title: Impact of rapid urbanization on the rates of infection by Vibrio cholerae O1 and enterotoxigenic Escherichia coli in Dhaka, Bangladesh.
abstract: BACKGROUND
  In Bangladesh, increases in cholera epidemics are being documented with a greater incidence and severity. The aim of this prospective study was to identify the prevalence and importance of V. cholerae O1 and enterotoxigenic Escherichia coli (ETEC) as causal agents of severe diarrhea in a high diarrhea prone urban area in Dhaka city.
  
  
  METHODS
  Systematic surveillance was carried out on all diarrheal patients admitted from Mirpur between March 2008 to February 2010 at the ICDDR, B hospital. Stool or rectal swabs were collected from every third diarrheal patient for microbiological evaluation.
  
  
  RESULTS
  Of diarrheal patients attending the hospital from Mirpur, 41% suffered from severe dehydration with 39% requiring intravenous rehydration therapy. More diarrheal patients were above five years of age (64%) than those below five years of age (36%). About 60% of the patients above five years of age had severe dehydration compared with only 9% of patients under five years of age. The most prevalent pathogen isolated was Vibrio cholerae O1 (23%) followed by ETEC (11%). About 8% of cholera infection was seen in infants with the youngest children being one month of age while in the case of ETEC the rate was 11%. Of the isolated ETEC strains, the enterotoxin type were almost equally distributed; ST accounted for 31% of strains; LT/ST for 38% and LT for 31%.
  
  
  CONCLUSIONS
  V. cholerae O1 is the major bacterial pathogen and a cause of severe cholera disease in 23% of patients from Mirpur. This represents a socioeconomic group that best reflects the major areas of high cholera burden in the country. Vaccines that can target such high risk groups in the country and the region will hopefully be able to reduce the disease morbidity and the transmission of pathogens that impact the life and health of people.
authors.affiliation: International Centre for Diarrheal Disease Research, Dhaka, Bangladesh.
authors.forename: Fahima
authors.initials: F
authors.lastname: Chowdhury
authors.forename: Mohammad Arif
authors.initials: MA
authors.lastname: Rahman
authors.forename: Yasmin A
authors.initials: YA
authors.lastname: Begum
authors.forename: Ashraful I
authors.initials: AI
authors.lastname: Khan
authors.forename: Abu S G
authors.initials: AS
authors.lastname: Faruque
authors.forename: Nirod Chandra
authors.initials: NC
authors.lastname: Saha
authors.forename: Nabilah Ibnat
authors.initials: NI
authors.lastname: Baby
authors.forename: M A
authors.initials: MA
authors.lastname: Malek
authors.forename: Anisha Rajeev
authors.initials: AR
authors.lastname: Kumar
authors.forename: Ann-Mari
authors.initials: AM
authors.lastname: Svennerholm
authors.forename: Mark
authors.initials: M
authors.lastname: Pietroni
authors.forename: Alejandro
authors.initials: A
authors.lastname: Cravioto
authors.forename: Firdausi
authors.initials: F
authors.lastname: Qadri
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001459:Bangladesh / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D002771:Cholera / Q000453:epidemiology* / Q000382:microbiology; D003967:Diarrhea / Q000453:epidemiology / Q000382:microbiology; D054307:Enterotoxigenic Escherichia coli / Q000302:isolation & purification*; D004927:Escherichia coli Infections / Q000453:epidemiology* / Q000382:microbiology; D005243:Feces / Q000382:microbiology; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies; D012007:Rectum / Q000382:microbiology; D012307:Risk Factors; D014507:Urbanization; D041241:Vibrio cholerae O1 / Q000302:isolation & purification*; D055815:Young Adult