Community-acquired infectious diarrhoea in children under 5 years of age in Dakar, Senegal.
BACKGROUND
In sub-Saharan Africa, infectious diarrhoea is a major cause of childhood morbidity and mortality. A cross-sectional study was undertaken to document the pathogens potentially involved in community-acquired childhood diarrhoea in Dakar, the capital of Senegal.


METHODS
Between September 2007 and March 2008, 176 children aged 1 month to 5 years were recruited consecutively from a primary health care institution in an urban area. Clinical data were recorded and stool samples were collected. Bacterial pathogens were identified using conventional methods and/or PCR assays. Rotaviruses and adenoviruses were detected by a rapid immunochromatographic test. Intestinal parasites were diagnosed by microscopy.


RESULTS
Rotavirus was the most common enteric pathogen, detected in 27% of patients, followed by Shigella (12%), diarrhoeagenic Escherichia coli (8%), enteric adenovirus (8%), Salmonella (4%), Campylobacter jejuni (3%) and Plesiomonas shigelloides (2%). Mixed bacterial/viral infections were detected in 6% of cases. Parasites, mostly protozoa, were detected in 14% of children. Using ipaH PCR, 30% of samples were positive for Shigella/entero-invasive E. coli. Detection of rotavirus was more frequently associated with younger age groups (<24 months), whereas bacterial diarrhoea was isolated more often in children over 1 year of age. Detection of bacterial pathogens was significantly associated with malnutrition. Antibiotics were prescribed for 77% of children who attended for consultation. No pathogen was found in 36% of them, whereas a virus was detected without any other associated bacterial or parasitic pathogen in 23% of patients.


CONCLUSIONS
In developing countries, there is a need to develop reliable, easy-to-use, inexpensive rapid diagnostic tests to guide the management of diarrhoea in infants and children and thereby prevent over-use of antimicrobial agents.
Centre Hospitalier Intercommunal de Poissy-Saint-Germain-en-Laye, France. jmsire@chi-poissy-st-germain.fr
Jean-Marie
JM
Sire
Benoit
B
Garin
Loic
L
Chartier
Ndeye Khota
NK
Fall
Adama
A
Tall
Abdoulaye
A
Seck
François-Xavier
FX
Weill
Sébastien
S
Breurec
Muriel
M
Vray
D000818:Animals; D001419:Bacteria / Q000145:classification / Q000302:isolation & purification*; D002675:Child, Preschool; D019411:Clinical Laboratory Techniques / Q000379:methods; D017714:Community-Acquired Infections / Q000453:epidemiology* / Q000209:etiology*; D003955:Diagnostic Tests, Routine / Q000379:methods; D003967:Diarrhea / Q000453:epidemiology* / Q000209:etiology*; D005243:Feces / Q000382:microbiology / Q000469:parasitology / Q000821:virology; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D010271:Parasites / Q000145:classification / Q000302:isolation & purification*; D012675:Senegal / Q000453:epidemiology; D014505:Urban Population; D014780:Viruses / Q000145:classification / Q000302:isolation & purification*