title: Surveillance for enteric pathogens in a case-control study of acute diarrhea in Western Kenya.
abstract: BACKGROUND
  Acute diarrhea remains a major public health problem in East African nations such as Kenya. Surveillance for a broad range of enteric pathogens is necessary to accurately predict the frequency of pathogens and potential changes in antibiotic resistance patterns.
  
  
  METHODS
  Stool samples were collected from September 2009 to September 2011; 193 and 239 samples, from age-matched cases and asymptomatic controls, were collected, respectively, from Kericho and Kisumu District Hospitals in western Kenya. Bacterial pathogens were identified by conventional microbiological methods; antibiotic susceptibility of bacterial isolates was ascertained using the MicroScan WalkAway 40 Plus. An enzyme immunoassay kit was used to detect rotavirus, and ova and parasite examination was conducted by microscopy and an enzyme immunoassay.
  
  
  RESULTS
  Rotavirus (10.2% and 10.5%) and Shigella (11% and 8%) were isolated significantly more often in the cases than the controls from Kericho and Kisumu District Hospitals respectively. The diarrheagenic Escherichia coli, Campylobacter jejuni and Salmonella were found most often in the cases while Giardia lamblia and Entamoeba histolytica/E. dispar were found more often in the controls. Most pathogens were isolated from children under 5 years old. More than 50% of the Shigella, Salmonella and diarrheagenic E. coli isolates were multidrug resistant to ampicillin, tetracycline and trimethoprim/sulfamethoxazole with several enteroaggregative and enterotoxigenic E. coli isolates producing extended-spectrum beta-lactamases.
  
  
  CONCLUSIONS
  Accurate epidemiologic information on acute diarrheal illness in Kenya will be critical for augmenting existing diarrhea management policies in terms of treatment and to strengthen future community awareness and health promotion programs.
authors.affiliation: United States Army Medical Research Unit - Kenya, Kericho Field Station, PO Box 1357, Hospital Road, Kericho, Kenya 20220.
authors.forename: Brett E
authors.initials: BE
authors.lastname: Swierczewski
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Odundo
authors.forename: Margaret C
authors.initials: MC
authors.lastname: Koech
authors.forename: Janet N
authors.initials: JN
authors.lastname: Ndonye
authors.forename: Ronald K
authors.initials: RK
authors.lastname: Kirera
authors.forename: Cliff P
authors.initials: CP
authors.lastname: Odhiambo
authors.forename: Erick K
authors.initials: EK
authors.lastname: Cheruiyot
authors.forename: Max T
authors.initials: MT
authors.lastname: Wu
authors.forename: James E
authors.initials: JE
authors.lastname: Lee
authors.forename: Chunlin
authors.initials: C
authors.lastname: Zhang
authors.forename: Edwin V
authors.initials: EV
authors.lastname: Oaks
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents / Q000494:pharmacology; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D003967:Diarrhea / Q000382:microbiology* / Q000469:parasitology* / Q000821:virology; D004755:Enterobacteriaceae / Q000187:drug effects / Q000302:isolation & purification; D004756:Enterobacteriaceae Infections / Q000382:microbiology; D005243:Feces / Q000382:microbiology / Q000469:parasitology / Q000821:virology; D005260:Female; D016829:Giardia lamblia / Q000302:isolation & purification; D006801:Humans; D007630:Kenya; D008297:Male; D008826:Microbial Sensitivity Tests; D011159:Population Surveillance; D012401:Rotavirus / Q000302:isolation & purification; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents