Volume 71, Issue 3
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645


During the period from February 1995 to February 1998, the epidemiology of diarrhea was studied among children less than three years of age residing in Egypt’s Nile Delta. Children were visited twice a week and a stool sample was collected from any of them with diarrhea. The incidence of -associated diarrhea was 0.2 episodes/child-year, with being the most common serogroup isolated (55% of episodes). Younger age and the warm months increased the risk of developing -associated diarrhea, while breastfeeding was protective. Children with were ill for a mean of four days and passed a mean of six stools per day. Common symptoms included fever (35%), vomiting (19%), and dehydration (16%). Dysentery, however, was unusual, occurring in only 11% of the cases. In conclusion, -associated diarrhea remains relatively common in Egyptian children and supports the need for additional control measures including vaccine development.


Article metrics loading...

The graphs shown below represent data from March 2017
Loading full text...

Full text loading...



  1. Guerrant RL, Hughes JM, Lima NL, Crane J, 1990. Diarrhea in developed and developing countries: magnitude, special settings, and etiologies. Rev Infect Dis 12 (Suppl 1) : S41–S50. [Google Scholar]
  2. Juckett G, 1999. Prevention and treatment of traveler’s diarrhea. Am Fam Physician 60 : 119–124, 135–136. [Google Scholar]
  3. Shlim DR, Hoge CW, Rajah R, Scott RM, Pandy P, Echeverria P, 1999. Persistent high risk of diarrhea among foreigners in Nepal during the first 2 years of residence. Clin Infect Dis 29 : 613–616. [Google Scholar]
  4. Kotloff KL, Winickoff JP, Ivanoff B, Clemens JD, Swerdlow DL, Sansonetti PJ, Adak GK, Levine MM, 1999. Global burden of Shigella infections: implications for vaccine development and implementation of control strategies. Bull World Health Organ 77 : 651–666. [Google Scholar]
  5. Mohle-Boetani JC, Stapleton M, Finger R, Bean NH, Poundstone J, Blake PA, Griffin PM, 1995. Communitywide shigellosis: control of an outbreak and risk factors in child day-care centers. Am J Public Health 85 : 812–816. [Google Scholar]
  6. Hoffman RE, Shillam PJ, 1990. The use of hygiene, cohorting, and antimicrobial therapy to control an outbreak of shigellosis. Am J Dis Child 144 : 219–221. [Google Scholar]
  7. Pickering LK, Evans DG, DuPont HL, Vollet JJ 3rd, Evans DJ Jr, 1981. Diarrhea caused by Shigella, rotavirus, and Giardia in day-care centers: prospective study. J Pediatr 99 : 51–56. [Google Scholar]
  8. Baer JT, Vugia DJ, Reingold AL, Aragon T, Angulo FJ, Bradford WZ, 1999. HIV infection as a risk factor for shigellosis. Emerg Infect Dis 5 : 820–823. [Google Scholar]
  9. Germani Y, Minssart P, Vohito M, Yassibanda S, Glaziou P, Hocquet D, Berthelemy P, Morvan J, 1998. Etiologies of acute, persistent, and dysenteric diarrheas in adults in Bangui, Central African Republic, in relation to human immunodeficiency virus serostatus. Am J Trop Med Hyg 59 : 1008–1014. [Google Scholar]
  10. Angulo FJ, Swerdlow DL, 1995. Bacterial enteric infections in persons infected with human immunodeficiency virus. Clin Infect Dis 21 (Suppl 1) : S84–S93. [Google Scholar]
  11. van Oosterhout JJ, van der Hoek W, 1994. Infection with HIV, a risk factor for epidemic dysentery? A case-control study from Zambia. AIDS 8 : 1512–1513. [Google Scholar]
  12. Mahoney FJ, Farley TA, Burbank DF, Leslie NH, McFarland LM, 1993. Evaluation of an intervention program for the control of an outbreak of shigellosis among institutionalized persons. J Infect Dis 168 : 1177–1180. [Google Scholar]
  13. Edwards BH, 1999. Salmonella and Shigella species. Clin Lab Med 19 : 469–487. [Google Scholar]
  14. DuPont HL, Levine MM, Hornick RB, Formal SB, 1989. Inoculum size in shigellosis and implications for expected mode of transmission. J Infect Dis 159 : 1126–1128. [Google Scholar]
