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Enteric pathogens in malnourished children with diarrhoea
R Kakai1, I A Wamola, J J Bwayo
1National Public Health Laboratory Services, Ministry of Health, Nairobi.
Insights
Malnutrition in children under five increases the risk of certain enteric infections like Campylobacter and ETEC-LT. Diarrhea in malnourished children often has unknown causes, possibly due to opportunistic pathogens.
Area of Science:
- Pediatrics
- Infectious Diseases
- Public Health
Background:
- Malnutrition is a significant health issue in children under five.
- Enteric infections are a common cause of illness and mortality in this age group.
- Understanding the relationship between malnutrition and specific enteric pathogens is crucial for effective treatment and prevention.
Purpose of the Study:
- To determine the prevalence of enteric pathogens in malnourished and well-nourished children.
- To investigate the association between malnutrition status and specific enteric infections.
- To explore potential opportunistic pathogens in malnourished children.
Main Methods:
- Stool samples were collected from 273 children under five at Kenyatta National Hospital.
- Pathogen detection included ELISA for Rotavirus, culture for Salmonella, Shigella, E. coli, and Campylobacter.
- Identification involved biochemical tests and serotyping.
Main Results:
- Campylobacter, ETEC-LT, and T. hominis were more prevalent in malnourished children.
- Enteropathogenic E. coli (EPEC) and Salmonella+ETEC-LT were more common in well-nourished children.
- A higher proportion of malnourished children had diarrhea of unknown etiology.
Conclusions:
- Campylobacter and T. hominis may act as opportunistic infections in malnourished children due to immunosuppression.
- The higher rate of unknown etiology diarrhea in malnourished children suggests other unidentified pathogens.
- Findings highlight the complex interplay between malnutrition and enteric infections in young children.
Abstract:
Enteric pathogens were determined from stools of 273 children aged less than 5 years at Kenyatta National Hospital (KNH), 43.6% (119/273) of whom were malnourished according to the Wellcome criteria. Rotavirus was detected by ELISA test, Salmonella, Shigella and E. coli by culture on MacConkey and Salmonella-Shigella agar at 37 degrees C overnight and Campylobacter on Skirrow's selective media at 42 degrees C for 48 hrs. These were identified by biochemical tests and serotyping using specific antisera. Whereas isolation rate for Campylobacter (0.0% vs 5.0%, p = 0.006), well malnourished ETEC-LT (0.6% vs 5.0%, p = 0.003) and T. hominis (0.0% vs 3.4%, p = 0.03) was higher in the malnourished children, EPEC (30.5% vs 10.1%, p < 0.001) and Salmonella+ETEC-LT (7.8% vs 1.7%, p = 0.02) was higher in children. The other enteric pathogens were equally isolated from normal and malnourished children. A larger proportion of malnourished children had diarrhoea of unknown aetiology compared to the well nourished (26.6% vs 50.4%, p < 0.001). Campylobacter and T. hominis may be opportunistic infections due to immuno-suppression in malnutrition. Diarrhoea of unknown aetiology may be due to aetiological agents that were not determined in this study.