Clinical evaluation and bacterial survey in infants and young children with diarrhoea in the Santa Cruz district, Bolivia.
Clinical and laboratory studies on a total of 211 of infants and young children admitted to the National Santa Cruz General Hospital for various types of diarrhoea during 1991-1992 are described. A peak cluster was observed in children aged 1 year of which 80 per cent were acute diarrhoea and the remaining 20 per cent were prolonged or chronic diarrhoea. The major bacterial pathogen was enteropathogenic Escherichia coli. Other bacterial pathogens such as Klebsiella, Shigella, Cholera, etc., were detected. Ascaris, E. histolytica, Giardia and Ankylostoma were also detected. Many of the patients infected with enteropathogenic E. coli showed elevated serum titre to these bacterial antigens. Most of the detected E. coli and Shigella revealed that they were resistant to ampicillin, trimethoprim/sulfamethoxazole, and erythromycin, and some were resistant to gentamycin and chloramphenicol in vitro tests. It was difficult to make a diagnosis by clinical diagnosis alone for cholera of the el Tor Ogawa type. The detection of faecal leukocytes seems to be an useful predictor for diagnosis of invasive diarrhoea with mucobloody stools. Faecal pH and erythrocytes did not seem to be reliable diagnostic predictors. Fourteen cases (7 per cent) died of diarrhoeal disease. Many of them had complications with marked dehydration, hypoelectrolytaemia, malnutrition and infections, and rapid deterioration within 10 days despite rehydration therapy. Timely rapid rehydration and restoration of electrolytes followed by suitable management of complications are necessary.
Department of International Cooperation, International Medical Center, Tokyo, Japan.
T
T
Ise
Y
Y
Tanabe
F
F
Sakuma
O
O
Jordan
E
E
Serrate
H
H
Pena
D017677:Age Distribution; D001838:Bolivia / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D003967:Diarrhea / Q000453:epidemiology* / Q000382:microbiology; D003968:Diarrhea, Infantile / Q000453:epidemiology / Q000382:microbiology; D004927:Escherichia coli Infections / Q000453:epidemiology; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male