Related Experiment Videos
Etiology of childhood diarrhea in Beijing, China
K C Kain1, R L Barteluk, M T Kelly
1Department of Pathology, University of British Columbia, Vancouver, Canada.
Insights
Newly identified pathogens contribute significantly to childhood diarrhea in Beijing, with enterotoxigenic Escherichia coli being the most common. Antimicrobial resistance complicates treatment, highlighting the need for effective therapeutic strategies.
Area of Science:
- Pediatric Infectious Diseases
- Microbiology
- Public Health
Background:
- Childhood diarrhea remains a significant health concern globally.
- The role of emerging enteropathogens in pediatric gastroenteritis requires ongoing investigation.
- Understanding pathogen prevalence and antimicrobial resistance is crucial for effective treatment strategies in China.
Purpose of the Study:
- To investigate the contribution of recognized and newly identified enteropathogens to childhood diarrhea in Beijing.
- To determine the prevalence of various bacterial and viral pathogens, including specific *E. coli* pathotypes.
- To assess antimicrobial resistance patterns among isolated pathogens.
Main Methods:
- A case-control study involving 221 children with diarrhea and 108 controls at Beijing Children's Hospital.
- Stool sample analysis included examination for ova, parasites, rotavirus, bacterial culture, and specific *E. coli* pathotype detection (ETEC, EIEC, EHEC, EAF+).
- Antimicrobial susceptibility testing was performed on bacterial isolates.
Main Results:
- Pathogens were identified in 56.5% of diarrhea cases versus 43.5% of controls (P=0.04).
- Enterotoxigenic *E. coli* (ETEC) was the most frequent pathogen (20%), followed by *Salmonellae* (12%) and rotavirus (7%).
- Significant isolation rates for *Salmonellae*, EAF+ *E. coli*, and mixed pathogens were observed in diarrhea patients compared to controls. High rates of multidrug resistance were noted in *Salmonella*, *Aeromonas*, and *Shigella* isolates.
Conclusions:
- Both traditional and newly recognized enteropathogens play a substantial role in childhood diarrhea in Beijing.
- The prevalence of specific *E. coli* pathotypes and *Salmonellae* highlights their importance in this population.
- Widespread antimicrobial resistance, particularly in *Salmonellae* and *Shigellae*, complicates treatment options, with only ciprofloxacin, cefotaxime, and imipenem showing universal in vitro susceptibility.
Abstract:
To determine the role of recently recognized enteropathogens in childhood diarrhea in China, 221 children with diarrhea and 108 controls seen at the Beijing Children's Hospital were studied during April and May 1989. Stools were examined for ova, parasites, and rotavirus, cultured for bacterial pathogens, and probed for enterotoxigenic Escherichia coli (ETEC), enteroinvasive E. coli (EIEC), enterohemorrhagic E. coli (EHEC), and enteropathogenic adherence factor-positive (EAF+) E. coli. Pathogens were identified in 56.5% of children with diarrhea and 43.5% of controls (P = 0.04). Detection of enteropathogens was significantly greater in patients examined within 1 week of symptom onset (65%) than in patients examined later (39%; P = 0.01). ETEC was the most frequently detected pathogen in children with diarrhea, accounting for 20% of the cases. Other agents identified in patients included the following: salmonellae, 12%; rotavirus, 7%; EIEC, 7%; EHEC, 7%; members of the Aeromonas hydrophila group, 6%; EAF+ E. coli, 5%; Ascaris lumbricoides, 3%; shigellae, 3%; campylobacters, 2%; and Vibrio spp., 0.5%. The isolation rates of salmonellae (P = 0.02), EAF+ E. coli (P = 0.04), and mixed pathogens (P = 0.05) were significantly greater for diarrhea patients than for controls. Resistance to multiple antimicrobial agents occurred in 39% of the Salmonella isolates, 22% of the Aeromonas isolates, and 17% of the Shigella isolates. Multiresistant salmonellae (P = 0.05) and shigellae were recovered from diarrheal stools only. Ciprofloxacin, cefotaxime, and imipenem were the only agents tested to which all bacterial isolates were susceptible in vitro. These results suggest that both traditional and newly recognized agents are important causes of childhood diarrhea in Beijing and that therapy may be complicated by indigenous antimicrobial resistance.