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The Detection of Enteropathogens in Acute Diarrhea in a Family Cohort Population in Rural Egypt

Ahmed M. Zaki^*, Herbert L. DuPont, Mohamed A. el Alamy^**, Raouf R. Arafat^**, Kareema Amin, Mustafa M. Awad^*, Lila Bassiouni, Imam Z. Imam, Girgis S. el Malih^*, Aisha el Marsafie^*, Mohammad S. Mohieldin^*,¶, Tary Naguib, Magda A. Rakha^*, Michael Sidaros^*, Nadia Wasef^*, Charles E. Wright AND Richard G. Wyatt

^* Central Health Laboratory
^** Epidemiology Study Center-Bilbeis
Serum and Vaccine Institute, Ministry of Health, Cairo, Egypt
The University of Texas Health Science Center at Houston, Texas
National Institutes of Health, Bethesda, Maryland

In 8 villages of rural northeastern Egypt, a 2-year study of the etiologic agents associated with episodes of diarrhea was carried out. Stool specimens (3,243) from 3,513 episodes of diarrhea were processed for enteropathogens. The most commonly identified agents in the group with diarrhea were Giardia lamblia (44%), heat stable enterotoxin (ST)-producing enterotoxigenic Escherichia coli (ETEC) (15%), heat labile toxin (LT)- producing ETEC (12%), enteropathogenic E. coli (EPEC) (4%), rotavirus (3%), Shigella (2%) and Salmonella (1%). Isolation rates were increased in cases compared to controls for all agents except G. lamblia and EPEC strains. Rotavirus, Salmonella and ST-producing ETEC were more frequently isolated during cooler months and Shigella and LT-ETEC occurred more commonly in warmer months. Campylobacter, EPEC, Giardia and E. histolytica did not show a discernable seasonal pattern. Rotavirus was primarily associated with diarrhea in infants only. Forty-four percent of children experienced at least 1 bout of rotavirus diarrhea by the age of 3 years. Vomiting was reported in 65% of cases of rotavirus infection. Dehydration was reported in >40% of those with rotavirus-, Salmonella-, Campylobacter-, LT-ETEC- and EPEC-associated illness and in those without an identifiable agent. While rotavirus was implicated in 3% of cases overall, when vomiting or vomiting plus dehydration occurred, rotavirus was identified with a rate of 10% and 12%, respectively. Dysentery was common only in Shigella cases, occurring in 24%. A decrease in occurrence of rotavirus, Campylobacter and possibly EPEC illness was seen in the infants <6 months of age who were breast-fed when compared to those who were not.

Accepted for publication April 30, 1986.

^¶ Deceased.

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