Clinic-Based Surveillance for Bacterial- And Rotavirus-Associated Diarrhea in Egyptian Children

Abstract

To identify enteropathogens for vaccine development, we implemented clinic-based surveillance for severe pediatric diarrhea in Egypt's Nile River Delta. Over 2 years, a physician clinically evaluated and obtained stool samples for microbiology from patients with diarrhea and less than 6 years of age. In the first (N = 714) and second clinic (N = 561), respectively, 36% (N = 254) and 46% (N = 260) of children were infected with rotavirus, enterotoxigenic Escherichia coli (ETEC), Campylobacter, or Shigella. When excluding mixed rotavirus-bacterial infections, for the first and second clinic, 23% and 10% had rotavirus-associated diarrhea, and 14% and 17% had ETEC-associated diarrhea, respectively. Campylobacter-associated diarrhea was 1% and 3%, and Shigella-associated diarrhea was 2% and 1%, respectively, for the two clinics. Rotavirus-associated diarrhea peaked in late summer to early winter, while bacterial agents were prevalent during summer. Rotavirus-associated cases presented with dehydration, vomiting, and were often hospitalized. Children with Shigella- or Campylobacter-associated diarrhea reported as watery diarrhea and rarely dysentery. ETEC did not have any clinically distinct characteristics. For vaccine development and/or deployment, our study suggests that rotavirus is of principle concern, followed by ETEC, Shigella, and Campylobacter.

Increase in the detection rate of viral and parasitic enteric pathogens among Egyptian children with acute diarrhea

“…Despite this, only a few studies report the burden of enteric viruses in North Africa [13,22]. This report, the first comprehensive surveillance describing etiologies of enteric viruses and parasites from children with diarrhea seeking medical care, demonstrated that inclusion of additional laboratory tests significantly The previous publication by our colleagues [7] characterized the frequency of bacterial etiologies of diarrhea in the same region, but in our study, additional analyses illustrated the significance of enteric viral infection in the first year of life in Egyptian children, both as a sole pathogen and as part of what may be a true polymicrobial infection. Also, low prevalence of enteric viruses was observed among children older than a year, which could be partly due to acquired immunity through previous exposures.…”

“…For the majority of these studies, the detection of enteric pathogens was limited to bacteria, and in some studies, Cryptosporidium and RV [5,7,19]. Overall pathogen identification in diarrheal stools was almost 50%.…”

“…From 2005 to 2007, stool and rectal swab specimens were collected from children with diarrhea (n = 2,112) presenting to two referral outpatient hospital clinics, one in Manshayet Nasser, Cairo, the second, Abu Homos General Hospital in the Nile Delta, using previously described methods [7]. Diarrhea was defined as the occurrence of at least three non-formed stools (or a minimum of one, if bloody) in a 24-hour period.…”

“…Determination of the frequency of diarrhea in an area, along with the proportion of disease caused by specific enteric agents of different origins, is considered the first step in controlling diarrheal diseases [3]. Of the bacterial infectious agents causing watery diarrhea, enterotoxigenic Escherichia coli (ETEC) has repeatedly been found in longitudinal and cross-sectional epidemiological surveillance studies to be one of the major pathogens afflicting children aged less than 5 years [4][5][6][7]. In Egypt, other common bacterial pathogens associated with diarrhea include Campylobacter spp.…”

Molecular Characterization of Diarrheagenic Escherichia coli from Libya

“…52 Recently, an ETEC colonization factor was identified in 49% of ETEC isolates from Egypt. 53 In this study CFs were identified in 37.5% (3 of 8) of the ETEC strains examined. Previous studies from Egypt reported closely similar findings with the predominance of CFA/IV, especially CS6 in ETEC strains.…”