  15. Replogle ML, Fleming DW, Cieslak PR, 2000. Emergence of antimicrobial-resistant shigellosis in Oregon. Clin Infect Dis 30 : 515–519. [Google Scholar]
  16. Cheasty T, Skinner JA, Rowe B, Threlfall EJ, 1998. Increasing incidence of antibiotic resistance in shigellas from humans in England and Wales: recommendations for therapy. Microb Drug Resist 4 : 57–60. [Google Scholar]
  17. Hoge CW, Gambel JM, Srijan A, Pitarangsi C, Echeverria P, 1998. Trends in antibiotic resistance among diarrheal pathogens isolated in Thailand over 15 years. Clin Infect Dis 26 : 341–345. [Google Scholar]
  18. Sack RB, Rahman M, Yunus M, Khan EH, 1997. Antimicrobial resistance in organisms causing diarrheal disease. Clin Infect Dis 24 (Suppl 1) : S102–S105. [Google Scholar]
  19. WHO, 1997. Vaccine research and development. New strategies for accelerating Shigella vaccine development. Wkly Epidemiol Rec 72 : 73–79. [Google Scholar]
  20. Zaki AM, DuPont HL, el Alamy MA, Arafat RR, Amin K, Awad MM, Bassiouni L, Imam IZ, el Malih GS, el Marsafie A, Mohieldin MS, Naguib T, Rakha MA, Sidaros M, Wasef N, Wright CE, Wyatt RG, 1986. The detection of enteropathogens in acute diarrhea in a family cohort population in rural Egypt. Am J Trop Med Hyg 35 : 1013–1022. [Google Scholar]
  21. Naficy AB, Abu-Elyazeed R, Holmes JL, Rao MR, Savarino SJ, Kim Y, Wierzba TF, Peruski L, Lee YJ, Gentsch JR, Glass RI, Clemens JD, 1999. Epidemiology of rotavirus diarrhea in Egyptian children and implications for disease control. Am J Epidemiol 150 : 770–777. [Google Scholar]
  22. Naficy AB, Frenck RW, Abu-Elyazeed R, Kim Y, Rao MR, Savarino SJ, Wierzba TF, Hall E, Clemens JD, 2000. Seroepidemiology of Helicobacter pylori infection in a population of Egyptian children. Int J Epidemiol 29 : 928–932. [Google Scholar]
  23. Abu-Elyazeed R, Wierzba TF, Mourad AS, Peruski LF, Kay BA, Rao M, Churilla AM, Bourgeois AL, Mortagy AK, Kamal SM, Savarino SJ, Campbell JR, Murphy JR, Naficy A, Clemens JD, 1999. Epidemiology of enterotoxigenic Escherichia coli diarrhea in a pediatric cohort in a periurban area of lower Egypt. J Infect Dis 179 : 382–389. [Google Scholar]
  24. Farmer JJ III, 1999. Enterobacteriaceae: Introduction and Identification. Murray PR, Baron EJ, Pfaller MA, Tenover FC, Yolken RH, eds. Manual of Clinical Microbiology. Washington, DC: American Society for Microbiology, 442–458.
  25. Bopp CA, Brenner FW, Wells JG, Strockbine N, 1999. Escherichia, Shigella, and Salmonella. Murray PR, Baron EJ, Pfaller MA, Tenover FC, Yolken RH, eds. Manual of Clinical Microbiology. Washington, DC: American Society for Microbiology, 459–474.
  26. Tilson DL, 1999. Vibrio. Murray PR, Baron EJ, Pfaller MA, Tenover FC, Yolken RH, eds. Manual of Clinical Microbiology. Washington, DC: American Society for Microbiology, 497–506.
  27. Nachamkin I, 1999. Campylobacter and Arcobacter. Murray P, ed. Manual of Clinical Microbiology. Washington, DC: American Society for Microbiology, 716–726.
  28. Lefebvre J, Gosselin F, Ismail J, Lorange M, Lior H, Woodward D, 1995. Evaluation of commercial antisera for Shigella sero-grouping. J Clin Microbiol 33 : 1997–2001. [Google Scholar]
  29. Nathoo KJ, Porteous JE, Siziya S, Wellington M, Mason E, 1998. Predictors of mortality in children hospitalized with dysentery in Harare, Zimbabwe. Cent Afr J Med 44 : 272–276. [Google Scholar]
  30. Saidi SM, Iijima Y, Sang WK, Mwangudza AK, Oundo JO, Taga K, Aihara M, Nagayama K, Yamamoto H, Waiyaki PG, Honda T, 1997. Epidemiological study on infectious diarrheal diseases in children in a coastal rural area of Kenya. Microbiol Immunol 41 : 773–778. [Google Scholar]
  31. Green MS, Block C, Cohen D, Slater PE, 1991. Four decades of shigellosis in Israel: epidemiology of a growing public health problem. Rev Infect Dis 13 : 248–253. [Google Scholar]
