An investigation of the bacterial and parasitic agents associated with diarrheal illness in 655 children under two years of age was conducted in Karachi, West Pakistan. Four hundred sixty-eight children of similar age but without diarrhea were studied as controls. Specimens were obtained from both hospitalized patients and out-patients.
Enteropathogenic bacteria were isolated from 19.6% of all diarrhea cases and 4.7% of all controls. Shigella, the commonest bacterial pathogen, was recovered from 12.4% of children ill with gastroenteritis and 1.3% of controls and showed an increasing incidence with age up to two years. Enteropathogenic Escherichia coli was found 2.5 times as often in diarrhea cases as in controls, and most frequently in the age groups from birth to 6 months and from 13 to 18 months. E. coli serotype 0126:K71 (B16) was the most common in the hospital cases and 0127:K63 (B8) in the clinic cases. Salmonella was found in less than 0.5% of all children.
Nutrition appeared to be an important factor in the children with diarrhea. Approximately 50% of hospital patients showed some degree of marasmus or kwashiorkor. Onset of diarrheal episodes appeared to be associated with weaning.
Parasites were found in equal incidence in diarrhea cases and controls with the exception of Giardia lamblia, which was found 1.6 times as often in children with gastrointestinal symptoms.
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Department of Microbiology, Wayne State University School of Medicine, Detroit, Michigan 48207. Formerly Professor of Microbiology, Jinnah Post-Graduate Medical Center.
Professor of Pediatrics, Children's Hospital, Jinnah Central Hospital Compound, Karachi, Pakistan.