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The epidemiology, clinical features, nutritional status, and causative agents of diarrhea were studied in 289 Bangladeshi children (147 boys and 142 girls) 2–5 years old. The use of improved diagnostic tests for amebiasis enabled for the first time analysis of the contribution of Entamoeba histolytica to total diarrheal illness in this community setting. The average incidence rate of diarrhea was 1.8/child-year, and the average number of diarrheal days was 3.7 days/child-year over an average observation period of 2.8 years/child. Seventy-five percent of the diarrheal episodes were 
2 days in duration. Persistent diarrhea was relatively uncommon (0.2% of the children) and chronic diarrhea was observed in only one episode. Compared with malnourished and/or stunted children, better-nourished children experienced significantly fewer diarrheal episodes. The diarrheal incidence rate for children with blood group A was significantly less that that of the children with blood groups O and AB. The most frequent bacterial enteropathogens isolated from diarrheal stool specimens were enterotoxigenic Escherichia coli (9%) and Aeromonas species (9%), followed by Plesimonas shigelloides (4%) and Shigella flexneri (3.8%). Rotavirus was the most common viral agent isolated from diarrheal stool samples (5%). Giardia lamblia, Cryptosporidium parvum, and E. histolytica were identified in 11%, 8.4%, and 8%, respectively, of the diarrheal stool specimens. Dysentery was observed in 7.7% of all diarrheal episodes. The most common pathogens isolated from dysenteric stool were S. flexneri (11.6%), Aeromonas sp. (10%), E. histolytica (8.7%), Campylobacter jejunii (5.8%), P. shigelloides (4.3%), and A. caviae (4.3%). The overall incidence rate of E. histolytica-associated diarrhea was 0.08/child-year. Visible blood and hemoccult test-detected blood loss was found in 7% and 25%, respectively, of cases of E. histolytica-associated diarrhea. Children who had recovered from a diarrheal episode with E. histolytica, but not E. dispar, had half the chance of developing subsequent E. histolytica-associated diarrhea, consistent with the development of species-specific acquired immunity. In conclusion, the use of modern diagnostic tests demonstrated that E. histolytica contributed to overall morbidity from diarrheal illness. Understanding the etiology, frequency, and consequences of acute diarrhea in children from a developing country should aid in the design of interventions to improve child health.
Received July 10, 2003. Accepted for publication July 27, 2003.
Acknowledgments: We thank Dr. Lyerly of TechLab Inc. for providing parasite fecal antigen detection tests. The ICCRD,B acknowledges the commitment of the National Institutes of Health (NIH) (Bethesda, MD) and the University of Virginia to its effort. We thank the parents and children of Mirpur for their participation, and the field team, including the study supervisor Lutfar Rahaman; field assistants Janata Rani Shaha, Salma Akther, Sahina Parveen, Nurjahan Akther Baby, and Dulari Begum; the Data Management Officer Mahbubur Rahman; and Dr. Hamidur Rahman from the laboratory staffs for their contributions to this study.
Financial support: The study was conducted at the ICDDR, B Centre for Health and Population Research with the support of a grant (AI-43596) from the NIH. This work was also supported by NIH grant AI-43596. Rashidul Haque is a Howard Hughes Medical Institute International Research Scholar and William A. Petri, Jr. is a Burroughs Wellcome Fund Scholar in Molecular Parasitology.
Disclosure: The authors wish to disclose that the University of Virginia has a license agreement with Techlab, Inc. for diagnostic tests for amebiasis. Dr. Petri donates all of his royalties from this agreement to the American Society of Tropical Medicine and Hygiene
Authors’ addresses: Rashidul Haque, Dinesh Mondal, and Selim Akther, Laboratory Sciences Division, Center for Health and Population Resaerch, International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B), GPO Box 128, Dhaka 1000, Bangladesh. Beth D. Kirkpatrick, Unit of Infectious Diseases, University of Vermont/Fletcher Allen Health Care, Burgess 303, MCHV Campus, Burlington, VT 05401. Barry M. Farr and William A. Petri, Jr., Department of Medicine, University of Virginia Health System, Charlottesville, VA 22908. R. Bradley Sack, Department of International Health, Johns Hopkins University Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD 21205-2179.
Reprint requests: Rashidul Haque, Laboratory Sciences Division, International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR, B), GPO Box 128, Dhaka1000, Bangladesh, Telephone: 880-2-881-751, extension 2411, Fax: 880-2-8812529 or 880-2-8823116, E-mail: rhaque{at}icddrb.org.
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