ETIOLOGY OF DIARRHEA IN CHILDREN YOUNGER THAN 5 YEARS OF AGE ADMITTED IN A RURAL HOSPITAL OF SOUTHERN MOZAMBIQUE

INÁCIO M. MANDOMANDO Centro de Investigação em Saúde da Manhiça, Moçambique; Instituto Nacional de Saude, Ministerio de Saude, Maputo, Mozambique; Centro de Salud Internacional, IDIBAPS, Hospital Clinic, Barcelona, Spain; Direcção Nacional de Saúde, Moçambique; Faculdade de Medicina, Universidade Eduardo Mondlane, Moçambique; Servei de Microbiologia, IDIBAPS, Hospital Clinic, Barcelona, Spain

Search for other papers by INÁCIO M. MANDOMANDO in
Current site
Google Scholar
PubMed
Close
,
EUSÉBIO V. MACETE Centro de Investigação em Saúde da Manhiça, Moçambique; Instituto Nacional de Saude, Ministerio de Saude, Maputo, Mozambique; Centro de Salud Internacional, IDIBAPS, Hospital Clinic, Barcelona, Spain; Direcção Nacional de Saúde, Moçambique; Faculdade de Medicina, Universidade Eduardo Mondlane, Moçambique; Servei de Microbiologia, IDIBAPS, Hospital Clinic, Barcelona, Spain

Search for other papers by EUSÉBIO V. MACETE in
Current site
Google Scholar
PubMed
Close
,
JOAQUIM RUIZ Centro de Investigação em Saúde da Manhiça, Moçambique; Instituto Nacional de Saude, Ministerio de Saude, Maputo, Mozambique; Centro de Salud Internacional, IDIBAPS, Hospital Clinic, Barcelona, Spain; Direcção Nacional de Saúde, Moçambique; Faculdade de Medicina, Universidade Eduardo Mondlane, Moçambique; Servei de Microbiologia, IDIBAPS, Hospital Clinic, Barcelona, Spain

Search for other papers by JOAQUIM RUIZ in
Current site
Google Scholar
PubMed
Close
,
SERGI SANZ Centro de Investigação em Saúde da Manhiça, Moçambique; Instituto Nacional de Saude, Ministerio de Saude, Maputo, Mozambique; Centro de Salud Internacional, IDIBAPS, Hospital Clinic, Barcelona, Spain; Direcção Nacional de Saúde, Moçambique; Faculdade de Medicina, Universidade Eduardo Mondlane, Moçambique; Servei de Microbiologia, IDIBAPS, Hospital Clinic, Barcelona, Spain

Search for other papers by SERGI SANZ in
Current site
Google Scholar
PubMed
Close
,
FATIMA ABACASSAMO Centro de Investigação em Saúde da Manhiça, Moçambique; Instituto Nacional de Saude, Ministerio de Saude, Maputo, Mozambique; Centro de Salud Internacional, IDIBAPS, Hospital Clinic, Barcelona, Spain; Direcção Nacional de Saúde, Moçambique; Faculdade de Medicina, Universidade Eduardo Mondlane, Moçambique; Servei de Microbiologia, IDIBAPS, Hospital Clinic, Barcelona, Spain

Search for other papers by FATIMA ABACASSAMO in
Current site
Google Scholar
PubMed
Close
,
XAVIER VALLÈS Centro de Investigação em Saúde da Manhiça, Moçambique; Instituto Nacional de Saude, Ministerio de Saude, Maputo, Mozambique; Centro de Salud Internacional, IDIBAPS, Hospital Clinic, Barcelona, Spain; Direcção Nacional de Saúde, Moçambique; Faculdade de Medicina, Universidade Eduardo Mondlane, Moçambique; Servei de Microbiologia, IDIBAPS, Hospital Clinic, Barcelona, Spain

Search for other papers by XAVIER VALLÈS in
Current site
Google Scholar
PubMed
Close
,
JAHIT SACARLAL Centro de Investigação em Saúde da Manhiça, Moçambique; Instituto Nacional de Saude, Ministerio de Saude, Maputo, Mozambique; Centro de Salud Internacional, IDIBAPS, Hospital Clinic, Barcelona, Spain; Direcção Nacional de Saúde, Moçambique; Faculdade de Medicina, Universidade Eduardo Mondlane, Moçambique; Servei de Microbiologia, IDIBAPS, Hospital Clinic, Barcelona, Spain

