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Etiology of Summer Diarrhea among the Navajo^*

The etiology of diarrhea in children and adults on the Navajo Indian Reservation was investigated in August 1975. Fifty-six ill individuals and 37 controls were included in the study. Shigella was most commonly associated with diarrhea, and was isolated from 32% of ill children and adults. Fifty percent of Shigella isolates tested were resistant to ampicillin. Heat-stable enterotoxin-(ST)-producing organisms were associated with noninflammatory diarrhea in adults (27% of these cases had ST-producing strains) but not in children. Heat-labile enterotoxin-producing organisms were found among controls as well as individuals with diarrhea. No children had evidence of rotavirus infection. These findings suggest that ST-producing organisms are important causes of sporadic cases of noninflammatory summer diarrhea among Navajo adults and confirm the importance of Shigella in inflammatory diarrhea among adults and children in this setting.

Accepted for publication October 27, 1979.

^* This study was supported by Contract No. NO1-A1-4258 from the National Institutes of Health, Bethesda, Maryland. Dr. Hughes was in the Career Development Program in the Bureau of Epidemiology, Center for Disease Control, Public Health Service, U.S. Department of Health, Education, and Welfare, Atlanta, Georgia; Dr. Barada was in the Indian Health Service, Public Health Service, U.S. Department of Health, Education, and Welfare, Fort Defiance, Arizona; Dr. Guerrant was George Morris Piersol Teacher and Research Scholar of the American College of Physicians.

Address reprint requests to: Richard L. Guerrant, M.D., Division of Geographic Medicine, Department of Medicine, Box 385 School of Medicine, University of Virginia, Charlottesville, Virginia 22908.