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[Etiology of bloody diarrhea in children from a rural community]
O Benítez1, F Uribe, A Navarro
1Centro de Investigaciones sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Morelos, Cuernavaca, México.
Insights
Bloody diarrhea in Mexican children was primarily caused by enteroaggregative E. coli (EAEC) and Shigella. Pathogen incidence increased with age, with seasonality affecting most, but not EAEC.
Area of Science:
- Pediatric Infectious Diseases
- Microbiology
- Epidemiology
Context:
- Investigated the etiology of bloody diarrhea in a longitudinal cohort of 75 children in rural Central Mexico.
- Analyzed 636 diarrhea episodes over the first two years of life, identifying 71 (11%) with blood.
Purpose:
- To determine the causative pathogens of bloody diarrhea in young children.
- To understand the epidemiological patterns and seasonality of these infections.
Summary:
- Enteroaggregative E. coli (EAEC) was the most frequent pathogen (35%), followed by Shigella (13%) and Shiga-like toxin-producing E. coli (11%).
- Single pathogen isolation occurred in 83% of cases; mixed infections were less common.
- Bloody diarrhea incidence rose during the first two years, decreasing after ten months, with EAEC showing endemic frequency.
Impact:
- Identifies key pathogens contributing to pediatric bloody diarrhea in the region.
- Highlights the distinct epidemiological patterns of different enteric pathogens.
- Provides data for targeted public health interventions and prevention strategies.
Abstract:
The etiology of bloody diarrhea was investigated in a cohort of 75 children followed longitudinally from birth during the first two years of life in a rural Village of Central Mexico. Of a total of 636 episodes of diarrhea, 71 (11%) showed presence of blood. A single associated pathogen was isolated in 59 (83%) of 71 children; 35% showed the presence of enteroaggregative E. coli (EAEC), 11% of E. coli producing Shiga-like toxins (SLT) I and/or II; 13% of Shigella, 7% of Campylobacterjejuni or enterotoxigenic E. coli (ETEC) and 4% enteropathogenic E. coli (EPEC), enteroinvasive E. coli (EIEC), Salmonella, Giardia lamblia or Hymenolepis nana. Mixed cultures were found in 16% of cases during the first year and in 18% during the second. These were mainly combinations of C. jejuni, with ETEC or EAEC. In 78% of children with bloody diarrhea the episode was single event during the first two years of life, lasting on average seven days. Epidemiologically, the incidence of bloody diarrhea rose steadily during the first two years of life, with a significant decrease after the tenth month. Prevalence was affected by seasonality in all pathogens, except for EAEC that had an endemic frequency. In the case of Shigella and SLT-producing E. coli clustering of cases and isolation of serologically identical strains indicated that infections were the result of common source outbreaks.