Search for other papers by JAHIT SACARLAL in
Current site
Google Scholar
PubMed
Close
,
MARGARITA M. NAVIA Centro de Investigação em Saúde da Manhiça, Moçambique; Instituto Nacional de Saude, Ministerio de Saude, Maputo, Mozambique; Centro de Salud Internacional, IDIBAPS, Hospital Clinic, Barcelona, Spain; Direcção Nacional de Saúde, Moçambique; Faculdade de Medicina, Universidade Eduardo Mondlane, Moçambique; Servei de Microbiologia, IDIBAPS, Hospital Clinic, Barcelona, Spain

Search for other papers by MARGARITA M. NAVIA in
Current site
Google Scholar
PubMed
Close
,
JORDI VILA Centro de Investigação em Saúde da Manhiça, Moçambique; Instituto Nacional de Saude, Ministerio de Saude, Maputo, Mozambique; Centro de Salud Internacional, IDIBAPS, Hospital Clinic, Barcelona, Spain; Direcção Nacional de Saúde, Moçambique; Faculdade de Medicina, Universidade Eduardo Mondlane, Moçambique; Servei de Microbiologia, IDIBAPS, Hospital Clinic, Barcelona, Spain

Search for other papers by JORDI VILA in
Current site
Google Scholar
PubMed
Close
,
PEDRO L. ALONSO Centro de Investigação em Saúde da Manhiça, Moçambique; Instituto Nacional de Saude, Ministerio de Saude, Maputo, Mozambique; Centro de Salud Internacional, IDIBAPS, Hospital Clinic, Barcelona, Spain; Direcção Nacional de Saúde, Moçambique; Faculdade de Medicina, Universidade Eduardo Mondlane, Moçambique; Servei de Microbiologia, IDIBAPS, Hospital Clinic, Barcelona, Spain

Search for other papers by PEDRO L. ALONSO in
Current site
Google Scholar
PubMed
Close
, and
JOAQUIM GASCON Centro de Investigação em Saúde da Manhiça, Moçambique; Instituto Nacional de Saude, Ministerio de Saude, Maputo, Mozambique; Centro de Salud Internacional, IDIBAPS, Hospital Clinic, Barcelona, Spain; Direcção Nacional de Saúde, Moçambique; Faculdade de Medicina, Universidade Eduardo Mondlane, Moçambique; Servei de Microbiologia, IDIBAPS, Hospital Clinic, Barcelona, Spain

Search for other papers by JOAQUIM GASCON in
Current site
Google Scholar
PubMed
Close
Restricted access

Diarrhea is one of the main causes of morbidity and mortality among children in sub-Saharan Africa and one of the main causes of hospital admissions in rural areas. Stool samples were collected from 529 children admitted with diarrhea to the Manhiça District Hospital (September 2000 to September 2001) and processed to detect bacterial enteropathogens, parasites, and virus. Diarrheagenic Escherichia coli, isolated from 120 samples (22.6%; enteropathogenic [9.6%], enterotoxigenic [6.8%], enteroaggregative [4.3%], and verotoxigenic [1.9%]) was the most frequently isolated pathogen, followed by Ascaris lumbricoides (9.3%). Others detected included Salmonella spp. and Giardia lamblia (2.5% each) and Campylobacter spp. (1.7%). A. lumbricoides (92% versus 8%; P < 0.001) and Strongyloides stercolaris (100% versus 0%; P = 0.008) were most frequently isolated in children older than 12 months of age. Resistance to trimethoprim-sulphametoxazole and ampicillin was high. Etiologic data on diarrheal diseases and susceptibility patterns of diarrheal pathogens are important tools for clinical management and control strategic planning.

Author Notes

  • 1

    Bryce J, Boschi-Pinto C, Shibuya K, Black RE, and the WHO Child Health Epidemiology Reference Group, 2005. WHO estimates of the causes of death in children. Lancet 365 :1147–1152.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 2

    Kosek M, Bern C, Guerrant RL, 2003. The magnitude of the global burden of diarrhea from studies published 1992–2000. Bull World Health Organ 81 :197–204.

  • 3

    Hamer DH, Simon F, Thea D, Keush GT, 1998. Childhood diarrhea in Sub-Saharan Africa. Child Health Research Project Special Report 2 :1–32.

  • 4

    Bern C, Martines J, de Joysa I, Glass RI, 1992. The magnitude of the global problem of diarrhoea disease. Bull World Health Organ 70 :705–714.

  • 5

    Victoria GC, Bryce J, Fontaine O, Monasch R, 2000. Reducing deaths from diarrhoea through oral rehydration therapy. Bull World Health Organ 78 :1246–1255.

