Microbial Agents Responsible for Diarrheal Infections in Flood Victims: A Study from Karachi, Pakistan

Abstract

The present study was aimed to determine the frequency of water borne diarrheal infections and gastroenteritis in two of the flood affected camps of Karachi and nearby areas. Each year approximately, 579,732 people are adversely affected by this phenomenon, putting Pakistan 9th in terms of flood-affected countries worldwide. Patients and Methods: All patients suffering from diarrhea (more than 3 stools per day for the last 2 days), abdominal pain, vomiting or fever who were residing in the camps were included in the study. After taking consent, a fresh stool sample for D/R and C/S, and 5 ml of venous blood sample for CP and ALT and other viral markers were collected from each patient suffering from any of the symptoms like jaundice, diarrhea, vomiting, fever and abdominal pain during past 2 -3 days. Direct microscopy of the stools was done to see any protozoal or bacterial infection. Culture of stool was also set up simultaneously. Hemoglobin % age was noted for each patient. Serology of Hepatitis E and A virus using ELISA (Anti HEV-IgM, and anti HAV IgM) was done in those with more than 2 times raised ALT level. Results: A total of 500 samples collected from refugee camps of flood affected areas near Karachi were included in this study. All patients were mal nourished, having below normal Hb% ages, and were suspected cases or patients of diarrhea with elevated ALT (Alanine Transaminase) values. Occult blood was found positive in 40% (200) specimens; protozoa were also seen i.e., trophozoit stage of Giardia lamblia in 45% (225) of specimens; Entamoeba coli in 95% (475) and Balantidium coli in 20% (100) of stool specimens, while cyst forms of Entamoeba histolytica were present in 35% (175) specimens. Bacteriological analysis showed high bacterial prevalence of E. coli with 63% (315), followed by Enterobacter specie with 55% (275), then 20% (100) and 12% (60) of Klebseilla oxytoca and Klebseilla S. T. Hakim et al. 107pneumoniae respectively. Proteus vulgaris and Citrobacter freundii found in the same ratio of 8% (40, 39) with 2% (10) specimens of no microbial growth. Overall <0.05 P value and 95% of confidence interval level was observed. Further serological evidences for water associated viral hepatitis revealed 4% (20) positive specimens for anti-HEV IgM antibodies, and 2.6% (13) positive specimens of anti-HAV IgM antibodies. Conclusion: The present study reveals the presence of HEV and HAV associated viral diarrhea along with the presence of protozoal and bacterial infections in the flood relief camps. It is suggested that there is a strong need of natural disaster associated awareness program for general population in order to minimize the mortality and morbidity ratio associated with diseases, which can be easily controlled by managing proper sanitary conditions and supply of safe and clear water.

Prevalence of rotavirus, adenovirus, hepatitis A virus and enterovirus in water samples collected from different region of Peshawar, Pakistan

“…Poor water and sewage systems are considered to be the main reasons for Hepatitis A and E infection endemic in Pakistan [20]. The results of the current study are in line with previous reports indicating high pervasiveness of diarrheal viruses in the developing countries of Asia, such as Pakistan, Bangladesh, India, Nepal, Vietnam, and even in China [21]. Poor distribution of water and the open drainage system in Peshawar; especially during the raining season when an overflow of drainage water can contaminate not only the drinking water pipeline, but also viruses accumulate on the ground water resources [22] and are cause for great alarm.…”

Assessment of Groundwater Quality and Associated Health Risks in Rural Areas of Sindh (Pakistan)

“…Analysis data showed that in presented study alkalinity ranged from 120-513 mg/L. Literature showed that elevated concentration of chloride may create problems in throat and digestive system along with imparting saline taste and corrosion problems [25]. Presented data showed that Cl ranged from 23-8575 mg/l and overall 49% water samples have high concentration of Cl than GVs.…”

Investigation of Portable Groundwater Quality and Health Risk Assessment of Selected Trace Metals in Flood Affected Areas of District Rajanpur, Pakistan

“…Similarly, higher contents of Cl in drinking water may create problems in throat and digestive system along with imparting saline taste and corrosion [23]. Alkalinity is also an important parameter of water quality but its concentration beyond certain limit causes many problems like hardness, kidney stone, gas trouble, damage of metallic pipes and severe irritation of skin, eyes and mucous membrane [24].…”