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Gastroenteritis in children: a two-year review in Manitoba. I. Etiology
Insights
This study investigated pediatric gastroenteritis in Canada, identifying common bacterial pathogens like E. coli and Shigella, alongside rotavirus. Despite identifying some causes, the origin of most childhood diarrhea cases remained undetermined.
Area of Science:
- Pediatric Infectious Diseases
- Microbiology
- Public Health
Background:
- Gastroenteritis is a significant cause of childhood hospitalization.
- Identifying the specific etiologic agents of gastroenteritis is crucial for effective treatment and prevention strategies.
Purpose of the Study:
- To determine the prevalence of bacterial and viral pathogens causing gastroenteritis in hospitalized children.
- To identify the most common pathogens in different age groups and seasons.
- To evaluate the utility of screening for specific enteropathogenic bacteria and rotavirus.
Main Methods:
- A two-year prospective study of 1,217 children hospitalized with gastroenteritis.
- Bacteriological examination for pathogens including enteropathogenic Escherichia coli, Shigella, and Salmonella.
- Rotavirus detection using specific diagnostic methods.
- Screening for enterotoxigenic E. coli, Aeromonas shigelloides, enteroinvasive E. coli, and cytotoxic toxin-producing organisms.
Main Results:
- Bacterial pathogens were identified in 25% of children; Shigella and enteropathogenic E. coli were most common.
- Rotavirus was detected in 11% of tested patients.
- Enteropathogenic E. coli and rotavirus were prevalent in infants, while Shigella predominated in older children.
- Bacterial diarrhea peaked in summer; rotavirus infections were more common in winter.
- Screening for enterotoxigenic and enteroinvasive E. coli yielded few positive results.
Conclusions:
- While rotavirus and specific bacterial pathogens like E. coli and Shigella are significant causes of pediatric gastroenteritis, a substantial proportion of cases remain etiologically unexplained.
- The findings highlight the importance of considering age and season in diagnosing pediatric diarrhea.
- Further research is needed to identify the causative agents of the majority of unexplained gastroenteritis cases in children.
Abstract:
During two years, 1,217 children hospitalized with gastroenteritis at the Children's Centre in Winnipeg, Manitoba, Canada were studied. Bacterial pathogens were present in 25% of these children: enteropathogenic Escherichia coli in 120, Shigella in 139, Salmonella in 24, and multiple pathogens in 18. Rotavirus was detected in 54 (11%) of 472 patients examined. Rotavirus and enteropathogenic E. coli were the most common pathogens in infants, and Shigella was the most common in older children. Bacterial diarrhea occurred more commonly in summer, whereas rotavirus infection occurred more commonly in winter. Among 276 children screened, enterotoxigenic E. coli was found in three, and Aeromonas shigelloides that produced a similar toxin in two others. Enteroinvasive E. coli was not detected in 70 children. Organisms producing toxins "cytotoxic" to HeLa cells were isolated from three of 90 children. Screening for enterotoxigenic or enteroinvasive organisms was not productive of a significant number of pathogens, and, although screening for rotavirus did improve the number of etiologic diagnoses, the etiology of the majority of cases of diarrhea remained unknown.