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A prospective study of Shiga-like toxin-associated diarrhea in a pediatric population
Insights
Shiga-like toxin-producing E. coli (SLTEC) infections were detected in 2.6% of hospitalized children with diarrhea. This prospective study highlights SLTEC as a significant cause of pediatric diarrheal illness, particularly in children aged 2-10 years.
Area of Science:
- Pediatric Infectious Diseases
- Microbiology
- Gastroenterology
Background:
- Population studies indicate children have the highest incidence of Shiga-like toxin-producing E. coli (SLTEC) infections.
- Previous case series lacked focus on the pediatric population, necessitating specific research.
Purpose of the Study:
- To determine the frequency of Shiga-like toxin (SLT) detection in hospitalized children.
- To investigate SLT-associated diarrhea in a pediatric cohort, minimizing bias.
Main Methods:
- Prospective study of children under 10 hospitalized with diarrheal symptoms.
- Systematic survey for diarrheal symptoms at admission and for 2 days.
- Enrollment of 227 patients and 92 age- and season-matched controls.
Main Results:
- SLT was detected in 6 (2.6%) pediatric patients; E. coli O157:H7 was isolated in 3.
- SLT was more prevalent in children aged 2-10 years and associated with bloody stools.
- Other pathogens included Salmonella (2.6%), Shigella (2.2%), Yersinia (1.3%), and rotavirus (20.3%).
Conclusions:
- SLTEC is a significant cause of diarrhea in hospitalized children.
- SLT-associated diarrhea presented seasonally (summer/fall), unlike rotavirus (winter/spring).
- Two SLT cases developed hemolytic uremic syndrome (HUS), and four had hemorrhagic colitis.
Abstract:
Although population-based studies have shown that children have the highest age-specific incidence of infection with the Shiga-like toxin-producing E. coli (SLTEC), these sporadic case series were not focused specifically on the pediatric age group. We undertook a prospective study to determine the frequency of detection of SLT in an exclusively pediatric population. The study design minimized ascertainment and referral bias by systematically defining the population by the presence of diarrheal symptoms rather than by specific diagnosis, previous submission of stool for culture, or referral to a diarrhea study. All children < 10 years of age hospitalized at a tertiary care pediatric hospital, irrespective of admission diagnosis, were surveyed prospectively at admission and for 2 days thereafter for the presence of defined diarrheal symptoms. From May 1, 1991, to April 30, 1992, 227 patients and 92 age- and season-matched controls were enrolled. Fecal SLT was detected in six (2.6%) patients, three of whom had E. coli O157:H7 organisms were isolated; SLT was not found in any of the controls. SLT was more commonly detected in children 2-10 years of age and in bloody stools. Salmonella was isolated in six (2.6%) cases, Shigella in five (2.2%), and Yersinia in three (1.3%); rotavirus was detected in 46 (20.3%). Two patients with SLT-associated diarrhea had hemolytic uremic syndrome (HUS), and four had hemorrhagic colitis. SLT-associated diarrhea occurred in the summer and fall months in contradistinction to that with rotavirus, which occurred in the winter and spring.(ABSTRACT TRUNCATED AT 250 WORDS)