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Etiology of childhood diarrhea in Korea
1Department of Microbiology, Hanyang University College of Medicine, Seoul, Korea.
Insights
Rotavirus and enterotoxigenic E. coli are key causes of childhood diarrhea in Korea. Certain bacterial pathogens like Clostridium difficile were also significantly more prevalent in children with diarrhea.
Area of Science:
- Microbiology
- Pediatrics
- Infectious Diseases
Background:
- Childhood diarrhea remains a significant health concern globally.
- Identifying specific enteropathogens is crucial for effective treatment and prevention strategies.
- Recent advances allow for the detection of newly recognized bacterial and viral pathogens.
Purpose of the Study:
- To investigate the prevalence and role of various enteropathogens, including newly recognized ones, in childhood diarrhea in Korea.
- To compare the isolation rates of specific pathogens between children with diarrhea and healthy controls.
- To determine seasonal patterns in the occurrence of major enteropathogens.
Main Methods:
- A case-control study was conducted involving 231 children with diarrhea and 104 controls in Seoul, Korea.
- Stool samples were analyzed for bacterial pathogens via culture and for rotavirus via specific testing.
- Escherichia coli isolates were further screened for Shiga-like toxin (SLT) I, SLT-II, enterohemorrhagic E. coli fimbriae, and enteroinvasiveness.
Main Results:
- One or more enteropathogens were identified in 75.8% of children with diarrhea.
- Rotavirus was the most common pathogen (47%), followed by enterotoxigenic E. coli (22%), Clostridium difficile (16%), and enteroadherent E. coli (15%).
- Significantly higher isolation rates were observed for heat-stable-enterotoxin-producing E. coli, C. difficile, and enteroadherent E. coli in children with diarrhea compared to controls.
Conclusions:
- Rotavirus and specific E. coli strains are major contributors to childhood diarrhea in Korea.
- Clostridium difficile is also a significant enteropathogen in this population.
- Peak incidence for rotavirus, enterotoxigenic E. coli, and C. difficile occurred during the cooler months of October and November.
Abstract:
To assess the role of recently recognized enteropathogens in childhood diarrhea in Korea, 231 children with diarrhea admitted to and 104 children without diarrhea seen at the well-baby clinic or the outpatient department of Hanyang University Hospital in Seoul, Korea, were evaluated during a 14-month period. Stools were cultured for bacterial pathogens, including enterotoxigenic (heat-labile and heat-stable enterotoxin-producing) and enteroadherent organisms. Only those stools obtained from patients with diarrhea were examined for rotavirus. All Escherichia coli isolates were screened for Shiga-like toxin (SLT) I, SLT-II, enterohemorrhagic E. coli fimbriae, and enteroinvasiveness by colony hybridization. One or more pathogens were identified in 75.8% of the children with diarrhea. Rotavirus was the most frequently identified pathogen, accounting for 47% of the cases. Other major enteropathogens were enterotoxigenic E. coli (22%), Clostridium difficile (16%), enteroadherent E. coli (15%), and enteropathogenic E. coli (6%). Shigella spp., Campylobacter jejuni, Salmonella spp., SLT-I-and enterohemorrhagic-E. coli-fimbria-probe-positive E. coli serotype O26:H11 and enteroinvasive E. coli were isolated from only a few patients. Aeromonas hydrophila and E. coli O157 were not isolated. Compared with those of the controls, the isolation rates of heat-stable-enterotoxin-producing E. coli (P less than 0.05), C. difficile (P less than 0.025), and enteroadherent E. coli (P less than 0.05) were significantly higher in the patients with diarrhea. The greatest number of rotavirus, enterotoxigenic E. coli, and C. difficile cases were identified during the cool, dry months of October and November.