title: Etiology of Acute Diarrhea in Tunisian Children with Emphasis on Diarrheagenic Escherichia coli: Prevalence and Identification of E. coli Virulence Markers.
abstract: BACKGROUND
  Diarrheal diseases can be caused by viral, bacterial and parasitic infections. This paper provides a preliminary image of diarrhea with regards to etiology and epidemiologic factors in Tunisian children less than five years of age.
  
  
  METHODS
  Overall, 124 diarrhoeal stools were collected from patients suffering from acute diarrhea and 54 stool samples from healthy children. All stools were examined for the presence of enteric pathogens.
  
  
  RESULTS
  In diarrheagenic children, 107 pathogenic bacteria were isolated (12 Salmonella spp. (9.7%) and 95 diarrheagenic Escherichia coli strains (76.6%): 29 enteroaggregative E.coli (EAEC) (23.4%), 15 enteroinvasive E.coli (EIEC) (12.1%), 17 enteropathogenic E.coli (EPEC) (13.7%), 26 enterotoxigenic E.coli (ETEC) (21%) and 2 enterohemoragic E.coli (EHEC) (1.6%). However, in the control group, 23 pathogenic E.coli strains were isolated (42.6%): 8 EAEC (14.8%), 12 EIEC (22.2%) and 3 EPEC (5.5%). Among diarrheagenic E.coli (DEC), only ETEC strains were significantly recovered from diarrheagenic children than from healthy controls (P < 0.0003). Group A rotavirus was identified in 33.9% (n=42) of diarrheagenic children and in 11.1% among the control group (n=6). Concerning norovirus, 8.9% (n=11) of the samples collected from diarrheagenic children and 9.2% (n=5) from the control group were positive. The prevalence of rotaviruses and Salmonella spp were also significantly higher in patients with diarrhea than in controls (P = 0.002 and P < 0.019, respectively). Finally, enteropathogenic parasites (Entamoeba coli and cryptosporidium Oocystes) were isolated from 4.8% and 9.2% of diarrheagenic and control children, respectively.
  
  
  CONCLUSIONS
  These results provide baseline data about the relative importance of different enteropathogens in Tunisian children.
authors.affiliation: 1. Laboratory of Infectious Diseases and Biological Agents, Faculty of Pharmacy, University of Monastir TU-5000 Monastir, Tunisia ; 1. Laboratory of Infectious Diseases and Biological Agents, Faculty of Pharmacy, University of Monastir TU-5000 Monastir, Tunisia.
authors.forename: Imen
authors.initials: I
authors.lastname: Ben Salem-Ben Nejma
authors.affiliation: 1. Laboratory of Infectious Diseases and Biological Agents, Faculty of Pharmacy, University of Monastir TU-5000 Monastir, Tunisia ; 3. National Reference Center for Enteric Viruses, Laboratory of Virology, CHU of Dijon, 2 Rue Angélique Ducoudray, University of Bourgogne 21000 Dijon France.
authors.forename: Mouna
authors.initials: M
authors.lastname: Hassine Zaafrane
authors.affiliation: 4. Polyclinique CNSS Sousse- Khzema Sousse 4000-Tunisia.
authors.forename: Fredj
authors.initials: F
authors.lastname: Hassine
authors.affiliation: 3. National Reference Center for Enteric Viruses, Laboratory of Virology, CHU of Dijon, 2 Rue Angélique Ducoudray, University of Bourgogne 21000 Dijon France.
authors.forename: Khira
authors.initials: K
authors.lastname: Sdiri-Loulizi
authors.affiliation: 3. National Reference Center for Enteric Viruses, Laboratory of Virology, CHU of Dijon, 2 Rue Angélique Ducoudray, University of Bourgogne 21000 Dijon France.
authors.forename: Moncef
authors.initials: M
authors.lastname: Ben Said
authors.affiliation: 1. Laboratory of Infectious Diseases and Biological Agents, Faculty of Pharmacy, University of Monastir TU-5000 Monastir, Tunisia.
authors.forename: Mahjoub
authors.initials: M
authors.lastname: Aouni
authors.affiliation: 2. Laboratory of Hygiene, 5 Rue de Kairouan 4000 Sousse Tunisia.
authors.forename: Ridha
authors.initials: R
authors.lastname: Mzoughi
keywords: Children; Diagnosis; Diarrhea; Enteric pathogens; Escherichia coli; Tunisia