Enteropathogenes Associated with Acute Diarhoea in Malnourished Children

Abstract

The aetiology of enteropathogens in acute diarrhoea in patients and controls was studied to demonstrate the influence malnutrition and the role of seasonal and socio-economic factors in the isolation rate of enteropathogens. A prospective series of 157 patients admitted with diarrhoea and 151 controls both groups, comprising malnourished and well nourished, were investigated during 1 year period (March-1988-April 1989) at The Children Emergency Hospital, Khartoum. 4 Pathogenic micro-organisms were identified in the stool specimens of 46% of the total studied population. 85.6% malnourished patients and 46.1% well nourished patients excreted pathogens, but only 15.7% and 8.8% malnourished and well nourished control respectively excreted enteropathogns. Enteropathogenic E. coli (EPEC) and Rota viruses (R.V.) were detected most frequently about 32.2% and 23.1% respectively in the index cases, and 9.6% of malnourished control excreted EPEC and 5.9% R.V. excreted R.V. The latter was not excreted by a well nourished controls. The recovery of these pathogens was independent of the nutritional status. Pathogenic bacteriae (Salmonella, Shigella, Campylobacter jejuni and Kelbsiella) were almost exclusively identified in small number in PEM patients with diarrhoea. Gardia lamblia was excreted in 7.5% of the total 308 children however, predominantly i.e, 13.5% in PEM with acute diarrhoea. Entamoebae histolytica were isolated in 2.5% of PEM patients. Multiple organisms were isolated in 35.0% of PEM patients with acute diarrhoea and in 10.3% well nourished patients with acute diarrhoea. Whereas in the control group only PEM children excreted multiple organisms. R.V. age distribution was between 7-12 months. Seasonal clustering occurred between November and January, the cold dry season in Khartoum, whereas EPEC had a later age of presentation, after the 2nd year of age. Its seasonal clustering was between July and October, the hot rainy season. No difference in severity of dehydration was found between EPEC and R.V. infections. Type of feeding, family size, mother’ pregnancy and education influenced the rate 5 of isolation of EPEC, G. lamblia & Campylobacter jujeni, whereas R.V. infection was found to be independent of these variables. Marasmus had an earlier age of presentation, than kwashiorkor, which had a late presentation. Both were highly prevalent. The duration of diarrhoea was longer and it occurred more frequently in children with PEM, who also sustained a severer degree of dehydration than well nourished children. Malnourished children were admitted with other illnesses particularly tuberculosis and measles.