title: Etiology of bloody diarrhea in Bolivian children: implications for empiric therapy. Bolivian Dysentery Study Group.
abstract: In Bolivia, few data are available to guide empiric therapy for bloody diarrhea. A study was conducted between December 1994 and April 1995 to identify organisms causing bloody diarrhea in Bolivian children. Rectal swabs from children <5 years old with bloody diarrhea were examined for Salmonella, Shigella, and Campylobacter organisms; fecal specimens were examined for Entamoeba histolytica. A bacterial pathogen was identified in specimens from 55 patients (41%). Shigella organisms were found in 39 specimens (29%); 37 isolates (95%) were resistant to ampicillin, 35 (90%) to trimethoprim-sulfamethoxazole, and 24 (62%) to chloramphenicol, but all were susceptible to nalidixic acid. Only 1 of 133 stool specimens contained E. histolytica trophozoites. Multidrug-resistant Shigella species are a frequent cause of bloody diarrhea in Bolivian children; E. histolytica is uncommon. Clinical predictors described in this study may help identify patients most likely to have Shigella infection. Laboratory surveillance is essential to monitor antimicrobial resistance and guide empiric treatment.
authors.affiliation: Foodborne and Diarrheal Diseases Branch, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
authors.forename: J M
authors.initials: JM
authors.lastname: Townes
authors.forename: R
authors.initials: R
authors.lastname: Quick
authors.forename: O Y
authors.initials: OY
authors.lastname: Gonzales
authors.forename: M
authors.initials: M
authors.lastname: Linares
authors.forename: E
authors.initials: E
authors.lastname: Damiani
authors.forename: C A
authors.initials: CA
authors.lastname: Bopp
authors.forename: S P
authors.initials: SP
authors.lastname: Wahlquist
authors.forename: L C
authors.initials: LC
authors.lastname: Hutwagner
authors.forename: E
authors.initials: E
authors.lastname: Hanover
authors.forename: E D
authors.initials: ED
authors.lastname: Mintz
authors.forename: R V
authors.initials: RV
authors.lastname: Tauxe
mesh_terms: D000818:Animals; D000900:Anti-Bacterial Agents / Q000494:pharmacology* / Q000627:therapeutic use; D001838:Bolivia; D002167:Campylobacter / Q000302:isolation & purification; D002169:Campylobacter Infections / Q000188:drug therapy / Q000382:microbiology; D002675:Child, Preschool; D003967:Diarrhea / Q000188:drug therapy / Q000382:microbiology* / Q000469:parasitology; D004352:Drug Resistance, Microbial; D018432:Drug Resistance, Multiple; D004404:Dysentery, Amebic / Q000188:drug therapy / Q000469:parasitology; D004405:Dysentery, Bacillary / Q000188:drug therapy* / Q000382:microbiology; D019348:Empiricism; D004748:Entamoeba histolytica / Q000302:isolation & purification; D005243:Feces / Q000469:parasitology; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008826:Microbial Sensitivity Tests; D012475:Salmonella / Q000302:isolation & purification; D012480:Salmonella Infections / Q000188:drug therapy / Q000382:microbiology; D012760:Shigella / Q000187:drug effects* / Q000302:isolation & purification*
chemical_list: D000900:Anti-Bacterial Agents