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Clinical and laboratory predictors of bacterial diarrhea in a tropical environment
1Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, MD.
Insights
Pediatric diarrhea in young children can be predicted. Identifying specific historical factors and fecal leukocytes in stool increases the likelihood of detecting bacterial pathogens.
Area of Science:
- Pediatric infectious diseases
- Microbiology
- Clinical diagnostics
Background:
- Diarrhea is a common pediatric illness, particularly in children under six.
- Bacterial pathogens are a significant cause of pediatric diarrhea.
- Accurate diagnostic tools are needed to identify bacterial causes promptly.
Purpose of the Study:
- To identify predictive historical factors for bacterial diarrhea in children.
- To evaluate the utility of fecal leukocytes as a screening tool.
- To determine the probability of bacterial pathogens based on clinical and laboratory findings.
Main Methods:
- Retrospective analysis of 180 pediatric patients (≤6 years) with diarrhea.
- Stool culture for bacterial pathogen isolation.
- Assessment of historical factors (onset, vomiting, stool frequency) and fecal leukocytes.
Main Results:
- Bacterial pathogens were isolated from 13% of patients.
- Abrupt onset, no prior vomiting, and >4 stools/24h were key predictive factors.
- Fecal leukocytes significantly increased the probability of positive bacterial stool culture (83% vs. 5%).
Conclusions:
- A combination of specific historical factors and fecal leukocytes can identify children at high risk for bacterial diarrhea.
- This approach aids in targeted stool culture, improving diagnostic efficiency.
- Early identification of bacterial pathogens is crucial for appropriate pediatric care in tropical environments.
Abstract:
A total of 180 patients with diarrhea, 6 years and below, were seen and evaluated in our pediatric clinic during the months of July to December, 1986. A bacterial pathogen was isolated from the stools in 24/180 (13%). The best historical factors for predictive accuracies were abrupt onset, no vomiting before the onset of diarrhea, and greater than four stools per 24 hours. The presence of fecal leukocytes was the best screening tool for stool culture positivity. The patients identified with the above three historical factors and positive for fecal leukocytes had an 83% probability of having a positive bacterial stool culture compared to only a 5% probability if any one of the factors was absent. We were able to identify a subpopulation of American dependents in a tropical environment with diarrhea who had a high probability of having a bacterial stool pathogen based on historical factors and the fecal leukocyte test.