  32. Rawashdeh MO, Ababneh AM, Shurman AA, 1994. Shigellosis in Jordanian children: a clinico-epidemiologic prospective study and susceptibility to antibiotics. J Trop Pediatr 40 : 355–359. [Google Scholar]
  33. Albert MJ, Faruque AS, Faruque SM, Sack RB, Mahalanabis D, 1999. Case-control study of enteropathogens associated with childhood diarrhea in Dhaka, Bangladesh. J Clin Microbiol 37 : 3458–3464. [Google Scholar]
  34. Khalil K, Khan SR, Mazhar K, Kaijser B, Lindblom GB, 1998. Occurrence and susceptibility to antibiotics of Shigella species in stools of hospitalized children with bloody diarrhea in Pakistan. Am J Trop Med Hyg 58 : 800–803. [Google Scholar]
  35. Ghosh AR, Sehgal SC, 1998. Shigella infections among children in Andaman–an archipelago of tropical islands in Bay of Bengal. Epidemiol Infect 121 : 43–48. [Google Scholar]
  36. Yurdakok K, Sahin N, Ozmert E, Berkman E, 1997. Shigella gastroenteritis: clinical and epidemiological aspects, and antibiotic susceptibility. Acta Paediatr Jpn 39 : 681–684. [Google Scholar]
  37. Lopez EL, Prado-Jimenez V, O’Ryan-Gallardo M, Contrini MM, 2000. Shigella and Shiga toxin-producing Escherichia coli causing bloody diarrhea in Latin America. Infect Dis Clin North Am 14 : 41–65. [Google Scholar]
  38. Prado V, Lagos R, Nataro JP, San Martin O, Arellano C, Wang JY, Borczyk AA, Levine MM, 1999. Population-based study of the incidence of Shigella diarrhea and causative serotypes in Santiago, Chile. Pediatr Infect Dis J 18 : 500–505. [Google Scholar]
  39. Townes JM, Quick R, Gonzales OY, Linares M, Damiani E, Bopp CA, Wahlquist SP, Hutwagner LC, Hanover E, Mintz ED, Tauxe RV, 1997. Etiology of bloody diarrhea in Bolivian children: implications for empiric therapy. Bolivian Dysentery Study Group. J Infect Dis 175 : 1527–1530. [Google Scholar]
  40. Baqui AH, Sack RB, Black RE, Haider K, Hossain A, Alim AR, Yunus M, Chowdhury HR, Siddique AK, 1992. Enteropathogens associated with acute and persistent diarrhea in Bangladeshi children less than 5 years of age. J Infect Dis 166 : 792–796. [Google Scholar]
  41. Oyofo BA, Subekti D, Tjaniadi P, Machpud N, Komalarini S, Setiawan B, Simanjuntak C, Punjabi N, Corwin AL, Wasfy M, Campbell JR, Lesmana M, 2002. Enteropathogens associated with acute diarrhea in community and hospital patients in Jakarta, Indonesia. FEMS Immunol Med Microbiol 34 : 139–146. [Google Scholar]
  42. Guerrero L, Calva JJ, Morrow AL, Velazquez FR, Tuz-Dzib F, Lopez-Vidal Y, Ortega H, Arroyo H, Cleary TG, Pickering LK, 1994. Asymptomatic Shigella infections in a cohort of Mexican children younger than two years of age. Pediatr Infect Dis J 13 : 597–602. [Google Scholar]
  43. Howard P, Alexander ND, Atkinson A, Clegg AO, Gerega G, Javati A, Kajoi M, Lupiwa S, Lupiwa T, Mens M, Saleu G, Sanders RC, West B, Alpers MP, 2000. Bacterial, viral and parasitic aetiology of paediatric diarrhoea in the highlands of Papua New Guinea. J Trop Pediatr 46 : 10–14. [Google Scholar]
  44. Ahmed F, Clemens JD, Rao MR, Ansaruzzaman M, Haque E, 1997. Epidemiology of shigellosis among children exposed to cases of Shigella dysentery: a multivariate assessment. Am J Trop Med Hyg 56 : 258–264. [Google Scholar]
  45. Lerman Y, Slepon R, Cohen D, 1994. Epidemiology of acute diarrheal diseases in children in a high standard of living rural settlement in Israel. Pediatr Infect Dis J 13 : 116–122. [Google Scholar]
  46. VanDerslice J, Popkin B, Briscoe J, 1994. Drinking-water quality, sanitation, and breast-feeding: their interactive effects on infant health. Bull World Health Organ 72 : 589–601. [Google Scholar]
  47. Bennish ML, Wojtyniak BJ, 1991. Mortality due to shigellosis: community and hospital data. Rev Infect Dis 13 (Suppl 4) : S245–S251. [Google Scholar]

Data & Media loading...

  • Received : 23 Dec 2003
  • Accepted : 22 Mar 2004

Most Cited This Month

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error