Pseudomonas aeruginosa-associated Diarrheal Diseases in Children.
BACKGROUND
The gastrointestinal tract is not the common infection site of Pseudomonas aeruginosa. The role of P. aeruginosa as a causative agent for diarrhea in children without preexisting disease is controversial.


METHODS
From 2003 to 2012, we reviewed the records of 259 diarrheal patients less than 5 years of age whose stool culture grew P. aeruginosa. Virulence phenotypes of bacterial isolates were determined in vitro, including cytotoxicity, penetration and adherence to epithelial cells.


RESULTS
The presence of P. aeruginosa in children with diarrhea less than 5 years old is 0.91%. P. aeruginosa-associated diarrheal diseases were classified into 4 groups: Shanghai fever (enteric infection and sepsis) (5%), P. aeruginosa enterocolitis (15%), P. aeruginosa-related diarrhea (19%) and antibiotic-associated diarrhea (43%). The remaining patients had coinfection with other pathogens (18%). Shanghai fever was the most severe enteric disease with invasive infection and complications. The clinical features of P. aeruginosa enterocolitis were prolonged fever with bloody or mucoid diarrhea mimicking bacterial enterocolitis. The clinical features of P. aeruginosa-related diarrhea and antibiotic-associated diarrhea were similar to viral or toxin-mediated diarrhea. Compared with other P. aeruginosa-associated diarrheal diseases, patients with Shanghai fever were younger, usually infants, and the characteristic laboratory findings included leukopenia, thrombocytopenia, high C-reactive protein, hyponatremia and hyperglycemia. Except for Shanghai fever, antibiotic treatment is not recommended. Isolates from Shanghai fever were more cytotoxic and adherent than isolates from uncomplicated diarrheal patients.


CONCLUSIONS
P. aeruginosa could be an enteric pathogen even in healthy children. Young age and highly virulent bacterial strains were risk factors for Shanghai fever.
From the *Department of Pediatrics, St. Paul's Hospital, Taoyuan, Taiwan; †Molecular Infectious Diseases Research Center, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan; ‡School of Medicine, College of Medicine, Fu-Jen Catholic University, New Taipei, Taiwan; and §Division of Pediatric Infectious Diseases, Chang Gung Children's Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan.
Chih-Hsien
CH
Chuang
Rajendra Prasad
RP
Janapatla
Yi-Hsin
YH
Wang
Hsin-Ju
HJ
Chang
Yhu-Chering
YC
Huang
Tzou-Yien
TY
Lin
Cheng-Hsun
CH
Chiu
D000818:Animals; D001422:Bacterial Adhesion; D002470:Cell Survival; D002675:Child, Preschool; D003967:Diarrhea / Q000175:diagnosis / Q000453:epidemiology* / Q000382:microbiology* / Q000503:physiopathology; D004285:Dogs; D005243:Feces / Q000382:microbiology; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D061985:Madin Darby Canine Kidney Cells; D008297:Male; D015995:Prevalence; D011552:Pseudomonas Infections / Q000175:diagnosis / Q000453:epidemiology* / Q000382:microbiology* / Q000503:physiopathology; D011550:Pseudomonas aeruginosa / Q000302:isolation & purification / Q000472:pathogenicity; D012189:Retrospective Studies