Enteric pathogens, intestinal permeability and nitric oxide production in acute gastroenteritis.
BACKGROUND
Aboriginal children hospitalized with diarrheal disease in northern Australia have high rates of acidosis, hypokalemia and osmotic diarrhea, as well as abnormal small bowel permeability and elevated nitric oxide (NO) production.


METHODS
In a study of 291 diarrheal admissions and 84 controls, we examined the relationship of diarrheal severity outcomes with specific enteric pathogens. NO production was measured by urine nitrate plus nitrite excretion on a low nitrate diet, small bowel permeability by the lactulose:rhamnose ratio on a timed blood specimen and stool pathogens by standard microbiologic investigations and PCR.


RESULTS
The addition of diagnostic tests for diarrheagenic Escherichia coli to standard stool microbiologic testing increased the rate of specific diagnoses from 53% to 75%, but with multiple pathogens isolated from 34%. The most frequently isolated pathogens from diarrheal patients were enteroaggregative E. coli (28.9%), rotavirus (26.5%), enteropathogenic E. coli (17.2%), Salmonella spp. (10.7%), Cryptosporidium parvum (7.2%) and Strongyloides stercoralis (7.2%). High geometric mean permeability ratios (95% confidence intervals) occurred with rotavirus (19.6; 15.3 to 25.1), enteroaggregative E. coli (21.2; 15.3 to 29.3) and Cryptosporidium (23.0; 15.1 to 35.1) compared with 9.4 (6.8 to 13.1) for no pathogens. NO production was highest for Cryptosporidium (3.7; 2.3 to 6.1) compared with 0.6 (0.4 to 1.1) for no pathogens. Multiple regression analysis revealed significant associations (P < 0.001) for rotavirus with acidosis and osmotic diarrhea, for Strongyloides with wasting and hypokalemia and for Cryptospoidium with severe and prolonged diarrhea.


CONCLUSIONS
Cryptosporidium, Strongyloides, rotavirus and enteroaggregative E. coli are important contributors to the severe manifestations of acute gastroenteritis in Australian Aboriginal children.
Northern Territory Clinical School, Flinders University, c/o Royal Darwin Hospital, Australia.
Renata
R
Kukuruzovic
Roy M
RM
Robins-Browne
Nicholas M
NM
Anstey
David R
DR
Brewster
D000818:Animals; D001315:Australia; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D003458:Cryptosporidium / Q000302:isolation & purification; D003967:Diarrhea / Q000150:complications / Q000382:microbiology / Q000503:physiopathology; D005260:Female; D005759:Gastroenteritis / Q000150:complications / Q000382:microbiology* / Q000503:physiopathology*; D006801:Humans; D007223:Infant; D007408:Intestinal Absorption / Q000502:physiology*; D007413:Intestinal Mucosa / Q000382:microbiology / Q000503:physiopathology; D007422:Intestines / Q000382:microbiology* / Q000503:physiopathology*; D016014:Linear Models; D008297:Male; D009569:Nitric Oxide / Q000378:metabolism*; D012401:Rotavirus / Q000302:isolation & purification; D013321:Strongyloides / Q000302:isolation & purification
D009569:Nitric Oxide