Detection of enteropathogens in fatal and potentially fatal diarrhea in Cairo, Egypt

A 1-year study of the etiology of acute diarrhea complicated by severe (10%) dehydration, active bleeding, shock and cardiovascular collapse, pneumonia, acute renal failure, or seizures in infants under 18 months of age was performed in Cairo, Egypt. Of 145 infants, 19 (13%) died or left the hospital moribund; the remaining 126 patients were classified as having potentially fatal illness. A variety of enteropathogens were identified with approximately equal frequency in the fatal and nonfatal complicated cases as well as in 135 controls with severe uncomplicated diarrhea. The agents most frequently detected in infants with severe diarrhea in this population which were felt to be etiologically important were rotavirus (33%), heat-stable enterotoxin-producing Escherichia coli (20%), heat-labile enterotoxin-producing E. coli (11%), enteropathogenic E. coli (8%), and Salmonella spp. (5%). The high rate of occurrence of Giardia lamblia (35%) probably represented the high carriage rate of the protozoan in this population. Complicated (fatal and potentially fatal) cases differed from control cases in a number of ways: the onset of diarrhea was more sudden, the course was progressive and of greater initial intensity, vomiting occurred more frequently, the patients more often had visited another physician before coming to the hospital, the patients more often had respiratory symptoms and pulmonary abnormalities on auscultation, hypoactive bowel sounds and abdominal distention were more common, as was oliguria, and the patients showed lower mean body weights.