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Occult blood and fecal leukocytes as screening tests in childhood infectious diarrhea: an old problem revisited
L Huicho1, D Sanchez, M Contreras
1Universidad Nacional Mayor de San Marcos, Lima, Peru.
Insights
Fecal leukocytes and occult blood tests can help identify invasive bacterial causes of childhood diarrhea. However, results should be interpreted alongside clinical signs for accurate diagnosis.
Area of Science:
- Pediatrics
- Infectious Diseases
- Gastroenterology
Background:
- Infectious diarrhea is a common childhood illness.
- Distinguishing between invasive and non-invasive pathogens is crucial for appropriate treatment.
- Fecal leukocytes and occult blood tests are commonly used screening tools.
Purpose of the Study:
- To evaluate the utility of fecal leukocytes and occult blood tests in diagnosing infectious diarrhea in children.
- To determine the association of these tests with specific pathogens and clinical presentations.
Main Methods:
- A 24-month study involving 446 children with diarrhea and 16 controls.
- Stool examinations for fecal leukocytes and occult blood.
- Correlation of test results with identified pathogens (Salmonella-Shigella-Campylobacter, rotavirus, enterotoxigenic Escherichia coli, cryptosporidia, Shigella) and clinical symptoms like dysentery.
Main Results:
- Fecal leukocytes were detected in 36-70% of children with invasive bacterial infections (e.g., Shigella).
- Occult blood was present in 38-43% of children with invasive pathogens.
- The agreement between positive fecal leukocytes and occult blood tests was poor (highest 50% for Shigella).
- Dysentery combined with positive tests strongly indicated invasive agents (88% with both tests positive, 72% with fecal leukocytes).
Conclusions:
- Fecal leukocytes and occult blood tests can be supportive in identifying invasive bacterial diarrhea in children.
- These screening tests have limitations and should be interpreted within the clinical context.
- A combined approach using clinical, epidemiological, and screening test data is recommended for managing infectious diarrhea.
Abstract:
During a 24-month period 446 children with diarrhea and 16 controls had examination of their stools for leukocytes and for occult blood. Fecal leukocytes were found in 36, 16 and 18% of children with Salmonella-Shigella-Campylobacter, rotavirus or enterotoxigenic Escherichia coli, or cryptosporidial diarrhea, respectively. Similarly 43, 39 and 38% of these groups, respectively, as well as 13% of controls had occult blood. Notably 70% of 10 Shigella cases had fecal leukocytes. In 166 children with mixed pathogens leukocytes were seen in 27 and 8% of children with Salmonella-Shigella-Campylobacter or noninvasive pathogen, respectively. Likewise 44 and 18% of these groups had occult blood. Agreement between both tests being positive was poor, the highest result being 50% for Shigella. Dysentery combined with both tests positive was associated with 15 (88%) cases of invasive agents present in stool cultures, and combination of dysentery with fecal leukocytes was associated with 21 (72%) cases of invasive agents recovered. The results of these tests should be interpreted in the context of the clinical situation. A combined clinical-epidemiologic and screening tests-based approach to infectious diarrhea of childhood is suggested.