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Enteropathogens associated with acute diarrheal disease in urban infants in São Paulo, Brazil
T A Gomes1, V Rassi, K L MacDonald
1Department of Microbiology, Immunology, and Parasitology, Escola Paulista de Medicina, Hospital Infantil Menino Jesus, Brazil.
Insights
Enteropathogenic Escherichia coli (EPEC) and rotavirus are leading causes of acute infantile diarrhea in São Paulo. EPEC prevalence increases with younger age and peaks in spring, while rotavirus peaks in colder months.
Area of Science:
- Microbiology
- Pediatrics
- Epidemiology
Background:
- Acute infantile diarrhea remains a significant global health concern.
- Understanding the specific enteropathogens causing diarrhea in infants is crucial for effective treatment and prevention.
Purpose of the Study:
- To investigate the prevalence and epidemiological characteristics of enteropathogens in infants with acute diarrhea.
- To identify the common causative agents and their association with clinical symptoms and demographics.
Main Methods:
- A case-control study involving 500 infants (≤12 months) with diarrhea and 500 age-matched controls.
- Enteropathogens were identified using laboratory diagnostic methods.
- Data on clinical presentation, age, and seasonality were collected.
Main Results:
- Enteropathogens were detected in 55% of cases versus 10% of controls.
- Key pathogens included enteropathogenic E. coli (EPEC) (26%), rotavirus (14%), Salmonella (8%), enterotoxigenic E. coli (7%), and Shigella (5%).
- EAF+ classic EPEC showed age- and season-specific patterns, while rotavirus peaked in fall/winter. Bloody stool was linked to Shigella.
Conclusions:
- EAF+ classic EPEC and rotavirus are major contributors to acute infantile diarrhea in São Paulo.
- EPEC prevalence is higher in younger infants and during spring.
- Antimicrobial resistance in EPEC necessitates further investigation and tailored treatment strategies.
Abstract:
To determine the prevalence and epidemiology of enteropathogens in acute infantile diarrhea, 500 infants less than or equal to 12 months of age with diarrhea and 500 age-matched control subjects coming to a São Paulo emergency room were studied. Enteropathogens were identified in 55% of case infants and 10% of controls; enteropathogenic Escherichia coli (EPEC) of classic EPEC serotypes producing EPEC adherence factor (EAF) (26% of case infants), rotavirus (14%), Salmonella species (8%), enterotoxigenic E. coli (7%), and Shigella species (5%) were associated with diarrhea. Isolation of EAF+ classic EPEC decreased with increasing age of cases and peaked in spring, whereas rotavirus was least common in early infancy and peaked in fall and winter. Bloody stool had a 36% positive predictive value for Shigella infection, EAF+ classic EPEC were highly resistant to antimicrobial drugs. Among poor São Paulo infants, EAF+ classic EPEC equaled or exceeded rotavirus throughout the year as a cause of diarrhea bringing children to medical attention.