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Associated infections in persistent diarrhoea--another perspective
A Sibal1, A K Patwari, V K Anand
1Diarrhoea Training and Treatment Unit, Kalawati Saran Children's Hospital and Lady Hardinge Medical College, New Delhi, India.
Insights
Persistent diarrhea in children is often linked to hidden non-gastrointestinal infections like urinary tract infections and respiratory infections. Investigating these infections is crucial for effective treatment and improved outcomes.
Area of Science:
- Pediatrics
- Infectious Diseases
- Public Health
Background:
- Persistent diarrhea (PD) is a significant cause of childhood morbidity and mortality.
- Non-gastrointestinal infections are often associated with PD but may be clinically unrecognized.
Purpose of the Study:
- To investigate the prevalence of non-gastrointestinal infections in children with persistent diarrhea.
- To assess the diagnostic utility of clinical screening versus investigations for these associated infections.
- To determine the impact of these infections on PD outcomes and mortality.
Main Methods:
- Retrospective analysis of 78 children aged 1 month to 5 years with persistent diarrhea.
- Clinical screening for acute respiratory infection (ARI), urinary tract infection (UTI), and acute suppurative otitis media (ASOM).
- Diagnostic investigations including chest X-ray, urine culture, and blood culture.
Main Results:
- 54% of children had at least one associated non-gastrointestinal infection; 28% had multiple infections.
- Urinary tract infection (32%) and pneumonia (39%) were frequently detected by investigations, often missed on clinical screening.
- E. coli was the most common pathogen in urine and blood cultures.
- Mortality was associated with severe malnutrition, sepsis, and ARI.
Conclusions:
- Persistent diarrhea in children is frequently associated with unrecognized non-gastrointestinal infections, particularly UTI and ARI.
- Systematic investigation is essential for accurate diagnosis and management of these co-existing infections.
- Early detection and treatment of associated infections can significantly improve patient outcomes and reduce mortality.
Abstract:
Seventy-eight children diagnosed as cases of persistent diarrhoea (PD) from 1 month to 5 years of age (mean age 8.92 months) hospitalized during a 2-year study period were screened for the presence of non-gastrointestinal infections. Clinical screening suggested acute respiratory infection (ARI) in 30 per cent cases, urinary tract infection (UTI) in 19 per cent and acute suppurative otitis media (ASOM) in 10 per cent of cases. Investigations revealed pneumonia on chest X-ray (39 per cent), positive urine culture (32 per cent), leucocytosis (31 per cent) and positive blood culture (22 per cent). Seven cases (9 per cent) of pneumonia and 10 cases (13 per cent) diagnosed to have UTI were not identified on clinical screening and could be detected only after investigations. E. coli was the commonest organism isolated from urine culture (23 per cent) and blood culture (14 per cent); 54 per cent of cases had one or the other associated infection and 28 per cent were suffering from more than one infection. Bacterial pathogens were more frequently isolated from blood in children < 6 months (P < 0.01), with vomiting (P < 0.001), and severe malnutrition (P < 0.05); from urine in association with fever (P < 0.001), duration of diarrhoea > 4 weeks (P < 0.05), and vomiting (P < 0.001). Pneumonia was detected on chest radiograph more frequently in children with severe malnutrition (P < 0.001). Sixty eight per cent of cases were successfully treated with dietary management and appropriate treatment of associated infections and 18 per cent of cases died. Mortality was highest in association with sever oral thrush, severe malnutrition, septicaemia, and ARI. Our results suggest that majority of cases of PD are associated with one or the other non-gastrointestinal infections particularly UTI and ARI which may be missed on clinical examination unless efforts are made to investigate these children. Early detection and appropriate management of these infections can considerably modify hospital course and outcome.