title: Epidemiology of sporadic bloody diarrhea in rural Western Kenya.
abstract: We conducted laboratory-based surveillance and a case-control study to characterize the epidemiology of bloody diarrhea in rural Western Kenya. From May 1997 through April 2001, we collected stool from 451 persons with bloody diarrhea presenting to four rural clinics. Cultures of 231 (51%) specimens yielded 247 bacterial pathogens: 198 Shigella (97 S. flexneri, 41 S. dysenteriae type 1, 39 S. dysenteriae type non-1, 13 S. boydii, 8 S. sonnei), 33 Campylobacter, 15 non-typhoidal Salmonella, and 1 Vibrio cholerae O1. More than 90% of the isolates (excluding Campylobacter) were resistant to trimethoprim-sulfamethoxazole and tetracycline, and more than 80% were resistant to ampicillin. Most (74%) ill persons received medication to which their isolate was resistant. Drinking Lake Victoria water and sharing latrines between multiple households increased risk of bloody diarrhea. Washing hands after defecating was protective. Providing safe drinking water and more latrines, and promoting hand washing could reduce the burden of illness from bloody diarrhea while limiting injudicious antimicrobial use.
authors.affiliation: Foodborne and Diarrheal Diseases Branch, and Biostatistics and Information Management Branch, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA. zud4@cdc.gov
authors.forename: John T
authors.initials: JT
authors.lastname: Brooks
authors.forename: Roger L
authors.initials: RL
authors.lastname: Shapiro
authors.forename: Lata
authors.initials: L
authors.lastname: Kumar
authors.forename: Joy G
authors.initials: JG
authors.lastname: Wells
authors.forename: Penelope A
authors.initials: PA
authors.lastname: Phillips-Howard
authors.forename: Ya-Ping
authors.initials: YP
authors.lastname: Shi
authors.forename: John M
authors.initials: JM
authors.lastname: Vulule
authors.forename: Robert M
authors.initials: RM
authors.lastname: Hoekstra
authors.forename: Eric
authors.initials: E
authors.lastname: Mintz
authors.forename: Laurence
authors.initials: L
authors.lastname: Slutsker
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000494:pharmacology; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D003470:Culture Media; D003967:Diarrhea / Q000453:epidemiology* / Q000382:microbiology; D005243:Feces / Q000382:microbiology; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000453:epidemiology* / Q000382:microbiology; D006090:Gram-Negative Bacteria / Q000145:classification / Q000187:drug effects / Q000302:isolation & purification; D016905:Gram-Negative Bacterial Infections / Q000453:epidemiology* / Q000382:microbiology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007630:Kenya / Q000453:epidemiology; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D011159:Population Surveillance; D012307:Risk Factors; D012424:Rural Population
chemical_list: D000900:Anti-Bacterial Agents; D003470:Culture Media