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Published on: March 10, 2020
Epidemiologic, clinical, and laboratory characteristics of acute vs. persistent diarrhea in periurban Lima, Peru
C F Lanata1, R E Black, R H Gilman
1Research Division, Instituto de Investigacion Nutricional, Lima, Peru.
Insights
Predicting persistent diarrhea in young children is challenging. Early clinical or lab signs do not reliably identify prolonged diarrheal episodes, necessitating careful management for all cases.
Area of Science:
- Pediatrics
- Infectious Diseases
- Public Health
Background:
- Diarrheal diseases are a major cause of childhood morbidity and mortality, particularly in resource-limited settings.
- Persistent diarrhea (lasting >14 days) is associated with increased risk of malnutrition and mortality in young children.
- Identifying predictors of persistent diarrhea early in its course is crucial for timely intervention.
Purpose of the Study:
- To investigate the incidence and duration of acute and persistent diarrhea in young children.
- To identify clinical and laboratory predictors of persistent diarrhea in its early stages.
- To evaluate the utility of early diagnostic tests in predicting diarrhea persistence.
Main Methods:
- A 27-month longitudinal study involving 677 children under 3 years old in a periurban community in Peru.
- Twice-weekly community-based surveillance to accurately record diarrhea incidence and duration.
- Clinical and laboratory assessments during diarrheal episodes, including fecal analysis.
Main Results:
- Overall diarrhea incidence was 8.1 episodes per child-year; persistent diarrhea incidence was 0.25 episodes per child-year.
- Younger age (0-5 months) and severe illness (≥6 stools/day) in the first week were associated with longer diarrhea duration.
- Early laboratory tests (fecal leukocytes, blood, reducing substances, pH, fat) were not predictive of persistence.
- Steatorrhea was common in acute diarrhea but decreased in persistent cases by the third week.
Conclusions:
- No early clinical or laboratory indicators reliably predict which acute diarrheal episodes will become persistent.
- Effective fluid and dietary management, along with vigilant follow-up, is essential for all diarrheal episodes.
- Early detection and intervention are critical for managing persistent diarrhea to prevent severe outcomes.
Abstract:
Longitudinal studies of acute and persistent diarrhea in 677 children less than 3 years old were conducted for 27 months in an underprivileged, periurban community near Lima, Peru. Incidence rates and accurate durations of diarrhea were obtained by twice-weekly community-based surveillance and clinical and laboratory features of diarrheal episodes were documented. Study children had an overall incidence of diarrhea of 8.1 episodes per child-year and an incidence of persistent (greater than 14 days) diarrhea of 0.25 episodes per child-year. Episodes of longer duration were associated with young age (0-5 months) and more severe illness (greater than or equal to 6 diarrheal stools per day) in the first week. None of the laboratory tests performed in the first week of illness (fecal leukocytes, blood, reducing substances, pH, or fat) proved of value to identify episodes that would become persistent. Although steatorrhea was commonly present in the acute phase of the illness, it became less frequent by the third or subsequent week of illness in the persistent diarrheas. These results suggest that there are no clinical or laboratory features of acute diarrhea that are strongly predictive of the subset of diarrheas that persist. Thus, it is important that all diarrheal episodes should have appropriate fluid and dietary management and follow-up to detect the persistent diarrheas that may need special intervention.
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