.0) 2(8.3) 5(3.1)
Stool with:
frank blood 5(6.0) 4(8.0) 4(16.6) 13(8.2)
mucus 31(37.3) 15(30) 12(50) 58(36.9)
_________________________________________________________
-
8/7/2019 Aetiology of Children Diarrhea in Tripoli-Libya
20/23
Table 5. Predictive values positive of some stool and clinical features for rotavirus,
bacterial and combined infections, and for unknown aetiology.
_____________________________________________________________
Predictive Values (%) Positive for*
Feature ---------------------------------------------------------------------------
Rotavirus Bacterial** Combined rotavirus Unknowninfection infection & bacterial infection aetiology
_____________________________________________________________
Blood (n=13) 0.0 61.5 7.7 30.8
Mucus (n=58) 17.2 41.4 8.6 32.8
Fever (n=62) 22.6 32.3 9.7 35.5
Vomiting (n=63) 25.4 23.8 12.7 38.1
Dehydration (n=17) 11.8 29.4 23.5 35.3
Seizures (n=5) 20.0 60.0 20.0 0.0
_____________________________________________________________
* Number of cases with the feature and a given type of infection divided by totalnumber of cases with the feature.
**Includes infection with Salmonella, Shigella, Campylobacter, Yersinia
enterocolitica, enteropathogenic E. coli, E. coli O157 and Aeromonas .
-
8/7/2019 Aetiology of Children Diarrhea in Tripoli-Libya
21/23
Table 6. Type of feeding of 131 children with dirrhoea
aged < 12 months and 131 age- and sex- matched controls.
___________________________________________________
Children with
Type of feeding diarrhoea without diarrhoea P value
___________________________________________________Breast 17(12.5) 32(24.4) 0.017
Mixed* 24(18.3) 31(23.7) NS**
Artificial 90(68.7) 68(51.9) 0.005
___________________________________________________
*Breast plus artificial feeding. **NS=not significant
-
8/7/2019 Aetiology of Children Diarrhea in Tripoli-Libya
22/23
Aetiology of Childhood Diarrhoea in Tripoli - Libya
Khalifa Sifaw Ghenghesh1*, Fauzi Bara2, Belqis Bukris2, and Salaheddin S. Abeid1
Dept. of Medical Microbiology1, Faculty of Medicine and Aljala Children Hospital2,
Tripoli - Libya
Diarrhoea in children is a major health problem. It is a cause of high mortalityand morbidity in developing countries. The present study was carried out to determine
the aetiology of diarrhoea in Libyan children in Tripoli area. Included in the study 157
children with diarrhoea (cases) and 157 age- and sex-matched controls. The age of the
children ranged from a few days to 3 years. Most (86%) of the children were less than
one year of age. The study was carried out between September, 1992 and August, 1993.
Standard methods were used to detect enteropathogens ( bacterial agents and rotavirus)
in the stool specimens. Rotavirus and Campylobacter spp were studied in 147 and 95
cases and in 90 and 95 controls respectively. Parasitic agents were not looked for in the
present study.
Rotavirus was detected in 35% of cases and 2% of controls, Salmonella spp. in
11% and 4%, Shigella spp. in 6% and 1%, Aeromonas spp. in 15% and 18%,
Campylobacter spp. in 6% and 3%, Yersinia enterocolitica in 0.6% and 0.0%,enteropathogenic E. coli in 14% and 8%, and enterohaemorrhagic E. coli (serogroup
O157:H7) in 7% and 4% respectively. The results obtained shows that rotavirus is the
leading causative agent of gastroenteritis in the population studied. Also Salmonella and
Shigella spp. were isolated significantly more from diarrhoeal cases than from controls
(P< 0.05, Chi-square test).
Table . Signs and symptoms among children with diarrhoea, by pathogen identified in
stool.
_____________________________________________________________
% of Cases with
Pathogen Identified*---------------------------------------------------------------------------Fever Vomiting dehydration Blood Mucus
_____________________________________________________________
Rotavirus (n=31) 45.2 48.4 6.5 0 35.5
Salmonella (n=8) 25 25 12.5 12.5 37.5
Shigella (n=6) 66.7 16.7 0.0 16.7 66.7
Aeromonas (n=11) 36.4 27.3 18.2 0.0 27.3
EPEC (n=3) 66.7 66.7 33.3 0.0 33.3
EHEC (n=4) 25 0.0 0.0 0.0 25
Campylobacter (n=3) 66.7 33.3 0.0 0.0 66.7
No pathogen (n=62) 36.5 38.1 9.5 6.3 28.6
_____________________________________________________________* Cases who had only one pathogen identified in stool.
E. coli:
Cases (A) Controls (B)
06 -2
06 -5
29
32
167 -1
112137
-
8/7/2019 Aetiology of Children Diarrhea in Tripoli-Libya
23/23
145
125
85
56
166
6471
113
101
51 -2
51 -4
54
83
132
165
38
4062
58
67
72
82
142
167 -7
155
136
165