  • 6

    Durley A, Shenoy A, Faruque AS, Suskind R, Ahmed T, 2004. Impact of a standardized management protocol on mortality of children with diarrhoea: an update of risk factors for childhood death. J Trop Pediatr 50 :271–275.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7

    Dgedge M, Novoa A, Macassa G, Sacarlal J, Black J, Michaud C, Cliff J, 2001. The Burden of disease in Maputo City, Mozambique: registered and autopsied deaths in 1994. Bull World Health Organ 79 :546–552.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8

    Gascon J, Vargas M, Schellenberg D, Urassa H, Casals C, Kahigwa E, Aponte J, Mshinda H, Vila J, 2000. Diarrhea in children under five years of age in Ifakara, Tanzania: Case-control study. J Clin Microbiol 38 :4459–4462.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9

    Vargas M, Gascon J, Casals C, Schellenberg D, Urassa H, Kahigwa E, Ruiz J, Vila J, 2004. Etiology of diarrhea in children less than five years of age in Ifakara, Tanzania. Am J Trop Med Hyg 70 :536–539.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10

    Huilan S, Zhen LG, Mathan MM, Mathew MM, Olarte J, Espejo R, Khin MU, Ghafoor MA, Khan MA, Sami Z, Sutton RG, 1991. Etiology of acute diarrhoea among children in developing countries: A multicentre study in five countries. Bull World Health Organ 69 :549–555.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11

    Okeke IN, Ojo O, Lamikanra A, Kapper JB, 2003. Etiology of acute diarrhea in adults southwestern Nigeria. J Clin Microbiol 41 :4525–4530.

  • 12

    Vila J, Vargas M, Casals C, Urassa H, Mshinda H, Schellenberg D, Gascon J, 1999. Antimicrobial resistance of diarrheagenic Escherichia coli isolated from children under the age of 5 years from Ifakara, Tanzania. Antimicrob Agents Chemother 43 :3022–3024.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13

    Shapiro RL, Kumar L, Phillips-Howard P, Wells JG, Adcock P, Brooks J, Ackers ML, Ochieng JB, Mintz E, Wahlquist S, Waiyaki P, Slutsker L, 2001. Antimicrobial-resistant bacterial diarrhea in rural western Kenya. J Infect Dis 183 :1701–1704.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14

    Guerrant RL, Van Gilder T, Steiner TS, Thielman NM, Slutsker L, Tauve RV, Hennessy T, Griffin PM, DuPont H, Sack RB, Tharr P, Neill M, Nachamkin I, Reller RB, Osterholm MT, Bennish ML, Pickerring LK, 2001. Pratice guidelines for the managment of infectious diarrhea. Clin Infect Dis 32 :31–51.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15

    Casburn-Jones AC, Farthing MJ, 2004. Management of infectious diarrhoea. Gut 53 :296–305.

  • 16

    Loscertales MP, Roca A, Ventura PJ, Abacassamo F, Dos Santos F, Sitaube M, Menedez C, Greenwoob BM, Saiz JC, Alonso P, 2002. Epidemiology and clinical presentation of respiratory syncytial virus infection in a rural area of southern Mozambique. Pediatr Infect Dis J 21 :148–155.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 17

    Network INDEPTH, 2004. INDEPTH Model Life Tables for Sub-Saharan Africa. Aldershot, UK: Ashgate Publishing.

    • PubMed
    • Export Citation
  • 18

    Alonso PL, Smith L, Schellenberg JR, Masanja H, Mwankusye S, Urassa H, Bastos de Azevedo I, Chongera J, Kobero S, Menendez C, Hurt N, Thomas MC, Lyimo E, Weiss NA, Hayes R, Kitua AY, Lopez MC, Kilama WL, Teuscher T, Tanner M, 1994. Randomised trial of efficacy of SPf66 vaccine against Plasmodium falciparum malaria in children in southern Tanzania. Lancet 344 :1175–1181.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 19

    Vargas M, Gascon J, Gallardo F, Jimenez De Anta MT, Vila J, 1998. Prevalence of diarrheagenic Escherichia coli strains detected by PCR in patients with traveler diarrhea. Clin Microbiol Infect 4 :682–688.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 20

    Rohner P, Pittet D, Pepey B, Nije-Kinge T, Auckenthaler R, 1997. Etiological agents of infectious diarrhea: implications for requests for microbial culture. J Clin Microbiol 35 :1427–1432.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 21

    Reisinger EC, Fritzsche C, Krause R, Krejs GJ, 2005. Diarrhea caused by primarily non-gastroentistinal infections. Nature Clin Pract Gastroenterol Hepatol 2 :216–222.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 22

