Gastroenteritis in Children: A Two-Year Review in Manitoba. I. Etiology

Abstract

During two years, 1,217 children hospitalized with gastroenteritis at the Children's Centre in Winnipeg, Manitoba, Canada were studied. Bacterial pathogens were present in 25% of these children: enteropathogenic Escherichia coli in 120, Shigella in 139, Salmonella in 24, and multiple pathogens in 18. Rotavirus was detected in 54 (11%) of 472 patients examined. Rotavirus and enteropathogenic E. coli were the most common pathogens in infants, and Shigella was the most common in older children. Bacterial diarrhea occurred more commonly in summer, whereas rotavirus infection occurred more commonly in winter. Among 276 children screened, enterotoxigenic E. coli was found in three, and Aeromonas shigelloides that produced a similar toxin in two others. Enteroinvasive E. coli was not detected in 70 children. Organisms producing toxins "cytotoxic" to HeLa cells were isolated from three of 90 children. Screening for enterotoxigenic or enteroinvasive organisms was not productive of a significant number of pathogens, and, although screening for rotavirus did improve the number of etiologic diagnoses, the etiology of the majority of cases of diarrhea remained unknown.

Escherichia colidiarrhoea

“…A study of Boston children suggested that ETEC were unimportant (Echeverria, Blacklow & Smith, 1975) and studies in Canada reached the same conclusion (Gurwith & Williams, 1977). In Europe a Swedish study and a small survey in Britain found that ETEC were uncommon as a cause of indigenous sporadic diarrhoea in those countries (Back, Blomberg & Wadstrom, 1977;Gross, Scotland & Rowe, 1979) and ETEC were not found in a Swiss study of 119 adults with diarrhoea (Loosli et al 1985).…”

“…Although outbreaks of EPEC enteritis now appear to be uncommon in temperate areas with good standards of hygiene, it has been shown that EPEC are still a common cause of enteritis in tropical countries (Maiya et al 1977) and among communities with poor standards of hygiene (Gurwith & Williams, 1977). The epidemiology of EPEC enteritis in tropical countries differs from that in Europe and North America in that although outbreaks in institutions are often reported in the tropics, sporadic cases and outbreaks occur more frequently in the community.…”

Differential Yield of Pathogens from Stool Testing of Nosocomial versus Community‐Acquired Paediatric Diarrhea

“…The identified contribution of bacteria in this study of 19.4% for CAD and 23.3% for NAD is in the higher end of the documented rates of bacterial diarrheas in children of developed countries, which have ranged from 5.1% to 31% (6,(8)(9)(10)12,21,27,33,36,(42)(43)(44). Bacterial culture was positive in 10.6% CAD specimens, with E coli identified as the most common non-C difficile bacteria, present in 3% of CAD episodes.…”

“…Knowledge of etiological agents of infectious diarrhea at a particular institution may help to determine focused empirical therapy and to choose the appropriate stool tests, possibly reducing the cost of hospitalization without affecting patient care. Previous studies in other localities have documented significant site to site differences with respect to the types of pathogens causing paediatric infectious diarrhea (5-12), but have not clearly differentiated community-acquired diarrhea (CAD) from nosocomial diarrhea (NAD) (5)(6)(7)9,11). A wide range of viral, bacterial and parasitic causes of infectious diarrhea are now recognized.…”

Virulence factors in environmental isolates of aeromonas spp..

“…The enterotoxin production of Aeromonas strains was measured by the suckling mouse test (10). Filtered supernatants (100 l) of the respective bacterial cultures were administered into the stomachs of 3-to 5-day-old mice.…”