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Clinical and laboratory predictors of invasive diarrhoea in children less than five years old
1Department of Pediatrics, Lady Hardinge Medical College, New Delhi, India.
Insights
Clinical signs like mucus in stool and lab findings of white blood cells (polymorphonuclear leucocytes) and red blood cells are better predictors of dysentery in children than just identifying invasive bacteria.
Area of Science:
- Pediatrics
- Infectious Diseases
- Microbiology
Background:
- Acute watery diarrhea is common in children under five.
- Dysentery, characterized by bloody stools, indicates a more severe invasive process.
- Identifying predictors of dysentery is crucial for timely and appropriate management.
Purpose of the Study:
- To evaluate clinical and laboratory predictors of dysentery in children under five with acute watery diarrhea.
- To compare the predictive value of clinical signs, laboratory findings, and bacterial isolation for dysentery.
Main Methods:
- A prospective study of 533 children under five with acute watery diarrhea.
- Clinical assessment for mucus in stool.
- Microscopic examination of stool for polymorphonuclear leucocytes (PMN) and red blood cells (RBC).
- Stool culture for isolation of invasive bacterial enteropathogens.
Main Results:
- Mucus in stool was a significant clinical predictor of bloody diarrhea (p=0.0000).
- Presence of PMN > 10/hpf and RBCs in stool were significant laboratory predictors (p=0.0000).
- Isolation of invasive bacteria predicted bloody diarrhea but was less significant than clinical and microscopic findings.
Conclusions:
- Clinical manifestations (mucoid stools) and microscopic stool findings (PMN, RBCs) are stronger indicators of invasive bacterial enteropathogens and dysentery development than mere bacterial isolation.
- Severity of invasion, as indicated by clinical and laboratory signs, is a more reliable predictor of dysentery in young children.
Abstract:
Five hundred and thirty-three children < 5 years of age with acute watery diarrhoea were followed for appearance of blood in their stools to evaluate various clinical and laboratory predictors of dysentery. The statistical analysis was performed in two steps. Firstly, clinical and laboratory variables were evaluated as 'predictors' for isolation of invasive bacterial enteropathogens from stool culture. Secondly, all the variables, including isolation of invasive bacterial enteropathogens, were analyzed for predicting bloody diarrhoea. Presence of mucus (sensitivity = 57.4%, specificity = 83.1%, positive predictive value = 24.8%, negative predictive value = 95.3%, p = 0.0000) was the only significant clinical predictor of bloody diarrhoea. Polymorphonuclear leucocytes (PMN) > 10/hpf (sensitivity = 55.3%, specificity = 92.4%, positive predictive value = 41.3%, negative predictive value = 95.5%, p = 0.0000) and red blood cells, regardless of their number, (sensitivity = 78.7%, specificity = 93%, positive predictive value = 52.1%, negative predictive value = 97.8%, p = 0.0000) on light microscopy of fresh stool samples were two significant laboratory findings. Isolation of invasive bacterial enteropathogens was also a significant predictor of bloody diarrhoea (sensitivity = 19.1%, specificity = 89.5%, positive predictive value = 15%, negative predictive value = 92% p = 0.0077) but ranked lower than the other 3 variables. Our results indicated that it is the severity of invasion caused by offending enteropathogens, clinically manifesting as mucoid stools and/or presence of PMN or RBC, which may be a better indicator of the invasive process and subsequent development of dysentery rather than mere isolation of invasive enteropathogens from the stools.