    Rappelli P, Folgosa E, Solinas ML, Da Costa JL, Pisanu C, Sidat M, Melo J, Cappuccinelli P, Colombo MM, 2005. Pathogenic enteric Escherichia coli in children with and without diarrhoea in Maputo, Mozambique. FEMS Immunol Med Microbiol 43 :67–72.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 23

    Pabst WL, Altwegg M, Kind C, Mirjanic S, Hardegger D, Nadal D, 2003. Prevalence of enteroaggregative Escherichia coli among children with and without diarrhoea in Switzerland. J Clin Microbiol 41 :2289–2293.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 24

    Valentiner-Branth P, Steinsland H, Fischer TK, Perch M, Scheutz F, Dias F, Aabay P, Mølbak K, Sommerfelt H, 2003. Cohort study of Guinean children: incidence, pathogenicity, conferred protection, and attributable risk for enteropathogens during the first 2 years of life. J Clin Microbiol 41 :4238–4245.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 25

    Albert MJ, Faruque SM, Faruque AS, Neogi PKB, Ansaruzzaman M, Bhuiyan MA, Alam K, Akbar MS, 1995. Controlled study of Escherichia coli diarrheal infections in Bangladeshi children. J Clin Microbiol 33 :973–977.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 26

    Galane PM, Le Roux M, 2001. Molecular epidemiology of Escherichia coli isolated from young South African children with diarrhoeal diseases. J Health Popul Nutr 19 :31–38.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 27

    Effler P, Isaacson M, Arntzen L, Heenan R, Canter P, Barrett T, Lee L, Mambo C, Levine W, Zaidi A, Griffin PM, 2001. Factors contributing to the emergence of Escherichia coli O157 in Africa. Emerg Infect Dis 7 :812–819.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 28

    Cunin P, Tedjouka E, Germani Y, Ncharre C, Bercion R, Morvan J, Martin PMA, 1999. An epidemic of bloody diarrhea: Escherichia coli O157 emerging in Cameroon? Emerg Infect Dis 5 :285–290.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 29

    Presterl E, Zwick RH, Reichmann S, Aichelburg A, Winkler S, Kremsner PG, Graninger W, 2003. Frequency and virulence properties of diarrheagenic Escherichia coli in children with diarrhea in Gabon. Am J Trop Med Hyg 69 :406–410.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 30

    Nataro JP, Kaper JB, 1998. Diarrheagenic Escherichia coli. Clin Microbiol Rev 11 :142–201.

  • 31

    Steele AD, Peenze I, de Beer MC, Pager CT, Yeats J, Potgieter N, Ramsaroop U, Page NA, Mitchell JO, Geyer A, Bos P, Alexander JJ, 2003. Anticipating rotavirus vaccine: Epidemiology and surveillance of rotavirus in South Africa. Vaccine 21 :354–360.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 32

    Parashar UD, Bresee JS, Gentsch JR, Glass RI, 1998. Rotavirus. Emerg Infect Dis 4 :561–570.

  • 33

    Anderson EJ, Weber SG, 2004. Rotavirus infectious in adults. Lancet Infect Dis 4 :91–99.

  • 34

    Urio EM, Collison EK, Gashe BA, Sebunya TH, Mpuchane S, 2001. Shigella and Salmonella strains isolated from children under 5 years of age in Gaborone, Botswana, and their antibiotic susceptibility patterns. Trop Med Intern Health 6 :55–59.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 35

    Navia MM, Capitano L, Ruiz J, Vargas M, Urassa H, Schellen-berg D, Gascon J, Vila J, 1999. Typing and characterization of mechanisms of resistence of Shigella spp isolated from feces of children under 5 years of age from Ifakara, Tanzania. J Clin Microbiol 37 :3113–3117.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 36

    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 35 :139– 146.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 37

    Niyogi SK, 2005. Shigellosis. J Microbiol 43 :133–143.

  • 38

    Chintu C, Bhat GJ, Walker AS, Mulenga V, Sinyinza F, Lishimpi K, Farrelly L, Kaganson N, Zumba A, Gillespie SH, Nunn AJ, Gibb DM, CHAP trial team, 2004. Co-trimoxazole as prophylaxis against opportunistic infections in HIV-infected Zambian children (CHAP): A double-blind randomised placebo-controlled trial. Lancet 364 :1865–1871.

    • PubMed
    • Search Google Scholar
    • Export Citation
Past two years Past Year Past 30 Days
Abstract Views 384 313 14
Full Text Views 804 5 0
PDF Downloads 246 6 0
 
 
 
 
Affiliate Membership Banner
 
 
Research for Health Information Banner
 
 
CLOCKSS
 
 
 
Society Publishers Coalition Banner
Save