title: Enteropathogens associated with acute diarrheal disease in urban infants in São Paulo, Brazil.
abstract: To determine the prevalence and epidemiology of enteropathogens in acute infantile diarrhea, 500 infants less than or equal to 12 months of age with diarrhea and 500 age-matched control subjects coming to a São Paulo emergency room were studied. Enteropathogens were identified in 55% of case infants and 10% of controls; enteropathogenic Escherichia coli (EPEC) of classic EPEC serotypes producing EPEC adherence factor (EAF) (26% of case infants), rotavirus (14%), Salmonella species (8%), enterotoxigenic E. coli (7%), and Shigella species (5%) were associated with diarrhea. Isolation of EAF+ classic EPEC decreased with increasing age of cases and peaked in spring, whereas rotavirus was least common in early infancy and peaked in fall and winter. Bloody stool had a 36% positive predictive value for Shigella infection, EAF+ classic EPEC were highly resistant to antimicrobial drugs. Among poor São Paulo infants, EAF+ classic EPEC equaled or exceeded rotavirus throughout the year as a cause of diarrhea bringing children to medical attention.
authors.affiliation: Department of Microbiology, Immunology, and Parasitology, Escola Paulista de Medicina, Hospital Infantil Menino Jesus, Brazil.
authors.forename: T A
authors.initials: TA
authors.lastname: Gomes
authors.forename: V
authors.initials: V
authors.lastname: Rassi
authors.forename: K L
authors.initials: KL
authors.lastname: MacDonald
authors.forename: S R
authors.initials: SR
authors.lastname: Ramos
authors.forename: L R
authors.initials: LR
authors.lastname: Trabulsi
authors.forename: M A
authors.initials: MA
authors.lastname: Vieira
authors.forename: B E
authors.initials: BE
authors.lastname: Guth
authors.forename: J A
authors.initials: JA
authors.lastname: Candeias
authors.forename: C
authors.initials: C
authors.lastname: Ivey
authors.forename: M R
authors.initials: MR
authors.lastname: Toledo
mesh_terms: D000208:Acute Disease; D000367:Age Factors; D001938:Brazil; D002169:Campylobacter Infections / Q000453:epidemiology / Q000382:microbiology; D016022:Case-Control Studies; D003968:Diarrhea, Infantile / Q000453:epidemiology / Q000382:microbiology*; D004405:Dysentery, Bacillary / Q000453:epidemiology / Q000382:microbiology*; D004927:Escherichia coli Infections / Q000453:epidemiology / Q000382:microbiology*; D005243:Feces / Q000382:microbiology; D006801:Humans; D007223:Infant; D011203:Poverty; D015995:Prevalence; D011446:Prospective Studies; D012400:Rotavirus Infections / Q000453:epidemiology / Q000382:microbiology*; D012480:Salmonella Infections / Q000453:epidemiology / Q000382:microbiology*; D012486:Salmonella typhimurium / Q000302:isolation & purification; D012621:Seasons; D014505:Urban Population